NUR 340 Cumulative Final NCLEX Questions

True or False: The nurse requests an unlicensed assistive personal (UAP) to assist him with patient care by obtaining a patient's blood pressure, then administering the patient's blood pressure medication because this is within the UAP's scope of practice.

False

A nurse cares for patients in a chiropractic office. What patient education might this nurse perform? Select all that apply. a. Applying heat or ice to an extremity b. Explaining the use of electrical stimulation c. Teaching a patient relaxation techniques d. Teaching a patient about a prescription e. Explaining an invasive procedure to a patient f. Teaching about dietary supplements

a, b, c, f Chiropractors may combine the use of spinal adjustments and other manual therapies with several other treatments and approaches including heat and ice, electrical stimulation, relaxation techniques, rehabilitative and general exercise, counseling about weight and diet, and using dietary supplements. Chiropractors do not prescribe medication or perform invasive procedures.

Nurse-sensitive indicators are driven by nursing care and interventions provided by nurses for patients. Which of the following are nurse-sensitive indicators? Select all that apply a. Patient falls b. Pressure injuries c. Headaches d. Surgery e. Community-Acquired Pneumonia

a, b

A nurse knows that in order to provide individualized, compassionate care, be a patient advocate, and collaborate effectively as an interdisciplinary healthcare team, she needs to have strong communication skills. Which of the following are examples of poor styles of communication that the nurse should avoid when speaking to patients and colleagues? (Select all that apply) a. Using cliches b. Nontherapeutic comments c. Giving false assurance d. Gossiping in the workplace e. Standing up for oneself using direct communication f. Incivility g. Giving advice

a, b, c, d, f, g

After administering medications to a patient, the nurse would likely: a. Scan the barcode on the patient's identification band b. Document the administration in the medication administration record c. Verify the patient's date of birth d. Reassess the patient and retake vital signs

b

A nurse who is comfortable with spirituality is caring for patients who need spiritual counseling. Which nursing action would be most appropriate for these patients? a. Calling the patient's own spiritual adviser first b. Asking whether the patient has a spiritual adviser the patient wishes to consult c. Attempting to counsel the patient and, if unsuccessful, making a referral to a spiritual adviser d. Advising the patient and spiritual adviser concerning health options and the best choices for the patient

b

A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What is the appropriate nursing intervention? a. Use short words and talk more loudly. b. Ask an interpreter for help. c. Explain why care can't be provided. d. Provide instructions in writing.

b

A nurse is planning care for a patient who was admitted to the hospital for treatment of a drug overdose. Which nursing actions are related to the outcome identification and planning step of the nursing process? Select all that apply. a. The nurse formulates nursing diagnoses. b. The nurse identifies expected patient outcomes. c. The nurse selects evidence-based nursing interventions. d. The nurse explains the nursing care plan to the patient. e. The nurse assesses the patient's mental status. f. The nurse evaluates the patient's outcome achievement.

b, c, d

Nurses incorporate telecare in patient care plans. Which services are MOST representative of this technologic advance? Select all that apply. a. Diagnostic testing b. Easy access to specialists c. Health and fitness apps d. Early warning and detection technologies e. Digital medication reminder systems f. Monitoring of progress following treatment

b, c, d Book slightly different than my professor: Telecare: technology that allows consumers to stay safe and independent in their own homes e.g. fitness apps, med. reminders, early warning/detection technologies Telehealth: use of electronic info and telecommunications technology to support and promote long-distance clinical healthcare, pt-provider health education, public health, and health administration Telemedicine: use of telecommunications to support the delivery of medical, diagnostic, and treatment-related services

A nurse examining a toddler in a pediatric office documents that the child is in the 90th percentile for height and weight and has blue eyes. These physical characteristics are primarily determined by which of the following? a. Socialization with caregivers b. Maternal nutrition during pregnancy c. Genetic information on chromosomes d. Meeting developmental tasks

c

A hospital nurse is admitting a patient who sustained a head injury in a motor vehicle accident. Which activity could the nurse delegate to licensed assistive personnel? a. Collecting information for a health history b. Performing a physical assessment c. Contacting the health care provider for medical orders d. Preparing the bed and collecting needed supplies

d

A nurse is assessing a patient who is visiting her gynecologist. The patient tells the nurse that she has been having a vaginal discharge that "smells bad and is green and foamy." She also complains of burning upon urination and dyspareunia. What sexually transmitted infection would the nurse suspect? a. Human papillomavirus (HPV) b. Syphilis c. Trichomoniasis d. Herpes simplex virus

c

A nurse conducts a windshield survey (observes the community; surroundings and people) on a neighborhood with well water contaminated by a local factory. The role of this nurse would likely be: a. Nurse midwife b. Critical care nurse specialist c. Community health nurse d. Public health nurse

d

A female age 87-years-old is being readmitted to a long-term care facility status post treatment for dehydration. Which nursing intervention (Take Action) is most appropriate for this resident who was recently discharged from an acute care hospital? a. Ensure that the patient drinks 600mL b. Encourage the patient to drink fluids and measure intake and output c. Provide at least 11.5 cups (2.7 L) of fluid/day and record all intake and output within the electronic record each shift d. Restrict oral fluids to prevent fluid volume excess, only provide intravenous fluids

c

A nurse is collecting evaluative data for a patient who is finished receiving chemotherapy for an osteosarcoma. Which nursing action represents this step of the nursing process? a. The nurse collects data to identify health problems. b. The nurse collects data to identify patient strengths c. The nurse collects data to justify terminating the care plan. d. The nurse collects data to measure outcome achievement.

d The nurse collects evaluative data to measure outcome achievement. While this may justify terminating the care plan, that is not necessarily so. Data to assess health problems and patient variables are collected during the first step of the nursing process.

A registered nurse assumes the role of nurse coach to provide teaching to patients who are recovering from a stroke. Which nursing intervention directly relates to this role? a. The nurse uses discovery to identify the patients' personal goals and create an agenda that will result in change. b. The nurse is the expert in providing teaching and education strategies to provide dietary and activity modifications. c. The nurse becomes a mentor to the patients and encourages them to create their own fitness programs. d. The nurse assumes an authoritative role to design the structure of the coaching session and support the achievement of patient goals.

a A nurse coach establishes a partnership with a patient and, using discovery, facilitates the identification of the patient's personal goals and agenda to lead to change rather than using teaching and education strategies with the nurse as the expert. A nurse coach explores the patient's readiness for coaching, designs the structure of a coaching session, supports the achievement of the patient's desired goals, and with the patient determines how to evaluate the attainment of patient goals.

A nurse is practicing community-based nursing in a mobile health clinic. What typically is the central focus of this type of nursing care? a. Individual and family health care needs b. Populations within the community c. Local health care facilities d. Families in crisis

a In contrast to community health nursing, which focuses on populations within a community, community-based nursing is centered on individual and family health care needs. Community-based nurses may help families in crisis and work in health care facilities, but these are not the focus of community-based nursing.

A nurse caring for a patient who is hospitalized following a double mastectomy is preparing a discharge plan for the patient. Which action should be the focus of this termination phase of the helping relationship? a. Determining the progress made in achieving established goals b. Clarifying when the patient should take medications c. Reporting the progress made in teaching to the staff d. Including all family members in the teaching session

a The orientation phase sets the tone and guidelines for establishing the relationship (introductions, roles, goals, duration); The Working phase is when the nurse works together with the pt to meet physical and psychosocial needs (interaction, active participation, and expression); The Termination phase is the conclusion of the initial agreement (progress, goals that have been accomplished, and ending the relationship)

A hospice nurse is caring for a patient with end-stage cancer. What action demonstrates this nurse's commitment to the principle of autonomy? a. The nurse helps the patient prepare a durable power of attorney document. b. The nurse gives the patient undivided attention when listening to concerns. c. The nurse keeps a promise to provide a counselor for the patient. d. The nurse competently administers pain medication to the patient.

a The principle of autonomy obligates nurses to provide the information and support patients and their surrogates need to make decisions that advance their interests.

An older nurse asks a younger coworker why the new generation of nurses just aren't ethical anymore. Which reply reflects the BEST understanding of moral development? a. "Behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop an ethical code." b. "I don't agree that nurses were more ethical in the past. It's a new age and the ethics are new!" c. "Ethics is genetically determined...it's like having blue or brown eyes. Maybe we're evolving out of the ethical sense your generation had." d. "I agree! It's impossible to be ethical when working in a practice setting like this!"

a I don't like this question, but c'est la vie The ability to be ethical, to make decisions, and to act in an ethically justified manner begins in childhood and develops gradually.

A charge nurse meets with staff to outline a plan to provide transcultural nursing care for patients in their health care facility. Which theorist promoted this type of caring as the central theme of nursing care, knowledge, and practice?a. Madeline Leininger b. Jean Watson c. Dorothy E. Johnson d. Betty Newman

a Madeline Leininger's theory provides the foundations of transcultural nursing care by making caring the central theme of nursing. Jean Watson stated that nursing is concerned with promoting and restoring health, preventing illness, and caring for the sick. The central theme of Dorothy E. Johnson's theory is that problems arise because of disturbances in the system or subsystem or functioning below optimal level. Betty Newman proposed that humans are in constant relationship with stressors in the environment and the major concern for nursing is keeping the patient system stable through accurate assessment of these stressors.

A nurse manager schedules a clinic for the staff to address common nursing interventions used in the facility and to explore how they can be performed more efficiently and effectively. The nurse manager's actions to change clinical practice are an example of a situation described by which nursing theory? a. Prescriptive theory b. Descriptive theory c. Developmental theory d. General systems theory

a Prescriptive theories address nursing interventions and are designed to control, promote, and change clinical nursing practice. Descriptive theories describe a phenomenon, an event, a situation, or a relationship. Developmental theory outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. General systems theory describes how to break whole things into parts and then to learn how the parts work together in "systems."

A nurse working in a rehabilitation facility focuses on the goal of restoring health for patients. Which examples of nursing interventions reflect this goal? Select all that apply. a. A nurse counsels adolescents in a drug rehabilitation program b. A nurse performs range-of-motion exercises for a patient on bedrest c. A nurse shows a diabetic patient how to inject insulin d. A nurse recommends a yoga class for a busy executive e. A nurse provides hospice care for a patient with end-stage cancer f. A nurse teaches a nutrition class at a local high school

a, b, c Activities to restore health focus on the person with an illness and range from early detection of a disease to rehabilitation and teaching during recovery. Recommending a yoga class for stress reduction is a goal of preventing illness, and teaching a nutrition class is a goal of promoting health. A hospice care nurse helps to facilitate coping with disability and death.

A nurse who is newly hired to manage a busy pediatric office is encouraged to use a transactional leadership style when dealing with subordinates. Which activities best exemplify the use of this type of leadership? Select all that apply. a. The manager institutes a reward program for employees who meet goals and work deadlines. b. The manager encourages the other nurses to participate in health care reform by joining nursing organizations. c. The manager promotes compliance by reminding subordinates that they have a good salary and working conditions. d. The manager makes sure all the employees are kept abreast of new developments in pediatric nursing. e. The manager works with subordinates to accomplish all the nursing tasks and goals for the day. f. The manager allows the other nurses to set their own schedules and perform nursing care as they see fit.

a, c Encouraging nurses to participate in health care reform is an example of a transformational leadership style. Ensuring that employees keep abreast of new developments in nursing care is a characteristic of quantum leadership. The group and leader work together to accomplish mutually set goals and outcomes with the democratic leadership style, and the laissez-faire style encourages independent activity by group members, such as setting their own schedules and work activities.

A nurse is using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model PET as a clinical decision-making tool when delivering care to patients. Which steps reflect the intended use of this tool? Select all that apply. a. A nurse recruits an interprofessional team to develop and refine an EBP question. b. A nurse draws from personal experiences of being a patient to establish a therapeutic relationship with a patient. c. A nurse searches the Internet to find the latest treatments for type 2 diabetes. d. A nurse uses spiritual training to draw strength when counseling a patient who is in hospice for an inoperable brain tumor. e. A nurse questions the protocol for assessing postoperative patients in the ICU. f. A nursing student studies anatomy and physiology of the body systems to understand the disease states of assigned patients.

a, c, e The JHNEBP model is a powerful problem-solving approach to clinical decision making, and is accompanied by user-friendly tools to guide individual or group use. It is designed specifically to meet the needs of the practicing nurse and uses a three-step process called PET: practice question, evidence, and translation. The goal of the model is to ensure that the latest research findings and best practices are quickly and appropriately incorporated into patient care. Steps in PET include, but are not limited to, recruiting an interprofessional team, developing and refining the EBP question, and conducting internal and external searches for evidence.

A nurse caring for culturally diverse patients in a health care provider's office is aware that patients of certain cultures are more prone to specific disease states than the general population. Which patients would the nurse screen for diabetes mellitus based on the patient's race? Select all that apply. a. A Native American patient b. An African-American patient c. An Alaska Native d. An Asian patient e. A White patient f. A Hispanic patient

a, c, e, f Native Americans, Alaska Natives, Hispanics, and Whites are more prone to developing diabetes mellitus. African Americans are prone to hypertension, stroke, sickle cell anemia, lactose intolerance, and keloids. Asians are prone to hypertension, liver cancer, thalassemia, and lactose intolerance.

A student nurse begins a clinical rotation in a long-term care facility and quickly realizes that certain residents have unmet needs. The student wants to advocate for these residents. Which statements accurately describe this concept? Select all that apply. a. Advocacy is the protection and support of another's rights. b. Patient advocacy is primarily performed by nurses. c. Patients with special advocacy needs include the very young and the older adult, those who are seriously ill, and those with disabilities. d. Nurse advocates make good health care decisions for patients and residents. e. Nurse advocates do whatever patients and residents want. f. Effective advocacy may entail becoming politically active.

a, c, f Patient advocacy is the responsibility of every member of the professional caregiving team—not just nurses. Nurse advocates do not make health care decisions for their patients and residents. Instead, they facilitate patient decision making. Advocacy does not entail supporting patients in all their preferences.

In order to provide culturally competent care, nurses must be alert to factors inhibiting sensitivity to diversity in the health care system. Which nursing actions are examples of cultural imposition? Select all that apply. a. A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. b. A nurse treats all patients the same whether or not they come from a different culture. c. A nurse tells another nurse that Jewish diet restrictions are just a way for them to get a special tray of their favorite foods. d. A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. e. A nurse directs interview questions to an older adult's daughter even though the patient is capable of answering them. f. A nurse refuses to care for a married gay man who is HIV positive because she is

a, d Cultural blindness occurs when a nurse treats all patients the same whether or not they come from a different culture. Culture conflict occurs when a nurse ridicules a patient by telling another nurse that Jewish diet restrictions are just a way for Jewish patients to get a special tray of their favorite foods. When a nurse refuses to respect an older adult's ability to speak for himself or herself, or if the nurse refuses to treat a patient based on that patient's sexual orientation, the nurse is engaging in stereotyping.

During a nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply. a. Group decision making b. Group leadership c. Group power d. Group identity e. Group patterns of interaction f. Group cohesiveness

a, d, e, f Solving problems involves group decision making; ascertaining that the staff completes a task on time and that all members agree the task is important is a characteristic of group identity; group patterns of interaction involve honest communication and member support; and cohesiveness occurs when members generally trust each other, have a high commitment to the group, and a high degree of cooperation. Group leadership occurs when groups use effective styles of leadership to meet goals; with group power, sources of power are recognized and used appropriately to accomplish group outcomes.

A nurse is a servant leader working in an economically depressed community to set up a free mobile health clinic for the residents. Which actions by the leader BEST exemplify a key practice of servant leaders? Select all that apply a. The nurse motivates coworkers to solicit funding to set up the clinic. b. The nurse sets only realistic goals that are present oriented and easily achieved. c. The nurse forms an autocratic governing body to keep the project on track. d. The nurse spends time with supporters to help them grow in their roles. e. The nurse first ensures that other's lowest priority needs are served. f. The nurse prizes leadership because of the need to serve others.

a, d, f Servant leadership means investing in those who support the organization's values and playing to their strengths, motivating others to follow and engage, and providing ongoing opportunities for collaborations; allows others to have a voice and practice leading themselves, the servant first makes sure the other people's HIGHEST priority needs are being served

Nurses today work in a wide variety of health care settings. What trend occurred during World War II that had a tremendous effect on this development in the nursing profession? a. There was a shortage of nurses and an increased emphasis on education. b. Emphasis on the war slowed development of knowledge in medicine and technology c. The role of the nurse focused on acute technical skills used in hospital settings. d. Nursing was dependent on the medical profession to define its priorities.

a. During WWII, large numbers of women worked outside the home, became more independent and assertive, which led to an increased emphasis on education

A nurse has taught a patient with diabetes how to administer his daily insulin. How should the nurse evaluate the teaching-learning process? a. By determining the patient's motivation to learn b. By deciding if the learning outcomes have been achieved c. By allowing the patient to practice the skill he has just learned d. By documenting the teaching session in the patient's medical record

b

A nurse uses Maslow's hierarchy of basic human needs to direct care for patients on an intensive care unit. For which nursing activities is this approach most useful? a. Making accurate nursing diagnoses b. Establishing priorities of care c. Communicating concerns more concisely d. Integrating science into nursing care

b

Review of a patient's record revealed that no one obtained informed consent for the heart surgery that was performed on the patient. Which intentional tort has been committed? a. Assault b. Battery c. Invasion of privacy d. False imprisonment

b Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Battery is an assault that is carried out. Every person is granted freedom from bodily contact by another person unless consent is granted. The Fourth Amendment gives citizens the right of privacy and the right to be left alone; a nurse who disregards these rights is guilty of invasion of privacy. Unjustified retention or prevention of the movement of another person without proper consent can constitute false imprisonment.

A nurse in the rehabilitation division states to the head nurse: "I need the day off and you didn't give it to me!" The head nurse replies, "Well, I wasn't aware you needed the day off, and it isn't possible since staffing is so inadequate." Instead of this exchange, what communication by the nurse would have been more effective? a. "I placed a request to have 8th of August off, but I'm working and I have a doctor's appointment." b. "I would like to discuss my schedule with you. I requested the 8th of August off for a doctor's appointment. Could I make an appointment?" c. "I will need to call in on the 8th of August because I have a doctor's appointment." d. "Since you didn't give me the 8th of August off, will I need to find someone to work for me?"

b Effective communication by the sender involves the implementation of nonthreatening information by showing respect to the receiver. The nurse should identify the subject of the meeting and be sure it occurs at a mutually agreed upon time.

A nurse wants to call an ethics consult to clarify treatment goals for a patient no longer able to speak for himself. The nurse believes his dying is being prolonged painfully. The patient's doctor threatens the nurse with firing if the nurse raises questions about the patient's care or calls the consult. What ethical conflict is this nurse experiencing? a. Ethical uncertainty b. Ethical distress c. Ethical dilemma d. Ethical residue

b Ethical distress results from knowing the right thing to do but finding it almost impossible to execute because of institutional or other constraints (in this case, the nurse fears the loss of job). Ethical uncertainty results from feeling troubled by a situation but not knowing if it is an ethical problem. Ethical dilemmas occur when the principles of bioethics justify two or more conflicting courses of action. Ethical residue is what nurses experience when they seriously compromise themselves or allow themselves to be compromised.

A nurse caring for patients in an institutional setting expresses a commitment to social justice. What action best exemplifies this attribute? a. Providing honest information to patients and the public b. Promoting universal access to health care c. Planning care in partnership with patients d. Documenting care accurately and honestly

b Providing honest information and documenting care accurately and honestly are examples of integrity, and planning care in partnership with patients is an example of autonomy.

A nurse is caring for a patient who is admitted to the hospital with injuries sustained in a motor vehicle accident. While he is in the hospital, his wife tells him that the bottom level of their house flooded, damaging their belongings. When the nurse enters his room, she notes that the patient is visibly upset. The nurse is aware that the patient will most likely be in need of which type of counseling? a. Long-term developmental b. Short-term situational c. Short-term motivational d. Long-term motivational

b Short-term counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life. Long-term counseling extends over a prolonged period; a patient experiencing a developmental crisis, for example, might need long-term counseling. Motivational interviewing is an evidence-based counseling approach that involves discussing feelings and incentives with the patient. A caring nurse can motivate patients to become interested in promoting their own health.

A nursing student asks the charge nurse about legal liability when performing clinical practice. Which statement regarding liability is true? a. Students are not responsible for their acts of negligence resulting in patient injury. b. Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. c. Hospitals are exempt from liability for student negligence if the student nurse is properly supervised by an instructor. d. Most nursing programs carry group professional liability making student personal professional liability insurance unnecessary.

b Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. Student nurses are responsible for their own acts of negligence if these result in patient injury. A hospital may also be held liable for the negligence of a student nurse enrolled in a hospital-controlled program because the student is considered an employee of the hospital. Nursing instructors may share responsibility for damages in the event of patient injury if an assignment called for clinical skills beyond a student's competency or the instructor failed to provide reasonable and prudent clinical supervision. Most nursing programs require students to carry personal professional liability insurance.

A nurse is teaching first aid to counselors of a summer camp for children with asthma. This is an example of what aim of health teaching? a. Promoting health b. Preventing illness c. Restoring health d. Facilitating coping

b Teaching first aid is a function of the goal to prevent illness. Promoting health involves helping patients to value health and develop specific health practices that promote wellness. Restoring health occurs once a patient is ill, and teaching focuses on developing self-care practices that promote recovery. When facilitating coping, nurses help patients come to terms with whatever lifestyle modification is needed for their recovery or to enable them to cope with permanent health alterations.

A nurse is using the ESFT model to understand a patient's conception of a diagnosis of chronic obstructive pulmonary disease (COPD). Which interview question would be MOST appropriate to assess the E aspect of this model—Explanatory model of health and illness? a. How do you get your medications? b. How does having COPD affect your lifestyle? c. Are you concerned about the side effects of your medications? d. Can you describe how you will take your medications?

b The ESFT model guides providers in understanding a patient's explanatory model (a patient's conception of her or his illness), social and environmental factors, and fears and concerns, and also guides providers in contracting for therapeutic approaches. Asking the questions: "How does having COPD affect your lifestyle?" explores the explanatory model, "How do you get your medications?" refers to the social and environmental factor, "Are you concerned about the side effects of your medications?" addresses fears and concerns, and "Can you describe how you will take your medications?" involves therapeutic contracting.

A nursing student is preparing to administer morning care to a patient. What is the MOST important question that the nursing student should ask the patient about personal hygiene? a. "Would you prefer a bath or a shower?" b. "May I help you with a bed bath now or later this morning?" c. "I will be giving you your bath. Do you use soap or shower gel?" d. "I prefer a shower in the evening. When would you like your bath?"

b The nurse should ask permission to assist the patient with a bath. This allows for consent to assist the patient with care that invades the patient's private zones.

A nurse is providing instruction to a patient regarding the procedure to change a colostomy bag. During the teaching session, the patient asks, "What type of foods should I avoid to prevent gas?" The patient's question allows for what type of communication on the nurse's part? a. A closed-ended answer b. Information clarification c. The nurse to give advice d. Assertive behavior

b The patient's question allows the nurse to clarify information that is new to the patient or that requires further explanation.

A nurse is caring for a patient in the ICU who is being monitored for a possible cerebral aneurysm following a loss of consciousness in the emergency department (ED). The nurse anticipates preparing the patient for ordered diagnostic tests. What aspect of nursing does this nurse's knowledge of the diagnostic procedures reflect? a. The art of nursing b. The science of nursing c. The caring aspect of nursing d. The holistic approach to nursing

b The science of nursing is the knowledge base for care that is provided. In contrast, the skilled application of that knowledge is the art of nursing. Providing holistic care to patients based on the science of nursing is considered the art of nursing.

A patient in a community health clinic tells the nurse, "I have a high temperature, feel awful, and I am not going to work." What stage of illness behavior is the patient exhibiting? a. Stage 1: Experiencing symptoms b. Stage 2: Assuming the sick role c. Stage 3: Assuming a dependent role d. Stage 4: Achieving recovery and rehabilitation

b When people assume the sick role, they define themselves as ill, seek validation of this experience from others, and give up normal activities. In stage 1: Experiencing symptoms, the first indication of an illness usually is recognizing one or more symptoms that are incompatible with one's personal definition of health. The stage of assuming a dependent role is characterized by the patient's decision to accept the diagnosis and follow the prescribed treatment plan. In the achieving recovery and rehabilitation role, the person gives up the dependent role and resumes normal activities and responsibilities.

Nurses perform health promotion activities at a primary, secondary, or tertiary level. Which nursing actions are considered tertiary health promotion? Select all that apply. a. A nurse runs an immunization clinic in the inner city. b. A nurse teaches a patient with an amputation how to care for the residual limb. c. A nurse provides range-of-motion exercises for a paralyzed patient. d. A nurse teaches parents of toddlers how to childproof their homes. e. A school nurse provides screening for scoliosis for the students. f. A nurse teaches new parents how to choose and use an infant car seat.

b, c Tertiary health promotion and disease prevention begins after an illness is diagnosed and treated to reduce disability and to help rehabilitate patients to a maximum level of functioning.

A nurse caring for patients in the intensive care unit develops values from experience to form a personal code of ethics. Which statements best describe this process? Select all that apply. a. People are born with values. b. Values act as standards to guide behavior. c. Values are ranked on a continuum of importance. d. Values influence beliefs about health and illness. e. Value systems are not related to personal codes of conduct. f. Nurses should not let their values influence patient care.

b, c, d A value is a belief about the worth of something, about what matters, which acts as a standard to guide one's behavior. A value system is an organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. A person's values influence beliefs about human needs, health, and illness; the practice of health behaviors; and human responses to illness. Values guide the practice of nursing care. An individual is not born with values; rather, values are formed during a lifetime from information from the environment, family, and culture.

Despite a national focus on health promotion, nurses working with patients in inner-city clinics continue to see disparities in health care for vulnerable populations. Which patients are considered vulnerable populations? Select all that apply. a. A White male diagnosed with HIV b. An African American teenager who is 6 months pregnant c. A Hispanic male who has type II diabetes d. A low-income family living in rural America e. A middle-class teacher living in a large city f. A White baby who was born with cerebral palsy

b, c, d, f National trends in the prevention of health disparities are focused on vulnerable populations, such as racial and ethnic minorities, those living in poverty, women, children, older adults, rural and inner-city residents, and people with disabilities and special health care needs.

A charge nurse in a busy hospital manages a skilled nursing unit using an autocratic style of leadership. Which leadership tasks BEST represent this style of leadership? Select all that apply. a. The charge nurse polls the other nurses for input on nursing protocols. b. The charge nurse dictates break schedules for the other nurses. c. The charge nurse schedules a mandatory in-service training on new equipment. d. The charge nurse allows the other nurses to divide up nursing tasks. e. The charge nurse delegates nursing responsibilities to the staff. f. The charge nurse encourages the nurses to work independently.

b, c, e Autocratic: complete control Laissez-Faire: relinquishes all control to the group Transactional: maintains control by reward/punishment Decentralized Decision-Making: autonomous, self-governance model of unit organization Democratic: sense of equality Servant: natural feeling of wanting to serve to enrich individuals, organizations, and create a more just/caring world Transformational: creates change, commitment to professional growth of self/others e.g. Nurse Managers Quantum: beyond traditional modes of leadership, the impact of the information age e.g. Nursing Directors

A nurse answers a patient's call light and finds the patient on the floor by the bathroom door. After calling for assistance and examining the patient for injury, the nurse helps the patient back to bed and then fills out an incident report. Which statements accurately describe steps of this procedure and why it is performed? Select all that apply. a. An incident report is used as disciplinary action against staff members. b. An incident report is used as a means of identifying risks. c. An incident report is used for quality control. d. The facility manager completes the incident report. e. An incident report makes facts available in case litigation occurs. f. Filing of an incident report should be documented in the patient record.

b, c, e A health care provider completes the incident form with documentation of the medical examination of the patient, employee, or visitor with an actual or potential injury. Documentation in the patient record should not include the fact that an incident report was filed.

A nurse is using general systems theory to describe the role of nursing to provide health promotion and patient teaching. Which statements reflect key points of this theory? Select all that apply. a. A system is a set of individual elements that rarely interact with each other b. The whole system is always greater than the sum of its parts c. Boundaries separate systems from each other and their environments d. A change in one subsystem will not affect other subsystems e. To survive, open systems maintain balance through feedback f. A closed system allows input from or output to the environment

b, c, e According to general systems theory, a system is a set of interacting elements contributing to the overall goal of the system. The whole system is always greater than its parts. Boundaries separate systems from each other and their environments. Systems are hierarchical in nature and are composed of interrelated subsystems that work together in such a way that a change in one element could affect other subsystems, as well as the whole. To survive, open systems maintain balance through feedback. An open system allows energy, matter, and information to move freely between systems and boundaries, whereas a closed system does not allow input from or output to the environment.

A nurse has volunteered to give influenza immunizations at a local clinic. What level of care is the nurse demonstrating? a. Tertiary b. Secondary c. Primary d. Promotive

c

A nursing student is nervous and concerned about working at a clinical facility. Which action would BEST decrease anxiety and ensure success in the student's provision of patient care? a. Determining the established goals of the institution b. Ensuring that verbal and nonverbal communication is congruent c. Engaging in self-talk to plan the day and decrease fear d. Speaking with fellow colleagues about how they feel

c

A visiting nurse working in a new community performs a community assessment. What assessment finding is indicative of a healthy community? a. It meets all the needs of its inhabitants b. It has mixed residential and industrial areas c. It offers access to health care services d. It consists of modern housing and condominiums

c A healthy community offers access to health care services to treat illness and to promote health. A healthy community does not usually meet all the needs of its residents, but should be able to help with health issues such as nutrition, education, recreation, safety, and zoning regulations to separate residential sections from industrial ones.

A nurse pleads guilty to a misdemeanor negligence charge for failing to monitor a patient's vital signs during routine eye surgery, leading to the death of the patient. The nurse's attorney explained in court that the nurse was granted recognition in a specialty area of nursing. What is the term for this type of credential? a. Accreditation b. Licensure c. Certification d. Board approval

c Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area. Nursing is one of the groups operating under state laws that promote the general welfare by determining minimum standards of education through accreditation of schools of nursing. Licensure is a legal document that permits a person to offer to the public skills and knowledge in a particular jurisdiction, where such practice would otherwise be unlawful without a license. State board of approval ensures that nurses have received the proper training to practice nursing.

A nurse in a NICU fails to monitor a premature newborn according to the protocols in place, and is charged with malpractice. What is the term for those bringing the charges against the nurse? a. Appellates b. Defendants c. Plaintiffs d. Attorneys

c The person or government bringing suit against another is called the plaintiff. Appellates are courts of law, defendants are the ones being accused of a crime or tort, and attorneys are the lawyers representing both the plaintiff and defendant.

When conducting quantitative research, the researcher collects information to support a hypothesis. This information would be identified as: a. The subject b. Variables c. Data d. The instrument

c Data refer to information that the researcher collects from subjects in the study (expressed in numbers). A variable is something that varies and has different values that can be measured. Instruments are devices used to collect and record the data, such as rating scales, pencil-and-paper tests, and biologic measurements.

A nurse is conducting quantitative research to examine the effects of following nursing protocols in the emergency department (ED) on patient outcomes. This is also known as what type of research? a. Descriptive b. Correlational c. Quasi-experimental d. Experimental

c Quasi-experimental research is often conducted in clinical settings to examine the effects of nursing interventions on patient outcomes. Descriptive research is often used to generate new knowledge about topics with little or no prior research. Correlational research examines the type and degree of relationships between two or more variables. Experimental research examines cause-and-effect relationships between variables under highly controlled conditions.

Based on the components of the physical human dimension, the nurse would expect which clinic patient to be most likely to have annual breast examinations and mammograms? a. Jane, whose best friend had a benign breast lump removed b. Sarah, who lives in a low-income neighborhood c. Tricia, who has a family history of breast cancer d. Nancy, whose family encourages regular physical examinations

c The physical dimension includes genetic inheritance, age, developmental level, race, and biological sex. These components strongly influence the person's health status and health practices. A family history of breast cancer is a major risk factor.

A nurse is teaching patients of all ages in a hospital setting. Which examples demonstrate teaching that is appropriately based on the patient's developmental level? Select all that apply. a. The nurse plans long teaching sessions to discuss diet modifications for an older adult diagnosed with type 2 diabetes. b. The nurse recognizes that a female adolescent diagnosed with anorexia is still dependent on her parents and includes them in all teaching sessions. c. The nurse designs an exercise program for a sedentary older adult male patient based on the activities he prefers. d. The nurse includes an 8-year-old patient in the teaching plan for managing cystic fibrosis. e. The nurse demonstrates how to use an inhaler to an 11-year-old male patient and includes his mother in the session to reinforce the teaching. f. The nurse continues a teaching session on STIs for a sexually active male adolescent despite his protest that "I've heard enough already!"

c, d, e For older adults: extra time, short teaching sessions, accommodation for sensory deficits, reduction of environmental distractions, and relating new info in familiar ways For School-Age Kids: include in the process, reinforcement by parents/providers For Adolescents: need for independence, establishing trust, respecting their opinions

A nurse instructor outlines the criteria establishing nursing as a profession. What teaching point correctly describes this criteria? Select all that apply. a. Nursing is composed of a well-defined body of general knowledge b. Nursing interventions are dependent upon medical practice c. Nursing is a recognized authority by a professional group d. Nursing is regulated by the medical industry e. Nursing has a code of ethics f. Nursing is influenced by ongoing research

c, e, f Nursing is recognized increasingly as a profession based on the following defining criteria: well-defined body of specific and unique knowledge, strong service orientation, recognized authority by a professional group, code of ethics, professional organization that sets standards, ongoing research, and autonomy and self-regulation.

A nurse incorporates concepts from current models of health when providing health promotion classes for patients. What is a key concept of both the health-illness continuum and the high-level wellness models? a. Illness as a fixed point in time b. The importance of family c. Wellness as a passive state d. Health as a constantly changing state

d

A veteran nurse, pleaded guilty to a misdemeanor negligence charge in the case of a 75-year-old woman who died after slipping into a coma during routine outpatient hernia surgery. The nurse admitted failing to monitor the woman's vital signs during the procedure. The surgeon who performed the procedure called the nurse's action pure negligence, stating that the patient could have been saved. The patient was a vibrant grandmother of 10 who had walked three quarters of a mile the morning of her surgery and had sung in her church choir the day before. What criteria must be established to prove that the nurse is guilty of malpractice or negligence in this case? a. The surgeon who performed the procedure called the nurse's action pure negligence, saying that the patient could have been saved. b. The fact that this patient should not have died since she was a healthy grandmother of 10, who was physically active and involved in her community. c. The nurse intended to harm the patient and was willfully negligent, as evidenced by the tragic outcome of routine hernia surgery. d. The nurse had a duty to monitor the patient's vital signs, and due to the nurse's failure to perform this duty in this circumstance, the patient died.

d Liability involves four elements that must be established to prove that malpractice or negligence has occurred: duty, breach of duty, causation, and damages. Duty refers to an obligation to use due care (what a reasonably prudent nurse would do) and is defined by the standard of care appropriate for the nurse-patient relationship. Breach of duty is the failure to meet the standard of care. Causation, the most difficult element of liability to prove, shows that the failure to meet the standard of care (breach) actually caused the injury. Damages are the actual harm or injury resulting to the patient.

A nurse administers the wrong medication to a patient and the patient is harmed. The health care provider who ordered the medication did not read the documentation that the patient was allergic to the drug. Which statement is true regarding liability for the administration of the wrong medication? a. The nurse is not responsible, because the nurse was following the doctor's orders. b. Only the nurse is responsible, because the nurse actually administered the medication. c. Only the health care provider is responsible, because the health care provider actually ordered the drug. d. Both the nurse and the health care provider are responsible for their respective actions.

d Nurses are legally responsible for carrying out the orders of the health care provider in charge of a patient unless an order would lead a reasonable person to anticipate injury if it was carried out. If the nurse should have anticipated injury and did not, both the prescribing health care provider and the administering nurse are responsible for the harms to which they contributed.

A nurse working in an "Aging in Place" facility interviews a married couple in their late seventies. Based on Duvall's Developmental Tasks of Families, which developmental task would the nurse assess for this couple? a. Maintenance of a supportive home base b. Strength of the marital relationship c. Ability to cope with loss of energy and privacy d. Adjustment to retirement years

d The developmental tasks of the family with older adults are to adjust to retirement and possibly to adjust to the loss of a spouse and loss of independent living. Maintaining a supportive home base and strengthening marital relationships are tasks of the family with adolescents and young adults. Coping with loss of energy and privacy is a task of the family with children.

A nurse enters a patient's room and examines the patient's IV fluids and cardiac monitor. The patient states, "Well, I haven't seen you before. Who are you?" What is the nurse's BEST response? a. "I'm just the IV therapist checking your IV." b. "I've been transferred to this division and will be caring for you." c. "I'm sorry, my name is John Smith and I am your nurse." d. "My name is John Smith, I am your nurse and I'll be caring for you until 11 PM."

d The nurse should identify himself, be sure the patient knows what will be happening, and the time period he will be with his patient.

A 3-year-old child is being admitted to a medical division for vomiting, diarrhea, and dehydration. During the admission interview, the nurse should implement which communication techniques to elicit the most information from the parents? a. The use of reflective questions b. The use of closed questions c. The use of assertive questions d. The use of clarifying questions

d The reflective question technique involves repeating what the person has said or describing the person's feelings. Open-ended questions encourage free verbalization and expression of what the parents believe to be true. Assertive behavior is the ability to stand up for yourself and others using open, honest, and direct communication.

A nurse enters the room of a patient with cancer. The patient is crying and states, "I feel so alone." Which response by the nurse is the most therapeutic action? a. The nurse stands at the patient's bedside and states, "I understand how you feel. My mother said the same thing when she was ill." b. The nurse places a hand on the patient's arm and states, "You feel so alone. c. "The nurse stands in the patient's room and asks, "Why do you feel so alone? Your wife has been here every day." d. The nurse holds the patient's hand and asks, "What makes you feel so alone?"

d The use of touch conveys acceptance, and the implementation of an open-ended question allows the patient time to verbalize freely.

A nurse manager of a busy cardiac unit observes disagreements between the RNs and the LPNs related to schedules and nursing responsibilities. At a staff meeting, the manager compliments all the nurses on a job well done and points out that expected goals and outcomes for the month have been met. The nurse concludes the meeting without addressing the disagreements between the two groups of nurses. Which conflict resolution strategy is being employed by this manager? a. Collaborating b. Competing c. Compromising d. Smoothing

d I don't really agree with this answer wholly though, it sounds more like avoidance to me Avoiding: aware, but ignores it, doesn't really resolve the conflict Collaborating: problem-solving, "win-win", honest communication Competing: "win-lose", when one party has more knowledge and resistance is due to ethical/safety issues Compromising: both parties have to be willing to give something up or it will feel like "lose-lose" Cooperating/Accommodating: one party lets the other "win" and may collect a future IOU Smoothing: reducing emotion in the conflict, but doesn't usually resolve it

A nurse is formulating a clinical question in PICOT format. What does the letter P represent? a. Comparison to another similar protocol b. Clearly defined, focused literature review of procedures c. Specific identification of the purpose of the study d. Explicit descriptions of the population of interest

d The P in the PICOT format represents an explicit description of the patient population of interest. I represents the intervention, C represents the comparison, O stands for the outcome, and T stands for the time.

A student nurse asks an experienced nurse why it is necessary to change the patient's bed every day. The nurse answers: "I guess we have just always done it that way." This answer is an example of what type of knowledge? a. Instinctive knowledge b. Scientific knowledge c. Authoritative knowledge d. Traditional knowledge

d Traditional knowledge is the part of nursing practice passed down from generation to generation, often without research data to support it. Scientific knowledge is that knowledge obtained through the scientific method (implying thorough research). Authoritative knowledge comes from an expert and is accepted as truth based on the person's perceived expertise. Instinct is not a source of knowledge.

A nurse is caring for patients of diverse cultures in a community health care facility. Which characteristics of cultural diversity that exist in the United States should the nurse consider when planning culturally competent care? Select all that apply. a. The United States has become less inclusive of same-sex couples. b. Cultural diversity is limited to people of varying cultures and races. c. Cultural diversity is separate and distinct from health and illness. d. People may be members of multiple cultural groups at one time. e. Culture guides what is acceptable behavior for people in a specific group. f. Cultural practices may evolve over time but mainly remain constant.

d, e, f

The role of nurses in today's society was influenced by the nurse's role in early civilization. Which statement best portrays this earlier role? a. Women who committed crimes were recruited into nursing the sick in lieu of serving jail sentences. b. Nurses identified the personal needs of the patient and their role in meeting those needs. c. Women called deaconesses made the first visits to the sick, and male religious orders cared for the sick and buried the dead. d. The nurse was the mother who cared for her family during sickness by using herbal remedies.

d. In early civilizations, the nurse usually was the mother who cared for her family during sickness by providing physical care and herbal remedies. This nurturing and caring role of the nurse has continued to the present.

Concept mapping's purpose is to identify, graphically display, and link concepts to promote critical thinking about a patient case. Place the following steps in concept mapping in the correct sequence. (1) Developing a basic skeleton diagram (2) Identify goals, outcomes, and interventions (3) Analyze nursing diagnoses relationships (4) Evaluate patients' responses (5) Analyze and categorize data

(1) Develop a basic skeleton diagram (2) Analyze and categorize data (3) Analyze nursing diagnoses relationships (4) Identify goals, outcomes, and interventions (5) Evaluate patients' responses

A nurse uses the classic elements of evaluation when caring for patients: (1) Interpreting and summarizing findings (2) Collecting data to determine whether evaluative criteria and standards are met (3) Documenting your judgment (4) Terminating, continuing, or modifying the plan (5) Identifying evaluative criteria and standards (what you are looking for when you evaluate—i.e., expected patient outcomes). Place them in the correct sequence.

(1) Identifying evaluative criteria and standards (what you are looking for when you evaluate—i.e., expected patient outcomes) (2) Collecting data to determine whether evaluative criteria and standards are met (3) Interpreting and summarizing findings (4) Documenting your judgment (5) Terminating, continuing, or modifying the plan

A nurse is prioritizing the following patient diagnoses according to Maslow's hierarchy of human needs: order them from the highest priority (1) Disturbed Body Image (2) Ineffective Airway Clearance (3) Spiritual Distress (4) Impaired Social Interaction

(1) Ineffective airway clearance - Physiological needs; safety needs next (2) Impaired social interaction - love and belonging needs (3) Disturbed Body Image - self-esteem needs (4) Spiritual Distress- self-actualization needs

Match the practices of each major religion in the US to the beliefs and healthcare implications: 1. Adventist a. No taking lives in any form, diet restrictions 2. American Muslim Mission b. No drugs or psychotherapy 3. Buddhism c. No narcotics or stimulants, Saturday regarded as sabbath, Holistic care approach 4. Christian Scientist d. Special undergarments only removed in an emergency 5. Hinduism e. Don't touch patient's lips when administering medications, postmortem rites and cremation 6. Islam f. Typically want Black providers, prayer rituals, extreme cleanliness, no pork 7. Jehovah's Witnesses g. Obligatory prayers, holy days, fasting (Ramadan), no pork, some women can't make decisions independent of their husband's consent 8. Prostestant h. Birth rituals, dietary restrictions, no treatment or procedures on the Sabbath, restrictions on male/female contact 9. Roman Catholic i. Private devotions, mass on Sundays, dietary restrictions, sexual ethics norms, only natural means of birth control (no abortion) 10. Sikhism j. Laying of the hands, Anointing of the sick 11. Unitarian k. No blood transfusions 12. Mormon l. can choose to take what is best for their health 13. Judaism m. uncut hair for men/women, steel bangle on wrist, don't remove head covering except in emergencies 14. Native American n. spiritual advisors, rituals

1. c 2. f 3. a 4. b 5. e 6. g 7. k 8. j 9. i 10. m 11. l 12. d 13. h 14. n

True or False: The purpose of a nurse practice act is for regulation of the scope of nursing practice to protect the nurse, the general public, and the overall welfare and safety of all persons provided care by nurses.

True

True or False: Deontological ethics theories are based on the belief that an action is wrong or right based on a rule, independent of its consequence.

True Utilitarian Ethics theories belief rightness or wrongness of an action depends on the consequences of the action

A 17-year-old college student calls the emergency department (ED) and tells the nurse that she was raped by a professor. She wants to come to the ED, but only if the nurse can assure her that they will not call her parents. What should be the nurse's first priority? a. Getting the patient into a safe environment and mobilizing support for her b. Encouraging the student to disclose the name of the professor so that his predatory behavior will be stopped c. Convincing the student to be assessed for pregnancy, STIs, or other complications d. Convincing the student to tell her parents so that she can receive their support

a

A 2-year-old grabs a handful of cake from the table and stuffs it in his mouth. According to Freud, what part of the mind is the child satisfying? a. Id b. Superego c. Ego d. Unconscious mind

a

A nurse caring for patients in a primary care setting submits paperwork for reimbursement from managed care plans for services performed. Which purpose best describes managed care as a framework for health care? a. A design to control the cost of care while maintaining the quality of care b. Care coordination to maximize positive outcomes to contain costs c. The delivery of services from initial contact through ongoing care d. Based on a philosophy of ensuring death in comfort and dignity

a

A nurse is caring for a patient who has crippling rheumatoid arthritis. Which nursing intervention best represents the use of integrative care? a. The nurse administers naproxen and uses guided imagery to take the patient's mind off the pain. b. The nurse prepares the patient's health care provider-approved herbal tea and uses meditation to relax the patient prior to bed. c. The nurse administers naproxen and performs prescribed range-of-motion exercises. d. The nurse arranges for acupuncture for the patient and designs a menu high in omega-3 fatty acids.

a

A nurse is telling a new mother from Africa that she shouldn't carry her baby in a sling created from a large rectangular cloth. The African woman tells the nurse that everyone in Mozambique carries babies this way. The nurse believes that bassinets are safer for infants. This nurse is displaying what cultural bias? a. Cultural imposition b. Clustering c. Cultural competency d. Stereotyping

a

A nurse notices a patient is walking to the bathroom with a stooped gait, facial grimacing, and gasping sounds. Based on these nonverbal clues, for which condition would the nurse assess? a. Pain b. Anxiety c. Depression d. Fluid volume deficit

a

A patient is being transferred from the ICU to a regular hospital room. What must the ICU nurse be prepared to do as part of this transfer? a. Provide a verbal report to the nurse on the new unit. b. Provide a detailed written report to the unit secretary. c. Delegate the responsibility for providing information. d. Make a copy of the patient's medical record.

a

A patient tells the nurse that she would like to use a mechanical barrier for birth control. Which method might the nurse recommend? a. Diaphragm b. Oral contraceptive pills c. Depo-Provera d. Evra patch

a

A school nurse is providing information for parents of teenagers regarding the human papillomavirus (HPV) and the recommended HPV vaccination. What teaching point would the nurse include? a. "HPV causes genital warts and cervical and other genital cancers." b. "HPV causes a single painless genital lesion and can lead to sterility." c. "50% of women between the ages of 14 and 19 are infected with HPV." d. "The HPV vaccination is only recommended for the female population."

a

When writing patient-centered outcomes, the nurse knows that SMART goals are used. The acronym SMART refers to what? a. Specific Problem, Measurable, Achievable, Realistic, Time Bound b. Specific Problem, Measurable, Accessible, Realistic, Time Bound c. Strategic, Measurable, Achievable, Realistic, Time Bound d. Specific Problem, Measurable, Achievable, Realistic, Trackable

a

Population health addresses the health status and health issues of aggregate populations and addresses ways in which resources may be allocated to address these concerns. What is the driving force behind the use by health corporations of analytics and big data to support population health? a. The transition from fee-for-service models to value-based payment models b. A growing older population with more complicated health needs c. The overcrowding and understaffing of hospitals d. The shortage of health care professionals, particularly nurses

a A growing older population with more complicated health needs, the overcrowding and understaffing of hospitals, and the shortage of health care professionals, particularly nurses, may be affected by population health assessment, but are not the driving force for the development of this technology.

The nurse records a patient's blood pressure as 148/100. What is the priority action of the nurse when determining the significance of this reading? a. Compare this reading to standards. b. Check the taxonomy of nursing diagnoses for a pertinent label. c. Check a medical text for the signs and symptoms of high blood pressure. d. Consult with colleagues.

a A standard, or a norm, is a generally accepted rule, measure, pattern, or model to which data can be compared in the same class or category

After having an abortion, a patient tells the visiting nurse, "I shouldn't have had that abortion because I'm Catholic, but what else could I do? I'm afraid I'll never get close to my mother or back in the Church again." She then talks with her priest about this feeling of guilt. Which evaluation statement shows a solution to the problem? a. Patient states, "I wish I had talked with the priest sooner. I now know God has forgiven me, and even my mother understands." b. Patient has slept from 10 PM to 6 AM for three consecutive nights without medication. c. Patient has developed mutually caring relationships with two women and one man. d. Patient has identified several spiritual beliefs that give purpose to her life.

a Because this patient's nursing diagnosis is Spiritual Distress: Guilt, an evaluative statement that demonstrates diminished guilt is necessary. Only answer a directly deals with guilt.

A nurse is using time management techniques when planning activities for patients. Which nursing action reflects effective time management? a. The nurse asks patients to prioritize what they want to accomplish each day b. The nurse includes a "nice to do" for every "need to do" task on the list c. The nurse "front loads" the schedule with "must do" priorities d. The nurse avoids helping other nurses if scheduling does not permit it

a By asking the patient to prioritize what they want to accomplish each day, the nurse is demonstrating an effective time management technique. In order to manage time, the nurse should establish goals and priorities for each day, differentiating "need to do" from "nice to do" tasks; the nurse should include the patient in this process. The nurse should also establish a time line, allocating priorities to hours in the workday in order to keep track of falling behind and correct the problem before the day is lost. The nurse should use teamwork appropriately to enhance the schedule.

A nurse working in a primary care facility prepares insurance forms in which the provider is given a fixed amount per enrollee of the health plan. What is the term for this type of reimbursement? a. Capitation b. Prospective payment system c. Bundled payment d. Rate setting

a Capitation plans give providers a fixed amount per enrollee in the health plan in an effort to build a payment plan that consists of the best standards of care at the lowest cost. The prospective payment system groups inpatient hospital services for Medicare patients into DRGs. With bundled payments, providers receive a fixed sum of money to provide a range of services. Rate setting means that the government could set targets or caps for spending on health care services.

A nurse is assessing a patient who is diagnosed with anorexia. Following the assessment, the nurse recommends that the patient meet with a nutritionist. This action best exemplifies the use of: a. Clinical judgment b. Clinical reasoning c. Critical thinking d. Blended competencies

a Clinical Judgement: the result/outcome of critical thinking/clinical reasoning Clinical reasoning: ways of thinking about pt care (determining, preventing, managing) Critical thinking: broad reasoning both inside and out of the clinical setting Blended Competencies: cognitive, technical, interpersonal, ethical/legal skills

A nurse writes the following outcome for a patient who is trying to lose weight: "The patient can explain the relationship between weight loss, increased exercise, and decreased calorie intake." This is an example of what type of outcome? a. Cognitive b. Psychomotor c. Affective d. Physical changes

a Cognitive outcomes involve increases in patient knowledge; psychomotor outcomes describe the patient's achievement of new skills; affective outcomes pertain to changes in patient values, beliefs, and attitudes; and physical changes are actual bodily changes in the patient (e.g., weight loss, increased muscle tone).

The nurse practitioner sees patients in a community clinic that is located in a predominately White neighborhood. After performing assessments on the majority of the patients visiting the clinic, the nurse notes that many of the minority groups living within the neighborhood have lost the cultural characteristics that made them different. What is the term for this process? a. Cultural assimilation b. Cultural imposition c. Culture shock d. Ethnocentrism

a Cultural imposition occurs when one person believes that everyone should conform to his or her own belief system. Culture shock occurs when a person is placed in a different culture perceived as strange, and ethnocentrism is the belief that the ideas, beliefs, and practices of one's own cultural group are best, superior, or most preferred to those of other groups

A nurse manager who works in a hospital setting is researching the use of energy healing to use as an integrative care practice. Which patient would be the best candidate for this type of CAT? a. A patient who is anxious about residual pain from cervical spinal surgery b. A patient who is experiencing abdominal discomfort c. A patient who has chronic pain from diabetes d. A patient who has frequent cluster headaches

a Energy healing is focused on pain that lingers after an injury heals, as well as pain complicated by trauma, anxiety, or depression. Nutritional and herbal remedies treat all chronic pain, but especially abdominal discomfort, headaches, and inflammatory conditions, such as rheumatoid arthritis.

An experienced nurse tells a beginning nurse not to bother studying too hard, since most clinical reasoning becomes "second nature" and "intuitive" once you start practicing. What thinking below should underlie the beginning nurse's response? a. Intuitive problem solving comes with years of practice and observation, and novice nurses should base their care on scientific problem solving. b. For nursing to remain a science, nurses must continue to be vigilant about stamping out intuitive reasoning. c. The emphasis on logical, scientific, evidence-based reasoning has held nursing back for years; it is time to champion intuitive, creative thinking! d. It is simply a matter of preference; some nurses are logical, scientific thinkers, and some are intuitive, creative thinkers.

a If the beginning nurse has an intuition about a patient, that information should be discussed with the faculty member, preceptor, or supervisor. there is a place for intuitive reasoning in nursing, but it will never replace logical, scientific reasoning. Critical thinking is contextual and changes depending on the circumstances, not on personal preference.

A school nurse is studying Kohlberg's theory of moral development to prepare a parent discussion addressing the problem of bullying. According to Kohlberg, which factor initially influences the moral development of children? a. Parent/caregiver-child communications b. Societal rules and regulations c. Social and religious rules d. A person's beliefs and values

a Kohlberg's stages of moral development begin in childhood but may develop well into adolescence and adulthood. Rules and regulations established by society are eventually challenged and evaluated as a person either accepts societal rules into his or her own internal set of values or rejects them.

When the initial nursing assessment revealed that a patient had not had a bowel movement for 2 days, the student nurse wrote the diagnostic label "constipation." What would be the instructor's BEST response to this student's diagnosis? a. "Was this diagnosis derived from a cluster of significant data or a single clue?" b. "This early diagnosis will help us manage the problem before it becomes more acute." c. "Have you determined if this is an actual or a possible diagnosis?" d. "This condition is a medical problem that should not have a nursing diagnosis."

a Nursing diagnoses should always be derived from clusters of significant data rather than from a single cue. A data cluster is a grouping of patient data or cues that point to the existence of a patient health problem. There may be a reason for the lack of a bowel movement for 2 days, or it might be this person's normal pattern.

A school nurse notices that a student is losing weight and decides to perform a focused nutritional assessment to rule out an eating disorder. What is the nurse's best action? a. Perform the focused assessment as this is an independent nurse-initiated intervention. b. Request an order from Jill's physician since this is a physician-initiated intervention. c. Request an order from Jill's physician since this is a collaborative intervention. d. Request an order from the nutritionist since this is a collaborative intervention.

a Performing a focused assessment is an independent nurse-initiated intervention; thus the nurse does not need an order from the physician or the nutritionist.

A nurse caring for older adults in a long-term care facility encourages an older adult to reminisce about past life events. This life review, according to Erikson, is demonstrating what developmental stage of the later adult years? a. Ego integrity b. Generativity c. Intimacy d. Initiative

a Reminiscence during the older years of a person's life provides a sense of fulfillment and purpose (ego integrity). Generativity is a developmental stage of the middle adult years. Intimacy is a developmental task of the adolescent to adult years, and initiative is a task of the preschooler to early school-age years.

A caregiver asks a nurse to explain respite care. How would the nurse respond? a. "Respite care is a service that allows time away for caregivers." b. "Respite care is a special service for the terminally ill and their family." c. "Respite care is direct care provided to people in a long-term care facility." d. "Respite care provides living units for people without regular shelter."

a Respite care is provided to enable a primary caregiver time away from the day-to-day responsibilities of homebound patients.

A nurse is counseling an older couple regarding sexuality. Which statement from the couple should the nurse address? a. "We're at the age when we should consider ceasing sexual activity." b. "We need more time for sexual stimulation than we used to." c. "If we are unable to have sex we can still have an intimate relationship." d. "If we change our position we can still have sex and be more comfortable."

a Sexual activity need not be hindered by age, and couples who have been consistently sexually active throughout their lives may continue their intimate relationship for as long as they desire.

A nurse performing a spiritual assessment collects assessment data from a patient who is homebound and unable to participate in religious activities. Which type of spiritual distress is this patient most likely experiencing? a. Spiritual Alienation b. Spiritual Despair c. Spiritual Anxiety d. Spiritual Pain

a Spiritual Alienation occurs when there is a "separation from the faith community." Spiritual Despair occurs when the patient is feeling that no one (not even God) cares. Spiritual Anxiety is manifested by a challenged belief and value system, and Spiritual Pain may occur when a patient is unable to accept the death of a loved one.

A student nurse is on a clinical rotation at a busy hospital unit. The RN in charge tells the student to change a surgical dressing on a patient while she takes care of other patients. The student has not changed dressings before and does not feel confident performing the procedure. What would be the student's best response? a. Tell the RN that he or she lacks the technical competencies to change the dressing independently. b. Assemble the equipment for the procedure and follow the steps in the procedure manual. c. Ask another student nurse to work collaboratively with him or her to change the dressing. d. Report the RN to his or her instructor for delegating a task that should not be assigned to student nurses.

a Student nurses should notify their nursing instructor or nurse mentor if they believe they lack any competencies needed to safely implement the care plan. It is within the realm of a student nurse to change a dressing if he or she is technically prepared to do so.

A nurse is using the SOAP format to document care of a patient who is diagnosed with type 2 diabetes. Which source of information would be the nurse's focus when completing this documentation? a. A patient problem list b. Narrative notes describing the patient's condition b. Overall trends in patient status c. Planned interventions and patient outcomes

a Subjective Data, Objective Data, Assessment, Plan: problem list alerts all caregivers to pt priorities Narrative Notes: description of condition, situation, response CBE (Charting By Exception): overall trends in pt status Case Management Model: Planned interventions and pt-expected outcomes are the focus

When interacting with a patient, the nurse answers, "I am sure everything will be fine. You have nothing to worry about." This is an example of what type of inappropriate communication technique? a. Cliché b. Giving advice c. Being judgmental d. Changing the subject

a Telling a patient that everything is going to be all right is a cliché. This statement gives false assurance and gives the patient the impression that the nurse is not interested in the patient's condition.

The nurse uses the agent-host-environment model of health and illness to assess diseases in patients. This model is based on what concept? a. Risk factors b. Demographic variables c. Behaviors to promote health d. Stages of illness

a The interaction of the agent, host, and environment creates risk factors that increase the probability of disease.

A public health nurse is leaving the home of a young mother who has a special needs baby. The neighbor states, "How is she doing, since the baby's father is no help?" What is the nurse's BEST response to the neighbor? a. "New mothers need support." b. "The lack of a father is difficult." c. "How are you today?" d. "It is a very sad situation."

a The nurse must maintain confidentiality when providing care. The statement "New mothers need support" is a general statement that all new parents need help. The statement is not judgmental of the family's roles.

An attorney is representing a patient's family who is suing a nurse for wrongful death. The attorney calls the nurse and asks to talk about the case to obtain a better understanding of the nurse's actions. How should the nurse respond? a. "I'm sorry, but I can't talk with you; you will have to contact my attorney." b. "I will answer your questions so you'll understand how the situation occurred." c. "I hope I won't be blamed for the death because it was so busy that day." d. "First tell me why you are doing this to me. This could ruin my career!"

a The nurse should not discuss the case with anyone at the facility (with the exception of the risk manager), with the plaintiff, with the plaintiff's lawyer, with anyone testifying for the plaintiff, or with reporters. This is one of the cardinal rules for nurse defendants.

A quality-assurance program reveals a higher incidence of falls and other safety violations on a particular unit. A nurse manager states, "We'd better find the people responsible for these errors and see if we can replace them." This is an example of: a. Quality by inspection b. Quality by punishment c. Quality by surveillance d. Quality by opportunity

a Quality by inspection focuses on finding deficient workers and removing them. Quality as opportunity focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork, with people sharing the skills and lessons they have learned. Quality by punishment and quality by surveillance are not quality-assurance methods used in the health care field.

Which of the following are effective information presentation concepts in system design in nursing informatics? (Select all that apply). a. Appropriate density when designing EMR screens b. Meaningful use of color c. Readability d. Preservation of context e. User acceptance testing f. Information that is synthesized to identify relationship

a, b, c, d User acceptance testing is a form of testing that systems undergo in the process of the system development lifecycle (SDLC) Information that is synthesized so that relationships are identified is the definition of Knowledge in the DIKW informatics scope and standards

Which of the following are components of the A's to Rise Above Moral Distress: (select all that apply) a. Ask b. Act c. Affirm d. Achieve e. Assess

a, b, c, e

Nurses document all aspects of the nursing process, assessment, diagnosis, planning, implementing, and evaluating, as well as all pertinent interactions with patients in written or electronic medical records (EMRs). Which of the following is true about patient records? (Select all that apply). a. Patient health information is private and confidential b. Patient records contain a compilation of the patient's health information c. A purpose of a patient record is to allow for communication of information amongst health care team members and the patient d. Patient records are not utilized for healthcare facility accreditation e. Patient records can be used for research purposes f. Patient health information can be utilized without a patient's permission during times of epidemic to determine trends regarding public health

a, b, c, e, f Purposes of a patient records are to communicate information amongst health care team members, the patient, insurance reimbursement, legal and regulatory bodies overview, accreditation, research, legislative, quality activities and credentialing.

Which patients would a nurse assess for menstrual cycle irregularities? Select all that apply. a. A patient who is breast-feeding b. A patient who is diagnosed with anorexia c. A patient who chooses to abstain from sexual intercourse d. A patient who has pelvic inflammatory disease e. A patient who is obsessed with exercising f. A patient who has a spinal cord injury

a, b, d, e Abstaining from sex and spinal cord injuries are not causes of menstrual irregularities.

High Reliability Organizations (HROs) exhibit what characteristics? (Select all that apply) a. Sensitivity to operations b. Commitment to resilience c. Magnet Status d. Reluctance to simplify e. Deference to expertise f. Preoccupation with failure

a, b, d, e, f

Components of an effective team structure include: (Select all that apply) a. Interact interdependently and adaptively b. Have complementary skills c. Have autocratic leadership d. Work toward a common goal e. Have clear roles and responsibilities f. Hold themselves mutually accountable for achieving the goal

a, b, d, e, f Autocratic leadership is basically authoritarian, with the leader having total control over the team, effective teams can have multiple styles of effective leadership, however, autocratic is not typically one of them except in an emergency situation calling for prompt and direct delegation

A nurse is caring for patients admitted to a long-term care facility. Which nursing actions are appropriate based on the religious beliefs of the individual patients? Select all that apply. a. The nurse dietitian asks a Buddhist if he has any diet restrictions related to the observance of holy days b. A nurse asks a Christian Scientist who is in traction if she would like to try nonpharmacologic pain measures. c. A nurse administering medications to a Muslim patient avoids touching the patient's lips d. A nurse asks a Roman Catholic woman if she would like to attend the local Mass on Sunday. e. The nurse is careful not to schedule treatment and procedures on Saturday for a Hindu patient. f. The nurse consults with the medicine man of a Native American patient and incorporates his suggestions into the care plan.

a, b, d, f The nurse dietitian should ask a Buddhist if he has any diet restrictions related to the observance of holy days. Since Catholic Scientists avoid the use of pain medications, the nurse should ask a Christian Scientist who is in traction if she would like to try nonpharmacologic pain measures. A nurse administering medications to a Hindu woman avoids touching the patient's lips. A nurse should ask a Roman Catholic woman if she would like to attend the local Mass on Sunday. The nurse is careful not to schedule treatment and procedures on Saturday for a Jewish patient due to observance of the Sabbath. The nurse would appropriately consult with the medicine man of a Native American patient and incorporates his or her suggestions into the care plan.

A nurse mentor is teaching a new nurse about the underlying beliefs of CATs versus allopathic therapies. Which statements by the new nurse indicate that teaching was effective? Select all that apply. a. "CAT proponents believe the mind, body, and spirit are integrated and together influence health and illness." b. "CAT proponents believe that health is a balance of body systems: mental, social, and spiritual, as well as physical." c. "Allopathy proponents believe that the main cause of illness is an imbalance or disharmony in the body systems." d. "Curing according to CAT proponents seeks to destroy the invading organism or repair the affected part." e. "The emphasis is on disease for allopathic proponents and drugs, surgery, and radiation are key tools for curing." f. "According to CAT proponents, health is the absence of disease."

a, b, e Allopathic beliefs include: The main causes of illness are considered to be pathogens (bacteria or viruses) or biochemical imbalances, curing seeks to destroy the invading organism or repair the affected part, and emphasis is on disease and high technology. Drugs, surgery, and radiation are among the key tools for dealing with medical problems. According to allopathic beliefs, health is the absence of disease.

A nurse researcher studies the effects of genomics on current nursing practice. Which statements identify genetic principles that will challenge nurses to integrate genomics in their research, education, and practice? Select all that apply. a. Genetic tests plus family history tools have the potential to identify people at risk for diseases. b. Pharmacogenetic tests can determine if a patient is likely to have a strong therapeutic response to a drug or suffer adverse reactions from the medication. c. Evidence-based review panels are in place to evaluate the possible risks and benefits related to genetic testing. d. Valid and reliable national data are available to establish baseline measures and track progress toward targets. e. Genetic variation can either accelerate or slow the metabolism of many drugs. f. It is beyond the role of the nurse to answer questions and discuss the impact of genetic findings on health and illness.

a, b, e Two emerging challenges exist related to genomic discoveries: (1) the need for evidence-based review panels to thoroughly evaluate the possible benefits and harms related to the expanding number of genetic tests and family health history tools; and (2) the need for valid and reliable national data to establish baseline measures and track progress toward targets

A nurse is teaching parents about normal developmental aspects of sexuality in their children. Which statements from parents would warrant further teaching? Select all that apply. a. "When my 2-year-old son touches his genitals, I push his hand away and tell him 'No'." b. "I should wean my infant by 4 months and encourage him to use a sippy cup." c. "I should explain sexuality to my 9-year-old in a factual manner when she asks me questions about her body." d. "I should explain about body changes to my 11-year-old prior to them happening to alleviate her fears." e. "I should teach my 10-year-old about contraception and ways to avoid sexually transmitted diseases." f. "I should allow my teenager to establish her own beliefs and moral value system by not sharing my own beliefs."

a, b, e, f Self-manipulation of genitals is normal behavior; parents should avoid telling a child this as "bad." Parents should avoid early weaning of infants to prevent oral deprivation. Parents should explain contraception and STIs to their adolescent children; it would be premature to do so for a 10-year-old. Parents should share their beliefs and moral system with their children. Parents should also give their children the desired information about sexuality in a clear, factual form and give them information about body changes before they experience them, to alleviate fears.

A discharge nurse is evaluating patients and their families to determine the need for a formal discharge plan or referrals to another facility. Which patients would most likely be a candidate for these services? Select all that apply. a. An older adult who is diagnosed with dementia in the hospital b. A 45-year-old man who is diagnosed with Parkinson's disease c. A 35-year-old woman who is receiving chemotherapy for breast cancer d. A 16-year-old boy who is being discharged with a cast on his leg e. A new mother who delivered a healthy infant via a cesarean birth f. A 59-year-old man who is diagnosed with end-stage bladder cancer

a, b, f those who are emotionally or mentally unstable (e.g., those with dementia), those who have recently diagnosed chronic disease (e.g., Parkinson's disease), and those who have a terminal illness (e.g., end-stage cancer). Other candidates include patients who do not understand the treatment plan, are socially isolated, have had major surgery or illness, need a complex home care regimen, or lack financial services or referral sources.

A nurse is using critical pathway methodology for choosing interventions for a patient who is receiving chemotherapy for breast cancer. Which nursing actions are characteristics of this system being used when planning care? Select all that apply. a. The nurse uses a minimal practice standard and is able to alter care to meet the patient's individual needs. b. The nurse uses a binary decision tree for stepwise assessment and intervention. c. The nurse is able to measure the cause-and-effect relationship between pathway and patient outcomes. d. The nurse uses broad, research-based practice recommendations that may or may not have been tested in clinical practice. e. The nurse uses preprinted provider orders used to expedite the order process after a practice standard has been validated through research. f. The nurse uses a decision tree that provides intense specificity and no provider flexibility.

a, c A critical pathway represents a sequential, interdisciplinary, minimal practice standard for a specific patient population that provides flexibility to alter care to meet individualized patient needs. It also offers the ability to measure a cause-and-effect relationship between pathway and patient outcomes.

A nurse is using the steps in informatics evaluation to evaluate the use of a portal as a patient resource. What are examples of activities that might occur in the "determining the question" step? Select all that apply. a. The nurse develops a clear, focused question to determine the data to be collected. b. The nurse determines what to evaluate. c. The nurse determines how the data ultimately should be reported. d. The nurse decides what specific data elements need to be collected. e. The nurse clarifies exactly how the data will be collected. f. The nurse performs comprehensive documentation of the data collected.

a, c The nurse determines what to evaluate during the step "determine what will be evaluated." The nurse decides what specific data elements need to be collected during the "determine the needed data" step. The nurse clarifies exactly how the data will be collected during the "determine the data collection method and sample size" step. The nurse performs comprehensive documentation of the data collected during the "document your outcome evaluation" step.

A nurse working in a hospital setting cares for patients with acute and chronic conditions. Which disease states are chronic illnesses? Select all that apply. a. Diabetes mellitus b. Bronchial pneumonia c. Rheumatoid arthritis d. Cystic fibrosis e. Fractured hip f. Otitis media

a, c, d

After instituting a new system for recording patient data, a nurse evaluates the "usability" of the system. Which actions by the nurse BEST reflect this goal? Select all that apply. a. The nurse checks that the screens are formatted to allow for ease of data entry. b. The nurse reorders the screen sequencing to maximize effective use of the system. c. The nurse ensures that the computers can be used by specified users effectively. d. The nurse checks that the system is intuitive, and supportive of nurses. e. The nurse improves end-user skills and satisfaction with the new system. f. The nurse ensures patient data is able to be shared across health care systems.

a, c, d System Usability: Simple-lack of visual clutter, concise info display, "less is more" Natural: level of automatic "familiarity", intuitive ease of use Minimizes cognitive load: present all the info needed for the task at hand, organized by meaningful relationships Efficient Interactions: Minimizes the # of steps needed, provides shortcuts Forgiveness/Feedback: allows users to discover the system design without fear of disastrous consequences Effective Use of Language: Language is concise, unambiguous, familiar/meaningful terminology Consistency: the level to which users can apply prior experience to the new system Reordering screen sequencing to maximize use and improving end-user skills and satisfaction with the new system refers to optimization. The ability to share patient data across health care systems is termed interoperability.

A nurse is attempting to improve care on the pediatric ward of a hospital. Which nursing improvements might the nurse employ when following the recommendations of the Institute of Medicine's Committee on Quality of Health Care in America? Select all that apply. a. Basing patient care on continuous healing relationships b. Customizing care to reflect the competencies of the staff c. Using evidence-based decision making d. Having a charge nurse as the source of control e. Using safety as a system priority f. Recognizing the need for secrecy to protect patient privacy

a, c, e Care should be based on continuous healing relationships and evidence-based decision making. Customization should be based on patient needs and values with the patient as the source of control. Safety should be used as a system priority, and the need for transparency should be recognized.

A new nurse who is being oriented to the subacute care unit is expected to follow existing standards when providing patient care. Which nursing actions are examples of these standards? Select all that apply. a. Monitoring patient status every hour b. Using intuition to troubleshoot patient problems c. Turning a patient on bed rest every 2 hours d. Becoming a nurse mentor to a student nurse e. Administering pain medication ordered by the physician f. Becoming involved in community nursing events

a, c, e Standards are the levels of performance accepted and expected by the nursing staff or other health care team members. They are established by authority, custom, or consent. Standards would include monitoring patient status every hour, turning a patient on bed rest every 2 hours, and administering pain medication ordered by the physician. Using intuition to troubleshoot patient problems, becoming a nurse mentor to a student nurse, and becoming involved in community nursing events are not patient care standards.

The nurse caring for infants in a hospital nursery knows that newborns continue to grow and develop according to individual growth patterns and developmental levels. Which terms describe these patterns? Select all that apply. a. Orderly b. Simple c. Sequential d. Unpredictable e. Differentiated f. Integrated

a, c, e, f

A nurse decides to become a home health care nurse. Which personal qualities are key to being successful as a community-based nurse? Select all that apply. a. Making accurate assessments b. Researching new treatments for chronic diseases c. Communicating effectively d. Delegating tasks appropriately e. Performing clinical skills effectively f. Making independent decisions

a, c, e, f Nurses working in the community must have the knowledge and skills to make accurate assessments, work independently, communicate effectively, and perform clinical skills accurately. Community-based nurses may be researchers and occasionally delegate care, but these are not key qualities for this type of nursing.

The nurse uses blended competencies when caring for patients in a rehabilitation facility. Which examples of interventions involve cognitive skills? Select all that apply. a. The nurse uses critical thinking skills to plan care for a patient. b. The nurse correctly administers IV saline to a patient who is dehydrated. c. The nurse assists a patient to fill out an informed consent form. d. The nurse learns the correct dosages for patient pain medications. e. The nurse comforts a mother whose baby was born with Down syndrome. f. The nurse uses the proper procedure to catheterize a female patient.

a, d Cognitive competencies: critical thinking, learning med doses Technical competencies: performing procedures correctly Ethical/Legal Competencies: informed consent Interpersonal Competencies: comforting, supporting

A nurse is performing sexual assessments of male patients in a long-term care facility. Which patients would the nurse flag as having an increased risk for erectile dysfunction? Select all that apply. a. A 72-year-old man with a history of diabetes b. A 78-year-old man who has a new partner c. A 75-year-old man who has Parkinson's disease d. An 80-year-old man who is an alcoholic e. An 85-year-old man who takes antihypertensive medication f. A 76-year-old man who smokes tobacco

a, d, e

Nurses provide care to patients as collaborative members of the health care team. Which roles may be performed by the advanced practice registered nurse? Select all that apply. a. Primary care provider b. Hospitalist c. Physical therapist d. Anesthetist e. Midwife f. Pharmacist

a, d, e APRNs, Clinical nurse specialists (CNS), nurse anesthetists, and nurse midwives have a master's or post-master's education level in a specific role for a specific population. Hospitalists are health care providers who provide care to patients when they visit the emergency department or are admitted to the hospital.

A nurse is teaching parents of preschoolers what type of behavior to expect from their children based on developmental theories. Which statements describe this stage of development? Select all that apply. a. According to Freud, the child is in the phallic stage. b. According to Erikson, the child is in the trust versus mistrust stage. c. According to Havighurst, the child is learning to get along with others. d. According to Fowler, the child imitates religious behavior of others. e. According to Kohlberg, the child defines satisfying acts as right. f. According to Havighurst, the child is achieving gender-specific roles.

a, d, e According to Freud, the child is in the phallic stage. According to Fowler, the child imitates religious behavior of others. According to Kohlberg, the child defines satisfying acts as right. According to Erikson, the child is in the initiative versus guilt stage. According to Havighurst, the child is learning sex differences, forming concepts, and getting ready to read. According to Havighurst, the adolescent, not the preschooler, is achieving gender-specific social roles.

A nurse researcher keeps current on the trends to watch in health care delivery. What trends are likely included? Select all that apply. a. Globalization of the economy and society b. Slowdown in technology development c. Decreasing diversity d. Increasing complexity of patient care e. Changing demographics f. Shortages of key health care professionals and educators

a, d, e, f Trends to watch in health care delivery include globalization of the economy and society, increasing complexity of patient care, changing demographics, shortages of key health care professionals and educators, technology explosion, and increasing diversity.

A nurse is using the implementation step of the nursing process to provide care for patients in a busy hospital setting. Which nursing actions best represent this step? Select all that apply. a. The nurse carefully removes the bandages from a burn victim's arm. b. The nurse assesses a patient to check nutritional status. c. The nurse formulates a nursing diagnosis for a patient with epilepsy. d. The nurse turns a patient in bed every 2 hours to prevent pressure injuries. e. The nurse checks a patient's insurance coverage at the initial interview. f. The nurse checks for community resources for a patient with dementia.

a, d, f During the implementing step of the nursing process, nursing actions planned in the previous step are carried out. The purpose of implementation is to assist the patient in achieving valued health outcomes: promote health, prevent disease and illness, restore health, and facilitate coping with altered functioning

A nurse demonstrates QSEN competencies when she: (Select all that apply) a. Takes a patient's preferences regarding substituting a hamburger for fish and chips on Friday based on his religion b. Requests a consultation and assessment from the speech therapist when a patient is having difficulty swallowing after a stroke c. Delegates the recording of vital signs to a UAP of a patient who is stable, without pain, and preparing to discharge the following day d. Stays up to date with best practice regarding straight catheterization of a 80 year old male client with benign prostatic hyperplasia e. Documents in a timely, factual manner using only approved abbreviations f. Implements using a bed alarm for a confused 75 year old female client with an unsteady gate to prevent falls

a,b,c,d,e,f All of these demonstrate QSEN competencies: Patient-Centered Care, Teamwork and Collaboration/Quality Improvement, Safety/Evidence-Based Practices, Informatics

After assessing a patient who is recovering from a stroke in a rehabilitation facility, a nurse interprets and analyzes the patient data. Which of the four basic conclusions has the nurse reached when identifying the need to collect more data to confirm a diagnosis of situational low self-esteem? a. No problem b. Possible problem c. Actual nursing diagnosis d. Clinical problem other than nursing diagnosis

b

Care coordination is dedicated to meeting patient needs and preferences in the delivery of high-quality care and high-value care. Which of the following is NOT a component of care coordination? a. Patient Perspective b. Insurance Company Perspective c. Family Perspective d. System Representative Perspective e. Health care professional perspective

b

The mother of an 8-year-old boy tells the nurse that she is worried because she has found her son masturbating on occasion. She asks the nurse how she should "handle this problem." What would be the best response of the nurse to this mother's concern? a. "Children should be taught not to masturbate because most people believe self-stimulation is wrong." b. "Masturbation is a means of learning what a person prefers sexually, and overreacting to it can lead to the child thinking sex is bad or dirty." c. "There are serious health risks associated with frequent masturbation, and the practice should be discouraged in children." d. "Children who masturbate demonstrate sexual dysfunction and should be seen by a child psychologist."

b

The nursing process ensures that nurses are person centered rather than task centered. Rather than simply approaching a patient to take vital signs, the nurse thinks, "How is Mrs. Barclay today? Are our nursing actions helping her to achieve her goals? How can we better help her?" This demonstrates which characteristic of the nursing process? a. Systematic b. Interpersonal c. Dynamic d. Universally applicable in nursing situations

b

Which statement or question MOST exemplifies the role of the nurse in establishing a discharge plan for a patient who has had major abdominal surgery? a. "I'll bet you will be so glad to be home in your own bed." b. "What are your expectations for recovery from your surgery?" c. "Be sure to take your pain medications and change your dressing." d. "You will just be fine! Please stop worrying."

b

A nurse makes a clinical judgment that an African American man in a stressful job is more vulnerable to developing hypertension than a White man in the same or a similar situation. The nurse has formulated what type of nursing diagnosis? a. Actual b. Risk c. Possible d. Wellness

b A clinical judgment that an individual, family, or community is more vulnerable to develop the problem than others in the same or similar situation is a Risk nursing diagnosis.

A nurse is collecting more patient data to confirm a patient diagnosis of emphysema. This is an example of formulating what type of diagnosis? a. Actual b. Possible c. Risk d. Collaborative

b An intervention for a possible diagnosis is to collect more patient data to confirm or rule out the problem. An intervention for an actual diagnosis is to reduce or eliminate contributing factors to the diagnosis. Interventions for a risk diagnosis focus on reducing or eliminating risk factors, and interventions for collaborative problems focus on monitoring for changes in status and managing these changes with nurse- and physician-prescribed interventions.

A nurse is about to perform pin site care for a patient who has a halo traction device installed. What is the FIRST nursing action that should be taken prior to performing this care? a. Administer pain medication. b. Reassess the patient. c. Prepare the equipment. d. Explain the procedure to the patient.

b Before implementing any nursing action, the nurse should reassess the patient to determine whether the action is still needed. Then the nurse may collect the equipment, explain the procedure, and, if necessary, administer pain medications.

A nurse working in a long-term care facility incorporates aromatherapy into her practice. For which patient would this nurse use the herb ginger? a. A patient who has insomnia b. A patient who has nausea c. A patient who has dementia d. A patient who has migraine headaches

b Ginger/peppermint for nausea, lavender or chamomile for insomnia, bergamot/eucalyptus for stress relief

A nurse is using informatics technology to decide which patients may be at risk for readmission. What is the term for this type of analytic? a. Data visualization b. Predictive analytics c. Big data d. Data recall

b Health Care Analytics: Data Visualization: graphic/pictorial format to grasp difficult concepts, identify patterns/trends Predictive Data: statistics of current/historical facts to predict future/unknown outcomes Big Data: Data from various sources and new technology to predict consumer needs, operation costs, care delivery, genomics, equipment purchase, and allows the transformation of data to information to knowledge to wisdom

The nurse caring for families in a free health care clinic identifies psychosocial risk factors for altered family health. Which example describes one of these risk factors? a. The family does not have dental care insurance or resources to pay for it. b. Both parents work and leave a 12-year-old child to care for his younger brother. c. Both parents and their children are considerably overweight. d. The youngest member of the family has cerebral palsy and needs assistance from community services

b Inadequate childcare resources is a psychosocial risk factor. Not having access to dental care and obese family members are lifestyle risk factors. Having a family member with birth defects is a biologic risk factor.

A nurse working in a pediatric clinic provides codes for a patient's services to a third-party payer who pays all or most of the care. This is an example of what mode of health care payment? a. Out-of-pocket payment b. Individual private insurance c. Employer-based group private insurance d. Government financing

b Individual private insurance: members pay monthly, are called third-party payers Out-of-pocket payments mean individual themselves pay Employer-based private insurance means you pay your employer and they give you insurance Government financing means Medicare, Medicaid, and other federally funded programs

A new nurse manager at a small hospital is interested in achieving Magnet status. Which action would help the hospital to achieve this goal? a. Centralizing the decision-making process b. Promoting self-governance at the unit level c. Deterring professional autonomy to promote teamwork d. Promoting evidence-based practice over innovative nursing practice

b Magnet hospitals use a decentralized decision-making process, self-governance at the unit level, and respect for and acknowledgment of professional autonomy. In Magnet hospitals, 14 characteristics, the Forces of Magnetism, have been recognized that identify quality patient care, excellent nursing care, and innovations in professional nursing practice.

A nurse is documenting the care given to a patient diagnosed with an osteosarcoma, whose right leg was amputated. The nurse accidentally documents that a dressing changed was performed on the left leg. What would be the best action of the nurse to correct this documentation? a. Erase or use correcting fluid to completely delete the error. b. Mark the entry "mistaken entry"; add correct information; date and initial. c. Use a permanent marker to block out the mistaken entry and rewrite it. d. Remove the page with the error and rewrite the data on that page correctly.

b Never document an intervention before carrying it out, write "error", single line cross out, date, time, initial, addendum if needed

A nurse manager who is attempting to institute the SBAR process to communicate with health care providers and transfer patient information to other nurses is meeting staff resistance to the change. Which action would be most effective in approaching this resistance? a. Containing the anxiety in a small group and moving forward with the initiative b. Explaining the change and listing the advantages to the person and the organization c. Reprimanding those who oppose the new initiative and praising those who willingly accept the change d. Introducing the change quickly and involving the staff in the implementation of the change

b Overcoming resistance to change can be done by awareness, education, explanation of advantages, relation to values/beliefs, opportunities for communication and feedback, gradual introduction, encouragement of career growth, involving people, and incentives

A nurse is caring for patients in a primary care center. What is the most likely role of this nurse based on the setting? a. Assisting with major surgery b. Performing a health assessment c. Maintaining patients' function and independence d. Keeping student immunization records up to date

b Performing patient health assessments is a common role of the nurse in a primary care center. Assisting with major surgery is a role of the nurse in the hospital setting. Maintaining patients' function and independence is a role of the nurse in an extended-care facility, and keeping student immunization records up to date is a role of the school nurse.

A home health care nurse is using the steps of the SDLC, to design a new system for home health care documentation. The nurse analyzes the old system and develops plans for the new system. What is the next step of the nurse in this process? a. Test b. Design c. Implement d. Evaluate

b SDLC refers to nursing informatics, system development lifecycle: (1) Analyze (2) Plan (3) Design (4) Build (5) Test (6) Train (7) Implement (8) Maintain (9) Evaluate

Nurses use the NIC Taxonomy structure as a resource when planning nursing care for patients. What information is found in this structure? a. Case studies illustrating a complete set of activities that a nurse performs to carry out nursing interventions b. Nursing interventions, each with a label, a definition, and a set of activities that a nurse performs to carry it out, with a short list of background readings c. A complete list of nursing diagnoses, outcomes, and related nursing activities for each nursing intervention d. A complete list of reimbursable charges for each nursing intervention

b The NIC Taxonomy lists nursing interventions, each with a label, a definition, a set of activities that a nurse performs to carry it out, and a short list of background readings. It does not contain case studies, diagnoses, or charges.

A nurse assesses a patient and formulates the following nursing diagnosis: Risk for Impaired Skin Integrity related to prescribed bed rest as evidenced by reddened areas of skin on the heels and back. Which phrase represents the etiology of this diagnostic statement? a. Risk for Impaired Skin Integrity b. Related to prescribed bed rest c. As evidenced by d. As evidenced by reddened areas of skin on the heels and back

b The etiology identifies the contributing or causative factors of the problem. "Risk for Impaired Skin Integrity" is the problem, and "as evidenced by reddened areas of skin on the heels and back" are the defining characteristics of the problem.

A friend of a nurse calls and tells the nurse that his girlfriend's father was just admitted to the hospital as a patient, and he wants the nurse to provide information about the man's condition. The friend states, "Sue seems unusually worried about her dad, but she won't talk to me and I want to be able to help her." What is the best initial response the nurse should make? a. "You shouldn't be asking me to do this. I could be fined or even lose my job for disclosing this information." b. "Sorry, but I'm not able to give information about patients to the public—even when my best friend or a family member asks." c. "Because of HIPAA, you shouldn't be asking for this information unless the patient has authorized you to receive it! This could get you in trouble!" d. "Why do you think Sue isn't talking about her worries?"

b The nurse should immediately clarify what he or she can and cannot do. Since the primary reason for refusing to help is linked to the responsibility to protect patient privacy and confidentiality, the nurse should not begin by mentioning the real penalties linked to abuses of privacy. Finally, it is appropriate to ask about Sue and her worries, but this should be done after the nurse clarifies what he or she is able to do.

After one nursing unit with an excellent safety record meets to review the findings of the audit, the nurse manager states, "We're doing well, but we can do better! Who's got an idea to foster increased patient well-being and satisfaction?" This is an example of leadership that values: a. Quality assurance b. Quality improvement c. Process evaluation d. Outcome evaluation

b Unlike quality assurance, quality improvement is internally driven, focuses on patient care rather than organizational structure, focuses on processes rather than people, and has no end points. Its goal is improving quality rather than assuring quality. Process evaluation and outcome evaluation are types of quality-assurance programs.

When may a health institution release a PHI for purposes other than treatment, payment, and routine health care operations, without the patient's signed authorization? Select all that apply. a. News media are preparing a report on the condition of a patient who is a public figure. b. Data are needed for the tracking and notification of disease outbreaks. c. Protected health information is needed by a coroner. d. Child abuse and neglect are suspected. e. Protected health information is needed to facilitate organ donation. f. The sister of a patient with Alzheimer's disease wants to help provide care.

b, c, d, e According to the HIPAA, a health institution is not required to obtain written patient authorization to release PHI for tracking disease outbreaks, infection control, statistics related to dangerous problems with drugs or medical equipment, investigation and prosecution of a crime, identification of victims of crimes or disaster, reporting incidents of child abuse, neglect or domestic violence, medical records released according to a valid subpoena, PHI needed by coroners, medical examiners, and funeral directors, PHI provided to law enforcement in the case of a death from a potential crime, or facilitating organ donations. Under no circumstance can a nurse provide information to a news reporter without the patient's express authorization. An authorization form is still needed to provide PHI for a patient who has Alzheimer's disease.

A nurse uses critical thinking skills to focus on the care plan of an older adult who has dementia and needs placement in a long-term care facility. Which statements describe characteristics of this type of critical thinking applied to clinical reasoning? Select all that apply. a. It functions independently of nursing standards, ethics, and state practice acts. b. It is based on the principles of the nursing process, problem solving, and the scientific method. c. It is driven by patient, family, and community needs as well as nurses' needs to give competent, efficient care. d. It is not designed to compensate for problems created by human nature, such as medication errors. e. It is constantly re-evaluating, self-correcting, and striving for improvement. f. It focuses on the big picture rather than identifying the key problems, issues, and risks involved with patient care.

b, c, e Critical thinking applied to clinical reasoning and judgment in nursing practice is guided by standards, policies and procedures, and ethics codes. It is based on principles of nursing process, problem solving, and the scientific method. It carefully identifies the key problems, issues, and risks involved, and is driven by patient, family, and community needs, as well as nurses' needs to give competent, efficient care. It also calls for strategies that make the most of human potential and compensate for problems created by human nature. It is constantly re-evaluating, self-correcting, and striving to improve

A nurse is providing health checkups for patients in a clinic located in a predominately LGBT community. Which health disparities should the nurse keep in mind related to this population? Select all that apply. a. LGBT youth are four times more likely to attempt suicide. b. LGBT youth are more likely to be homeless. c. Lesbians are less likely to get preventive services for cancer. d. Lesbians and bisexual females are more likely to be underweight. e. Transgender people have a high prevalence of HIV and sexually transmitted infections. f. LGBT populations have the lowest rates of tobacco, alcohol, and other drug use in the country.

b, c, e LGBT youth are two to three times more likely to attempt suicide. Lesbians and bisexual females are more likely to be overweight or obese. LGBT populations have the highest rates of tobacco, alcohol, and other drug use in the country. These health issues are partly thought to be the effects of chronic stress resulting from stigmatization.

An RN working on a busy hospital unit delegates patient care to UAPs. Which patient care could the nurse most likely delegate to a UAP safely? Select all that apply. a. Performing the initial patient assessments b. Making patient beds c. Giving patients bed baths d. Administering patient medications e. Ambulating patients f. Assisting patients with meals

b, c, e, f Performing the initial patient assessment and administering medications are the responsibility of the RN. In most cases, patient hygiene, bed-making, ambulating patients, and helping to feed patients can be delegated to a UAP.

A nurse is caring for a patient who presents with labored respirations, productive cough, and fever. What would be appropriate nursing diagnoses for this patient? Select all that apply. a. Bronchial pneumonia b. Impaired gas exchange c. Ineffective airway clearance d. Potential complication: sepsis e. Infection related to pneumonia f. Risk for septic shock

b, c, f

A nurse is providing health care to patients in a health care facility. Which of these patients are receiving secondary health care? Select all that apply. a. A patient enters a community clinic with signs of strep throat. b. A patient is admitted to the hospital following a myocardial infarction. c. A mother brings her son to the emergency department following a seizure. d. A patient with osteogenesis imperfecta is being treated in a medical center. e. A mother brings her son to a specialist to correct a congenital heart defect. f. A woman has a hernia repair in an ambulatory care center.

b, c, f Secondary health care treats problems that require specialized clinical expertise, such as an MI, a seizure, and a hernia repair. Treating strep throat is primary health care. Tertiary health care involves management of rare and complex disorders that require a subspecialist, such as osteogenesis imperfecta and congenital heart malformations.

A nurse on a busy surgical unit relies on informal planning to provide appropriate nursing responses to patients in a timely manner. What are examples of this type of planning? Select all that apply. a. A nurse sits down with a patient and prioritizes existing diagnoses. b. A nurse assesses a woman for postpartum depression during routine care. c. A nurse plans interventions for a patient who is diagnosed with epilepsy. d. A busy nurse takes time to speak to a patient who received bad news. e. A nurse reassesses a patient whose PRN pain medication is not working. f. A nurse coordinates the home care of a patient being discharged.

b, d, e Informal planning is a link between identifying a patient's strength or problem and providing an appropriate nursing response. This occurs, for example, when a busy nurse first recognizes postpartum depression in a patient, takes time to assess a patient who received bad news about tests, or reassesses a patient for pain. Formal planning involves prioritizing diagnoses, formally planning interventions, and coordinating the home care of a patient being discharged.

A nurse works for a health care provider who practices the naturopathic system of medicine. What is the focus of nursing actions based on this type of medical practice? Select all that apply. a. Treating the symptoms of the disease b. Providing patient education c. Focusing on treating individual body systems d. Making appropriate interventions to prevent illness e. Believing in the healing power of nature f. Encouraging patients to take responsibility for their own health

b, d, e, f Naturopathic medicine emphasizes pt responsibility, education, health maintenance, and disease preventing, minimizing harmful side effects, avoiding suppression of symptoms, treating the person as a whole, the healing power of nature, and treating the cause of an illness or disease rather than its symptoms

A nurse who is a discharge planner in a large metropolitan hospital is preparing a discharge plan for a patient after a kidney transplant. Which actions would this nurse typically perform to ensure continuity of care as the patient moves from acute care to home care? Select all that apply. a. Performing an admission health assessment b. Evaluating the nursing plan for effectiveness of care c. Participating in the transfer of the patient to the postoperative care unit d. Making referrals to appropriate facilities e. Maintaining records of patient satisfaction with services f. Assessing the strengths and limitations of the patient and family

b, d, f Although in smaller facilities a discharge planner may perform an admission health assessment and assist with patient transfers, it is not the usual job of the discharge planner. In most facilities, maintaining records of patient satisfaction is the role of the public relations manager or office manager.

A registered nurse is writing a diagnosis for a patient who is in traction because of multiple fractures from a motor vehicle accident. Which nursing actions are related to this step in the nursing process? Select all that apply. a. The nurse uses the nursing interview to collect patient data. b. The nurse analyzes data collected in the nursing assessment. c. The nurse develops a care plan for the patient. d. The nurse points out the patient's strengths. e. The nurse assesses the patient's mental status. d. The nurse identifies community resources to help his family cope.

b, d, f The purposes of diagnosing are to identify how an individual, group, or community responds to actual or potential health and life processes; identify factors that contribute to or cause health problems (etiologies); and identify resources or strengths the individual, group, or community can draw on to prevent or resolve problems. In the diagnosing step of the nursing process, the nurse interprets and analyzes data gathered from the nursing assessment, identifies patient strengths, and identifies resources the patient can use to resolve problems. The nurse assesses and collects patient data in the assessment step and develops a care plan in the planning step of the nursing process.

A nurse working in a primary care facility assesses patients who are experiencing various levels of health and illness. Which statements define these two concepts? Select all that apply. a. Health and illness are the same for all people. b. Health and illness are individually defined by each person. c. People with acute illnesses are actually healthy. d. People with chronic illnesses have poor health beliefs. e. Health is more than the absence of illness. f. Illness is the response of a person to a disease.

b, e, f

Thoughtful practice is person and patient-centered, considerate, and compassionate nursing care. When a nurse engages in evaluation of outcomes for the purpose of personal learning, which component of thoughtful practice is he/she participating in? a. The nurse's personal attributes, knowledge base, and clinical expertise b. Reflective Practice c. Clinical reasoning d.. The nursing process (ADPIE)

b.

A hospice nurse is caring for a patient who is dying of pancreatic cancer. The patient tells the nurse "I feel no connection to God" and "I'm worried that I find no real meaning in life." What would be the nurse's best response to this patient? a. Give the patient a hug and tell him that his life still has meaning. b. Arrange for a spiritual adviser to visit the patient. c. Ask if the patient would like to talk about his feelings. d. Call in a close friend or relative to talk to the patient.

c

A nurse is guiding a patient in the practice of meditation. Which teaching point is most useful in helping the patient to achieve a state of calmness, physical relaxation, and psychological balance? a. Teach the patient to always lie down in a comfortable position during meditation. b. Teach the patient to focus on multiple problems that the patient feels demand attention. c. Teach the patient to let distractions come and go naturally without judging them. d. Teach the patient to suppress distracting or wandering thoughts to maintain focus.

c

A nurse is performing spirituality assessments of patients living in a long-term care facility. What is the best question the nurse might use to assess for spiritual needs? a. Can you describe your usual spiritual practices and how you maintain them daily? b. Are your spiritual beliefs causing you any concern? c. How can I and the other nurses help you maintain your spiritual practices? d. How do your religious beliefs help you to feel at peace?

c

A nurse is preparing an infant and his family for a hernia repair to be performed in an ambulatory care facility. What is the primary role of the nurse during the admission process? a. To assist with screening tests b. To provide patient teaching c. To assess what has been done and what still needs to be done d. To assist with hernia repair

c

A nurse is providing a lecture on complimentary and alternative treatments (CATs) to a group of patients in a rehabilitation facility. Which teaching point should the nurse include? a. CATs are safe interventions used to supplement traditional care. b. Many patients use CAT as outpatients but do not wish to continue as inpatients. c. Many nurses are expanding their clinical practice by incorporating CAT to meet the demands of patients. d. Most complementary and alternative therapies are relatively new and their efficacy has not been established.

c

A nurse who is caring for patients on a pediatric ward is assessing the children for their spiritual needs. Which is the most important source of learning for a child's own spirituality? a. The child's church or religious organization b. What parents say about God and religion c. How parents behave in relationship to one another, their children, others, and to God d. The spiritual adviser for the family

c

A nurse who was raised as a strict Roman Catholic but who is no longer a practicing Catholic stated she couldn't assist patients with their spiritual distress because she recognizes only a "field power" in each person. She said, "My parents and I hardly talk because I've deserted my faith. Sometimes I feel real isolated from them and also from God—if there is a God." Analysis of these data reveals which unmet spiritual need? a. Need for meaning and purpose b. Need for forgiveness c. Need for love and relatedness d. Need for strength for everyday living

c

A patient is being treated on a surgical unit for an open fracture of the right lower extremity, after sustaining the injury in a motor vehicle accident. The patient is informed by a family member that his elderly father is ill. The patient requests to leave the hospital. The patient's nurse notifies the healthcare provider who advises the patient against disrupting his treatment due to the risk of infection and impairment in mobility. The patient decides to leave the hospital: a. By elopement b. Discharged successfully c. Against Medical Advice (AMA) d. The patient cannot legally leave the hospital due to incapacity

c

A patient with sickle cell anemia lives 20 miles away from the nearest medical center and relies solely on public transportation to receive health care. As a result, the patient has been hospitalized several times in the past year with sickle cell crises. The nurse caring for the patient during her recent hospitalization is revising a care plan to reflect which important issue: a. Sickle cell anemia b. Transfusion reactions c. Accessibility to health care d. Daily supplementation of iron and vitamin C

c

A resident who is called to see a patient in the middle of the night is leaving the unit but then remembers that he forgot to write a new order for a pain medication a nurse had requested for another patient. Tired and already being paged to another unit, he verbally tells the nurse the order and asks the nurse to document it on the health care provider's order sheet. What is the nurse's BEST response? a. State: "Thank you for taking care of this! I'll be happy to document the order on the health care provider's order sheet." b. Get a second nurse to listen to the order, and after writing the order on the health care provider order sheet, have both nurses sign it. c. State: "I am sorry, but VOs can only be given in an emergency situation that prevents us from writing them out. I'll bring the chart and we can do this quickly." d. Try calling another resident for the order or wait until the next shift

c

Just cultures are work environments that encourage the reporting of errors so that systems can investigate errors fairly and justly without immediately subscribing blame. All of the following are types of behaviors contributing to errors in healthcare except: a. Human error b. Reckless behavior c. Medical negligence d. At-risk behavior

c

Nurses test new technology in phases. In which phase would the nurse "test drive" the new system? a. Unit b. Function c. User acceptance d. Integration

c

The community health nurse would recognize the following to be a risk factor for altered family health by observing this in an identified family member: a. A mother assisting her 10 year old son with homework b. A 27 year old pregnant woman discussing her last prenatal care appointment c. A 77 year old woman who has inadequate dental care d. A 44 year old man who regularly eats fruits and vegetables

c

The nurse is providing care to a patient 4-hours post-operative an abdominal hysterectomy. What is a nursing diagnosis that this patient would likely require? a. Disturbed body image related to loss of a body organ associated with female reproduction b. Imbalanced nutrition, less than body requirements related to having had nothing to eat or drink prior to surgery c. Pain related to abdominal surgery to remove the uterus d. Fluid volume deficit related to blood loss during surgery

c

The nurse practices using critical thinking indicators (CTIs) when caring for patients in the hospital setting. The best description of CTIs is: a. Evidence-based descriptions of behaviors that demonstrate the knowledge that promotes critical thinking in clinical practice b. Evidence-based descriptions of behaviors that demonstrate the knowledge and skills that promote critical thinking in clinical practice c. Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practice d. Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, standards, and skills that promote critical thinking in clinical practice

c

A nurse is using a concept map care plan to devise interventions for a patient with sickle cell anemia. What is the BEST description of the "concepts" that are being diagrammed in this plan? a. Protocols for treating the patient problem b. Standardized treatment guidelines c. The nurse's ideas about the patient problem and treatment d. Clinical pathways for the treatment of sickle cell anemia

c A concept map care plan is a diagram of patient problems and interventions. The nurse's ideas about patient problems and treatments are the "concepts" that are diagrammed. These maps are used to organize patient data, analyze relationships in the data, and enable the nurse to take a holistic view of the patient's situation. Answers (a) and (b) are incomplete because the concepts being diagrammed may include protocols and standardized treatment guidelines but the patient problems are also diagrammed concepts. Clinical pathways are tools used in case management to communicate the standardized, interdisciplinary care plan for patients.

A nurse writes the following outcome for a patient who is trying to stop smoking: "The patient values a healthy body sufficiently to stop smoking." This is an example of what type of outcome? a. Cognitive b. Psychomotor c. Affective d. Physical changes

c Affective outcomes pertain to changes in patient values, beliefs, and attitudes. Cognitive outcomes involve increases in patient knowledge; psychomotor outcomes describe the patient's achievement of new skills; physical changes are actual bodily changes in the patient (e.g., weight loss, increased muscle tone).

A nurse is using information from informatics technology that is synthesized so that relationships between lung cancer diagnoses and smoking are identified. What part of "DIKW" does this represent? a. Data b. Information c. Knowledge d. Wisdom

c Data: discrete entities are described without interpretation Information: Data is interpreted, organized, or structured Knowledge: Information is synthesized so that relationships are identified and live-time system communications Wisdom: Appropriate use of knowledge (nursing knowledge too) and ongoing development to manage and solve human problems

A nurse is caring for a confused elderly client brought to the emergency room by her husband who reports that his wife is "not normally like this, she was fine when we went to bed last night, but when she came into the kitchen this morning, she couldn't find any of the cutlery to make breakfast, poured orange juice in her cereal, and then just started rifling through the cabinets, but she wouldn't tell me what she was looking for." Based on this clients presentation, the nurse suspects what diagnosis? a. Dementia b. Depression c. Delirium d. Urinary incontinence

c Dementia- Chronic and progressive cognitive decline. Example is Alzheimer's Disease. ---Sundowning Syndrome occurs when dementia patient becomes agitated, confused, and restless after dark. Downward decline in the patient with dementia is called cascade iatrogenesis Delirium- Temporary state of confusion, an acute illness that can last from hours to several days. Causes can be infection (i.e. UTIs), drug interactions or metabolic problems, poly pharmacy. RNs, use reality orientation to redirect patient to reality

A nurse is interviewing a 42-year-old patient who is visiting an internist for a blood pressure screening. The patient states: "I'm currently a sales associate, but I'm considering a different career and I'm a little anxious about the process." According to Levinson, what phase of adult life is this patient experiencing? a. Entering the adult world b. Settling down c. Midlife transition d. Entering middle-adulthood

c Entering the adult world: ages 22-28, building on previous decisions and choices Settling Down: ages 33-40, investing energy into areas of life that are most personally important Midlife Transition: ages 4-45, reappraisal of goals and values, anxiety, fear Entering Middle-Adulthoo: ages 45-50, choices have been made, a new life structure has been formed, and a commitment to new tasks

Which of the following statements is accurate? a. Genomics alone is the basis for precision medicine b. Genetics scrutinizes the functioning and composition of an individual's genetic makeup as a whole and determines relationships amongst them c. Genomics if the study of genomic information about a person, used for their clinical care for diagnosis and/or therapeutic decision-making d. Pharmacogenomics uses a person's genetic makeup to choose drugs that are likely to work for that particular individual, but is not yet able to determine drug doses most likely to be effective for an individual.

c Genetics scrutinizes functioning and composition of a single gene. Pharmacogenetics is used to choose drugs and doses that are likely to work for a particular person. Genomics if the study of genomic information about a person, used for their clinical care for diagnosis and/or therapeutic decision-making. All of these in combination are the basis for precision medicine.

Mr. Brown's teenage daughter had been involved in shoplifting. He expresses much anger toward her and states he cannot face her, let alone discuss this with her: "I just will not tolerate a thief." Which nursing intervention would the nurse take to assist Mr. Brown with his deficit in forgiveness? a. Assure Mr. Brown that many parents feel the same way. b. Reassure Mr. Brown that many teenagers go through this kind of rebellion and that it will pass. c. Assist Mr. Brown to identify how unforgiving feelings toward others hurt the person who cannot forgive. d. Ask Mr. Brown if he is sure he has spent sufficient time with his daughter.

c Helping Mr. Brown identify how his unforgiving feelings may be harmful to him is the only nursing intervention that directly addresses his unmet spiritual need concerning forgiveness. Assuring Mr. Brown that many parents would feel the same way or that many teenagers shoplift out of rebelliousness may make him feel better initially, but neither option addresses his need to forgive. Suggesting that Mr. Brown may not have spent enough time with his daughter is likely to make him feel guilty.

A nurse who is working with women in a drop-in shelter studies Carol Gilligan's theory of morality in women to use when planning care. According to Gilligan, what is the motivation for female morality? a. Law and justice b. Obligations and rights c. Response and care d. Order and selfishness

c In Gilligan's theory, men and women have different ways of looking at the world. Men are more likely to associate morality with obligations, rights, and justice, whereas women are more likely to see moral requirements emerging from the needs of others within the context of a relationship. This moral orientation of women is called the ethic of care, which develops through three levels: Level 1—Preconventional: Selfishness, Level 2—Conventional: Goodness, Level 3—Postconventional: Nonviolence.

An RN on a surgical unit is behind schedule administering medications. Which of the RN's other tasks can be safely delegated to a UAP? a. The assessment of a patient who has just arrived on the unit b. Teaching a patient with newly diagnosed diabetes about foot care c. Documentation of a patient's I & O on the flow chart d. Helping a patient who has recently undergone surgery out of bed for the first time

c Nurses CAN'T delegate assessment, discharge planning, teaching, care planning, triage, interpretation of pt data, care of invasive lines, admin of parenteral meds Nurses CAN delegate bathing, grooming, ambulation, feeding, v/s, I&Os, weights, simple dressing changes, transfers, and postmortem care

The nurse is helping a patient turn in bed and notices the patient's heels are red. The nurse places the patient on precautions for skin breakdown. This is an example of what type of planning? a. Initial planning b. Standardized planning c. Ongoing planning d. Discharge planning

c Ongoing planning is problem oriented and has as its purpose keeping the plan up to date as new actual or potential problems are identified. Initial planning addresses each problem listed in the prioritized nursing diagnoses and identifies appropriate patient goals and the related nursing care. Standardized care plans are prepared care plans that identify the nursing diagnoses, outcomes, and related nursing interventions common to a specific population or health problem. During discharge planning, the nurse uses teaching and counseling skills effectively to help the patient and family develop sufficient knowledge of the health problem and the therapeutic regimen to carry out necessary self-care behaviors competently at home.

A nurse working in an emergency department assesses how patients' religious beliefs affect their treatment plan. With which patient would the nurse be most likely to encounter resistance to emergency lifesaving surgery? a. A patient of the Adventist faith b. A patient who practices Buddhism c. A patient who is a Jehovah's Witness d. A patient who is an Orthodox Jew

c Patients who practice the Jehovah's Witness faith believe blood transfusions violate God's laws and do not allow them. The other religious groups do not restrict modern lifesaving treatment for their members.

A nurse is caring for a patient who has complications related to type 2 diabetes mellitus. The nurse researches new procedures to care for foot ulcers when developing a care plan for this patient. Which QSEN competency does this action represent? a. Patient-centered care b. Evidence-based practice c. Quality improvement d. Informatics

c Quality Improvement: routinely updating nursing policies and procedures Pt-Centered Care: listening, respect, compassion EBP: adhering to internal policies and standardized skills Informatics: info and technology to communicate, manage knowledge, document, support decision making

An 18-year-old presents at a women's health care clinic seeking oral contraceptives for the first time. She tells the nurse that she wants to have sex with her boyfriend, but doesn't know what to expect. Which statement by the nurse is not accurate? a. "Vaginal intercourse is most commonly performed in the missionary position." b. "The side-by-side position achieves better clitoral stimulation than the missionary position." c. "Achieving simultaneous orgasms is the goal of vaginal intercourse." d. "The period after coitus is just as significant as the events leading up to it."

c Simultaneous orgasms, or both people attaining orgasm at the same moment, are difficult to achieve, and a preoccupation with attaining simultaneous orgasms might disrupt the ultimate intimacy and satisfaction possible during coitus.

A female patient who is receiving chemotherapy for breast cancer tells the nurse, "The treatment for this cancer is worse than the disease itself. I'm not going to come for my therapy anymore." The nurse responds by using critical thinking skills to address this patient problem. Which action is the first step the nurse would take in this process? a. The nurse judges whether the patient database is adequate to address the problem. b. The nurse considers whether or not to suggest a counseling session for the patient. c. The nurse reassesses the patient and decides how best to intervene in her care. d. The nurse identifies several options for intervening in the patient's care and critiques the merit of each option.

c Step 1 of critical thinking: identify the purpose or goal of your thinking-Reassessing the pt helps to direct thinking toward the goal/problem identification Step 2: once the problem is identified, the nurse judges the adequacy of the knowledge, identifies potential problems, uses resources, and critiques the decision

A nurse is teaching a 50-year-old male patient how to care for his new ostomy appliance. Which teaching aid would be most appropriate to confirm that the patient has learned the information? a. Ask Me 3 b. Newest Vital Sign (NVS) c. Teach-back method d. TEACH acronym

c Teach-back: assesses literacy, confirms understanding Ask Me 3: to promote understanding and improve communication b/t pt and providers NVS: screening tool to assess low health literacy to improve communication b/t pt and providers TEACH: to maximize effectiveness of teaching- Tuning into the pt, Editing pt info, Acting on every teaching moment, Clarifying often, Honoring the pt as a partner in the process

A nurse cares for dying patients by providing physical, psychological, social, and spiritual care for the patients, their families, and other loved ones. What type of care is the nurse providing? a. Respite care b. Palliative care c. Hospice care d. Extended care

c The hospice nurse combines the skills of the home care nurse with the ability to provide daily emotional support to dying patients and their families. Palliative care, which can be used in conjunction with medical treatment and in all types of health care settings, is focused on the relief of physical, mental, and spiritual distress. Extended-care facilities include transitional subacute care, assisted-living facilities, intermediate and long-term care, homes for medically fragile children, retirement centers, and residential institutions for mentally and developmentally or physically disabled patients of all ages.

A new RN is being oriented to a nursing unit that is currently understaffed and is told that the UAPs have been trained to obtain the initial nursing assessment. What is the best response of the new RN? a. Allow the UAPs to do the admission assessment and report the findings to the RN. b. Do his or her own admission assessments but don't interfere with the practice if other professional RNs seem comfortable with the practice. c. Tell the charge nurse that he or she chooses not to delegate the admission assessment until further clarification is received from administration. d. Contact his or her labor representative to report this practice to the state board of nursing.

c The nurse should not delegate this nursing admission assessment because only nurses can perform this intervention. The nurse should seek clarification for this policy from the nursing administration.

A man who is a declared agnostic is extremely depressed after losing his home, his wife, and his children in a fire. His nursing diagnosis is Spiritual Distress: Spiritual Pain related to inability to find meaning and purpose in his current condition. What is the most important nursing intervention to plan? a. Ask the patient which spiritual adviser he would like you to call. b. Recommend that the patient read spiritual biographies or religious books. c. Explore with the patient what, in addition to his family, has given his life meaning and purpose in the past. d. Introduce the belief that God is a loving and personal God.

c The nursing intervention of exploring with the patient what, in addition to his family, has given his life meaning and purpose in the past is more likely to correct the etiology of his problem, Spiritual Pain, than any of the other nursing interventions listed.

A patient tells the nurse counselor that he can only get sexual pleasure by looking at the body of a person other than his wife from a distance. How would the nurse document this data? a. Masochism b. Pedophilia c. Voyeurism d. Sadism

c Voyeurism is the achievement of sexual arousal by looking at the body of someone other than a person's own sexual partner. Masochism refers to gaining sexual pleasure from the humiliation of being abused. Pedophilia is a term used to describe the practice of adults gaining sexual fulfillment by performing sexual acts with children. Sadism refers to the practice of gaining sexual pleasure while inflicting abuse on another person.

A nurse develops a detailed care plan for a 16-year-old patient who is a new single mother of a premature infant. The plan includes collaborative care measures and home health care visits. When presented with the plan, the patient states, "We will be fine on our own. I don't need any more care." What would be the nurse's best response? a. "You know your personal situation better than I do, so I will respect your wishes." b. "If you don't accept these services, your baby's health will suffer." c. "Let's take a look at the plan again and see if we can adjust it to fit your needs." d. "I'm going to assign your case to a social worker who can explain the services better."

c When a patient does not follow the care plan despite your best efforts, it is time to reassess strategy. The first objective is to identify why the patient is not following the therapy. If the nurse determines, however, that the care plan is adequate, the nurse must identify and remedy the factors contributing to the patient's noncompliance.

A home health care nurse is scheduled to visit a 38-year-old woman who has been discharged from the hospital with a new colostomy. Which duties would the nurse perform for this patient in the entry phase of the home visit? Select all that apply. a. Collect information about the patient's diagnosis, surgery, and treatments. b. Call the patient to make initial contact and schedule a visit. c. Develop rapport with the patient and her family. d. Assess the patient to identify her needs. e. Assess the physical environment of the home. f. Evaluate safety issues including the neighborhood in which she lives.

c, d, e Pre-Entry Phase: makes initial phone call, collects info, assess pt's environment for safety issues Entry Phase: develops rapport, makes assessments, develops nursing dxs, establishes desired outcomes, plans, implements, teaches

A nurse is documenting patient data in the medical record of a patient admitted to the hospital with appendicitis. The health care provider has ordered 10-mg morphine IV every 3 to 4 hours. Which examples of documentation of care for this patient follow recommended guidelines? Select all that apply. a. 6/12/20 0945 Morphine 10 mg administered IV. Patient's response to pain appears to be exaggerated. M. Patrick, RN b. 6/12/20 0945 Morphine 10 mg administered IV. Patient seems to be comfortable. M. Patrick, RN c. 6/12/20 0945 30 minutes following administration of morphine 10 mg IV, patient reports pain as 2 on a scale of 1 to 10. M. Patrick, RN d. 6/12/20 0945 Patient reports severe pain in right lower quadrant. M. Patrick, RN e. 6/12/20 0945 Morphine IV 10 mg will be administered to patient every 3 to 4 hours. M. Patrick, RN f. 6/12/20 0945 Patient states she does not want pain medication despite return of pain. After discussing situation, patient agrees to medication administration. M. Patrick, RN

c, d, f Documentation needs to be complete, accurate, concise, current, and written in a factual manner

A nurse performs nurse-initiated nursing actions when caring for patients in a skilled nursing facility. Which are examples of these types of interventions? Select all that apply. a. A nurse administers 500 mg of ciprofloxacin to a patient with pneumonia. b. A nurse consults with a psychiatrist for a patient who abuses pain killers. c. A nurse checks the skin of bedridden patients for skin breakdown. d. A nurse orders a kosher meal for an orthodox Jewish patient. e. A nurse records the I&O of a patient as prescribed by his health care provider. f. A nurse prepares a patient for minor surgery according to facility protocol.

c, d, f Nurse-initiated interventions, or independent nursing actions, involve carrying out nurse-prescribed interventions resulting from their assessment of patient needs written on the nursing care plan, as well as any other actions that nurses initiate without the direction or supervision of another health care professional. Protocols and standard orders empower the nurse to initiate actions that ordinarily require the order or supervision of a health care provider. Consulting with a psychiatrist is a collaborative intervention.

A nurse designing a new EHR system for a pediatric office follows usability concepts in system design. Which concepts are recommended in system design? Select all that apply. a. Users should not explore with forgiveness for unintended consequences. b. Shortcuts for frequent users should not be incorporated into the system. c. Content emphasis should be on information needed for decision making. d. The less times users need to apply prior experience to a new system the better. e. All the information needed should be presented to reduce cognitive load. f. The number of steps it takes to complete tasks should be minimized

c, e, f

Nursing students are reviewing information about health care delivery systems in preparation for a quiz the next day. Which statements describe current U.S. health care delivery practices? Select all that apply. a. Access to care depends only on the ability to pay, not the availability of services. b. The Patient Protection and Affordable Care Act provides private health care insurance to underserved populations. c. Every health insurance plan in the Health Insurance Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. d. The uninsured pay for more than one third of their care out of pocket and are usually charged lower amounts for their care than the insured pay. e. Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do. f. Quality of care can be defined as the right care for the right person at the right time.

c, e, f Health Insurance Marketplace: helps people more easily find insurance that fits their budge, every plan offers comprehensive coverage Access to care depends on ability to pay and availability of services in the US, PPACA provides Medicaid or subsidized coverage to qualifying people with incomes up to 400% of poverty; the uninsured pay for more than 1/3 of their care out of pocket and are often charged more than those who are insured

Which of the following actions by the student nurse indicates a need for further teaching in the adaptation of the nursing process for the older adult? a. Leaning forward when interviewing the older adult to demonstrate attention and that they are listening to what the patient is saying b. Smiling to demonstrate that the student nurse is relaxed and warm c. Avoiding direct eye gaze to demonstrate respect for the older adult from the younger student nurse d. Nodding affirmatively to show the patient the student nurse is listening actively and focused on the content of the conversation

c. Although in some cultures, direct eye contact is avoided as a sign of respect, in this case, direct eye gaze to the patient allows for clarification of information, that the student nurse is interested in what is being said by the patient, and shows a readiness to start and engage in a conversation

The stages of change model is often integrated into nursing practice for determination of a client's readiness and willingness to implement health-related behavioral change and incorporates all of the following EXCEPT: a. Precontemplation, a patient is unaware or unwilling to change a behavior b. Contemplation, a patient is aware of the problem, but is unwilling to change a behavior c. Preparation, a patient intends to take action to change a behavior d. Action, a patient participates in active modification of a behavior e. Maintenance, a patient works to sustain the behavioral change f. Relapse, a patient falls back into old patterns of behavior

c. Contemplation, a patient is aware of the problem, but there is no commitment to action to make the desired behavioral change

A nurse is discharging a patient from the hospital following a heart stent procedure. The patient asks to see and copy his medical record. What is the nurse's best response? a. "I'm sorry, but patients are not allowed to copy their medical records." b. "I can make a copy of your record for you right now." c. "You can read your record while you are still a patient, but copying records is not permitted according to HIPAA rules." d. "I will need to check with our records department to get you a copy."

d

A nurse is teaching patients about contraception methods. Which statement by a patient indicates a need for further teaching? a. "Depo-Provera is not effective against sexually transmitted infections, but contraceptive protection is immediate if I get the injection on the first day of my period." b. "The hormonal ring contraceptive, NuvaRing, protects against pregnancy by suppressing ovulation, thickening cervical mucus, and preventing the fertilized egg from implanting in the uterus." c. "Abstinence is an effective method of contraception and may be used as a periodic or continuous strategy to prevent pregnancy and STIs." d. "Withdrawal is an effective method of birth control as well as an effective method of reducing the spread of sexually transmitted infections."

d

A nurse notices that a coworker, a nurse anesthesiologist, takes restroom breaks frequently and seems to always return to the floor with with more energy, almost as though he is euphoric. A few weeks later, the nurse asks a different coworker to waste 10mg of ketamine with him and they discover that the nurse anesthesiologist has wasted small amounts of ketamine daily for the last 2 weeks, however, the supply of ketamine does not match the documentation of what should be remaining. In this type of situation, what is the nurse's best course of action? a. The nurses should agree to keep their suspicions about their coworker to themselves because they do not want to get him into trouble b. The nurse should begin to work support groups and options regarding substance abuse treatment into conversations with his coworker c. The nurse should call the police because theft and possession of drugs is a criminal offense d. The nurse should privately report his suspicions to his nurse manager about his colleague to keep patients safe

d

A patient whose last name is Goldstein was served a kosher meal ordered from a restaurant on a paper plate because the hospital made no provision for kosher food or dishes. Mr. Goldstein became angry and accused the nurse of insulting him: "I want to eat what everyone else does—and give me decent dishes." Analysis of these data reveals what finding? a. The nurse should have ordered kosher dishes also. b. The staff must have behaved condescendingly or critically. c. Mr. Goldstein is a problem patient and difficult to satisfy. d. Mr. Goldstein was stereotyped and not consulted about his dietary preferences.

d

A school nurse is providing sex education classes for adolescents. Which statement by the nurse accurately describes normal sexual functioning? a. "Each person is born with a certain amount of sexual drive, which can be depleted in later years." b. "If you want to be a great athlete, sexual abstinence is necessary when you are training." c. "If you have a nocturnal emission (wet dream), it is an indicator of a sexual disorder." d. "It is natural for a woman to have as strong a desire for sex and enjoy it as much as a man."

d

A student health nurse is counseling a college student who wants to lose 20 lb. The nurse develops a plan to increase the student's activity level and decrease her consumption of the wrong types of foods and excess calories. The nurse plans to evaluate the student's weight loss monthly. When the student arrives for her first "weigh-in," the nurse discovers that instead of the projected weight loss of 5 lb, the student has lost only 1 lb. Which is the BEST nursing response? a. Congratulate the student and continue the care plan. b. Terminate the care plan since it is not working. c. Try giving the student more time to reach the targeted outcome. d. Modify the care plan after discussing possible reasons for the student's partial success.

d

Even though the nurse performs a detailed nursing history in which spirituality is assessed on admission, problems with spiritual distress may not surface until days after admission. What is the probable explanation? a. Patients usually want to conceal information about their spiritual needs. b. Patients are not concerned about spiritual needs until after their spiritual adviser visits. c. Family members and close friends often initiate spiritual concerns. d. Illness increases spiritual concerns, which may be difficult for patients to express in words.

d

Identify an outcome for a patient that is recovering from community acquired pneumonia on intravenous antibiotics, that required 2 L of oxygen by nasal cannula for the first 3 days of their hospitalization related to oxygen saturations ranging between 89% to 92%. However, now (day 4 and 5) has oxygen saturations ranging between 96% to 100% on room air. a. the patient no longer requires 2L oxygen delivery by nasal cannula and for the last 2 days, has had oxygen saturations in the ranges of 96% to 100% on room air b. The patient's pulse oximetry readings have been between 96% and 100% c. the patient no longer requires oxygen delivery by nasal cannula and has had oxygen saturations between 95% and 100% d. The patient is on day 5 of IV antibiotics to treat a community-acquired pneumonia. Upon auscultations, lungs sounds are bilaterally clear. The patient is not longer on oxygen and pulse oximetry readings on room air range from 96% to 100%

d

A nurse is testing a new computer program designed to store patient data. In what phase of testing would the nurse determine if the system can handle high volumes of end-users or care providers using the system at the same time? a. Unit b. Function c. Integration d. Performance

d Phases of Testing: Unit, Function, Integrative, Performance, User Acceptance

A nurse ensures that a hospital room prepared by an aide is ready for a new ambulatory patient. Which condition would the nurse ask the aide to correct? a. The bed linens are folded back. b. A hospital gown is on the bed. c. Equipment for taking vital signs is in the room. d. The bed is in the highest position.

d A properly prepared hospital room includes a bed in the lowest position

The school nurse uses the principles and theories of growth and development when planning programs for high school students. According to Havighurst, what is a developmental task for this age group? a. Finding a congenial social group b. Developing a conscience, morality, and a scale of values c. Achieving personal independence d. Achieving a masculine or feminine gender role

d According to Havighurst, it is the role of the adolescent to achieve a masculine or feminine gender role. Developing a conscience, morality, and a scale of values and achieving personal independence are roles of middle childhood. Finding a congenial social group is a role of young adulthood.

A nurse is counseling an older woman who has been hospitalized for dehydration secondary to a urinary tract infection. The patient tells the nurse: "I don't like being in the hospital. There are too many bad bugs in here. I'll probably go home sicker than I came in." She also insists that she is going to get dressed and go home. She has the capacity to make these decisions. What is the legal responsibility of the nurse in this situation? a. To inform the patient that only the primary health care provider can authorize discharge from a hospital b. To collect the patient's belongings and prepare the paperwork for the patient's discharge c. To request a psychiatric consult for the patient and inform her PCP of the results d. To explain that the choice carries a risk for increased complications and make sure that the patient has signed a release form

d Against Medical Advice (AMA): pt is legally free to leave the hospital, but needs to sign a form releasing the providers and hospital from legal responsibility for their health status, which then becomes part of their medical record

A nurse is counseling a patient who refuses to look at or care for a new colostomy. The patient tells the nurse, "I don't care what I look like anymore, I don't even feel like washing my hair, let alone changing this bag." The nurse diagnoses Altered Health Maintenance is an example of what type of problem? a. Collaborative problem b. Interdisciplinary problem c. Medical problem d. Nursing problem

d Altered Health Maintenance is a nursing problem, because the diagnosis describes a problem that can be treated by nurses within the scope of independent nursing practice. Collaborative and interdisciplinary problems require a teamwork approach with other health care professionals to resolve the problem. A medical problem is a traumatic or disease condition validated by medical diagnostic studies.

A student nurse is organizing clinical responsibilities for a patient who is diabetic and is being treated for foot ulcers. The patient tells the student, "I need to have my hair washed before I can do anything else today; I'm ashamed of the way I look." The patient's needs include diagnostic testing, dressing changes, meal planning and counseling, and assistance with hygiene. How would the nurse best prioritize this patient's care? a. Explain to the patient that there is not enough time to wash her hair today because of her busy schedule. b. Schedule the testing and meal planning first and complete hygiene as time permits. c. Perform the dressing changes first, schedule the testing and counseling, and complete hygiene last. d. Arrange to wash the patient's hair first, perform hygiene, and schedule diagnostic testing and counseling.

d As long as time constraints permit, the most important priorities when scheduling nursing care are priorities identified by the patient as being most important. In this case, washing the patient's hair and assisting with hygiene puts the patient first and sets the tone for an effective nurse-patient partnership.

A state attorney decides to charge a nurse with manslaughter for allegedly administering a lethal medication. This is an example of what type of law? a. Public law b. Private law c. Civil law d. Criminal law

d Criminal law concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft of over $300, and illegal possession of drugs. Public law regulates relationships between people and the government. Private or civil law includes laws relating to contracts, ownership of property, and the practice of nursing, medicine, pharmacy, and dentistry.

A patient states she feels so isolated from her family and church, and even from God, "in this huge medical center so far from home." A nurse is preparing nursing goals for this patient. Which is the best goal for the patient to relieve her spiritual distress? a. The patient will express satisfaction with the compatibility of her spiritual beliefs and everyday living. b. The patient will identify spiritual beliefs that meet her need for meaning and purpose. c. The patient will express peaceful acceptance of limitations and failings. d. The patient will identify spiritual supports available to her in this medical center.

d Each of the four options represents an appropriate spiritual goal, but identifying spiritual supports available to this patient in the medical center demonstrates a goal to decrease her sense of isolation.

Which assessment question would be most appropriate for a patient who is experiencing dyspareunia? a. "Do you currently have a new partner?" b. "Have you been diagnosed with a neurologic disorder?" c. "Do you take antihypertensive medication?" d. "Do you use antihistamines?"

d Factors contributing to dyspareunia include diabetes; hormonal imbalances; vaginal, cervical, or rectal disorders; antihistamine, alcohol, tranquilizer, or illicit drug use; and cosmetic or chemical irritants to genitals.

The Roman Catholic family of a baby who was born with hydroencephalitis requests a baptism for their infant. Why is it imperative that the nurse provides for this baptism to be performed? a. Baptism frequently postpones or prevents death or suffering. b. It is legally required that nurses provide for this care when the family makes this request. c. It is a nursing function to assure the salvation of the baby. d. Not having a Baptism for the baby when desired may increase the family's sorrow and suffering.

d Failure to ensure that an infant baptism is performed when parents desire it may greatly increase the family's sorrow and suffering, which is an appropriate nursing concern. Whether baptism postpones or prevents death and suffering is a religious belief that is insufficient to bind all nurses. There is no legal requirement regarding baptism, and although some nurses may believe part of their role is to ensure the salvation of the baby, this function would understandably be rejected by many.

A nurse is caring for a postoperative patient who is experiencing pain. Which CAT might the nurse use to ensure active participation by the patient to achieve effective pre- or postoperative pain control? a. Acupuncture b. Therapeutic Touch c. Botanical supplements d. Guided imagery

d Imagery involves using all five senses to imagine an event or body process unfolding according to a plan. A patient can be encouraged to "go to a favorite place." With the other modalities, the patient is more passive.

A nurse is asked to act as a mentor to a new nurse. Which nursing action is related to this process? a. The nurse mentor accepts payment to introduce the new nurse to his or her responsibilities b. The nurse mentor hires the new nurse and assigns duties related to the position c. The nurse mentor makes it possible for the new nurse to participate in professional organizations d. The nurse mentor advises and assists the new nurse to adjust to the work environment of a busy emergency department

d Mentors: advises and assists Preceptors: paid to introduce new nurse to new responsibilities through teaching and guiding

A nurse states, "That patient is 78 years old—too old to learn how to change a dressing." What is the nurse demonstrating? a. Cultural imposition b. Clustering c. Cultural competency d. Stereotyping

d Stereotyping is assuming that all members of a group are alike.

A nurse working in a long-term care facility bases patient care on five caring processes: knowing, being with, doing for, enabling, and maintaining belief. This approach to patient care best describes whose theory? a. Travelbee's b. Watson's c. Benner's d. Swanson's

d Swanson's 5 caring processes, caring as "a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility" Travelbee: Human-to-Human Relationship model Benner: caring is a basic way of being in the world and is central to human expertise, curing, and healing Watson: all humans have value, to be cared for, respected, nurtured, understood, and assisted

A nurse is looking for trends in a postoperative patient's vital signs. Which documents would the nurse consult first? a. Admission sheet b. Admission nursing assessment c. Flow sheet d. Graphic record

d While one recording of vital signs should appear on the admission nursing assessment, the best place to find sequential recordings that show a pattern or trend is the graphic record. The admission sheet does not include vital sign documentation, and neither does the flow sheet.

A nurse is using the ISBARR physician reporting system to report the deteriorating mental status of Mr. Sanchez, a patient who has been prescribed morphine via a patient-controlled analgesia pump (PCA) for pain related to pancreatic cancer. Place the following nursing statements related to this call in the correct ISBARR order. a. "I am calling about Mr. Sanchez in Room 202 who is receiving morphine via a PCA pump for pancreatic cancer." b. "Mr. Sanchez has been difficult to arouse and his mental status has changed over the past 12 hours since using the pump." c. "You want me to discontinue the PCA pump until you see him tonight at patient rounds." d. "I am Rosa Clark, an RN working on the second floor of South Street Hospital." e. "Mr. Sanchez was admitted 2 days ago following a diagnosis of pancreatic cancer." f. "I think the dosage of morphine in Mr. Sanchez's PCA pump needs to be lowered."

d, a, e, b, f, c Identity/Introductions Situation Background Assessment Recommendation Read-Back

A home health nurse performs a careful safety assessment of the home of a frail older adult to prevent harm to the patient. The nurse's action reflects which principle of bioethics? a. Autonomy b. Beneficence c. Justice d. Fidelity e. Nonmaleficence

e Nonmaleficence is defined as the obligation to prevent harm. Autonomy is respect for another's right to make decisions, beneficence obligates us to benefit the patient, justice obligates us to act fairly, and fidelity obligates us to keep our promises.

Nursing in the United States is regulated by the state nurse practice act. What is a common element of each state's nurse practice act? a. Defining the legal scope of nursing practice b. Providing continuing education programs c. Determining the content covered in the NCLEX examination d. Creating institutional policies for health care practice

a Nurse practice acts are established in each state to regulate the practice of nursing by defining the legal scope of nursing practice, creating a state board of nursing to make and enforce rules and regulations, define important terms and activities in nursing, and establish criteria for the education and licensure of nurses.

A student nurse interacting with patients on a cardiac unit recognizes the four concepts in nursing theory that determine nursing practice. Of these four, which is most important? a. Person b. Environment c. Health d. Nursing

a Of the four concepts, the most important is the person. The focus of nursing, regardless of definition or theory, is the person.

The nurse is prioritizing nursing care for a patient in a long-term care facility. Which examples of nursing interventions help meet physiologic needs? Select all that apply. a. Preventing falls in the facility b. Changing a patient's oxygen tank c. Providing materials for a patient who likes to draw d. Helping a patient eat his dinner e. Facilitating a visit from a spouse f. Referring a patient to a cancer support group.

b, d

A nurse working in a long-term care facility personally follows accepted guidelines for a healthy lifestyle. How does this nurse promote health in the residents of this facility? a. By being a role model for healthy behaviors b. By not requiring sick days from work c. By never exposing others to any type of illness d. By budgeting time and resources efficiently

a

A nurse is preparing to teach a patient with asthma how to use his inhaler. Which teaching method would be the BEST choice to teach the patient this skill? a. Demonstration b. Lecture c. Discovery d. Panel session

a Demonstration: for techniques, procedures, exercises, equipment Lecture: for a large group, more effective when interactive Discovery: for problem-solving techniques and independent thinking Panel Session: for factual material, sharing experiences and emotions

Newly hired nurses in a busy suburban hospital are required to read the state nurse practice act as part of their training. Which topics are covered by this act? Select all that apply. a. Violations that may result in disciplinary action b. Clinical procedures c. Medication administration d. Scope of practice e. Delegation policies f. Medicare reimbursement

a, d Each state has a nurse practice act that protects the public by broadly defining the legal scope of nursing practice. Practicing beyond those limits makes nurses vulnerable to charges of violating the state nurse practice act. Nurse practice acts also list the violations that can result in disciplinary actions against nurses. Clinical procedures are covered by the health care institutions themselves. Medication administration and delegation are topics covered by the board of nursing. Laws governing Medicare reimbursement are enacted through federal legislation.

A nurse performs an assessment of a family consisting of a single mother, a grandmother, and two children. Which interview questions directed to the single mother could the nurse use to assess the affective and coping family function? Select all that apply. a. Who is the person you depend on for emotional support? b. Who is the breadwinner in your family? c. Do you plan on having any more children? d. Who keeps your family together in times of stress? e. What family traditions do you pass on to your children? f. Do you live in an environment that you consider safe?

a, d The five major areas of family function are physical, economic, reproductive, affective and coping, and socialization. Asking who provides emotional support in times of stress assesses the affective and coping function. Assessing the breadwinner focuses on the economic function. Inquiring about having more children assesses the reproductive function, asking about family traditions assesses the socialization function, and checking the environment assesses the physical function.

A nurse studies the culture of Native Alaskans to determine how their diet affects their overall state of health. Which method of qualitative research is the nurse using? a. Historical b. Ethnography c. Grounded theory d. Phenomenology

b Ethnographic research was developed by the discipline of anthropology and is used to examine issues of culture of interest to nursing. Historical research examines events of the past to increase understanding of the nursing profession today. The basis of grounded theory methodology is the discovery of how people describe their own reality and how their beliefs are related to their actions in a social scene. The purpose of phenomenology (both a philosophy and a research method) is to describe experiences as they are lived by the subjects being studied.

The nurse caring for patients postoperatively uses careful hand hygiene and sterile techniques when handling patients. Which of Maslow's basic human needs is being met by this nurse? a. Physiologic b. Safety and security c. Self-esteem d. Love and belonging

b

A nurse forms a contractual agreement with a morbidly obese patient to achieve optimal weight goals. Which statement best describes the nature of this agreement? a. "This agreement forms a legal bond between the two of us to achieve your weight goals." b. "This agreement will motivate the two of us to do what is necessary to meet your weight goals." c. "This agreement will help us determine what learning outcomes are necessary to achieve your weight goals." d. "This agreement will limit the scope of the teaching session and make stated weight goals more attainable."

b A contractual agreement is a pact two people make, setting out mutually agreed-on goals. Contracts are usually informal and not legally binding. When teaching a patient, such an agreement can help motivate both the patient and the teacher to do what is necessary to meet the patient's learning outcomes. The agreement notes the responsibilities of both the teacher and the learner, emphasizing the importance of the mutual commitment.

According to the National Advisory Council on Nurse Education and Practice, what is a current health care trend contributing to 21st century challenges to nursing practice? a. Decreased numbers of hospitalized patients b. Older and more acutely ill patients c. Decreasing health care costs owing to managed care d. Slowed advanced in medical knowledge and technology

b The National Advisory Council on Nurse Education and Practice identifies the following critical challenges to nursing practice in the 21st century: A growing population of hospitalized patients who are older and more acutely ill, increasing health care costs, and the need to stay current with rapid advances in medical knowledge and technology.

A nurse is planning teaching strategies based on the affective domain of learning for patients addicted to alcohol. What are examples of teaching methods and learning activities promoting behaviors in this domain? Select all that apply. a. The nurse prepares a lecture on the harmful long-term effects of alcohol on the body. b. The nurse explores the reasons alcoholics drink and promotes other methods of coping with problems. c. The nurse asks patients for a return demonstration for using relaxation exercises to relieve stress. d. The nurse helps patients to reaffirm their feelings of self-worth and relate this to their addiction problem. e. The nurse uses a pamphlet to discuss the tenants of the Alcoholics Anonymous program to patients. f. The nurse reinforces the mental benefits of gaining self-control over an addiction.

b, d, f Affective learning: changes in attitudes, values, and feelings Cognitive learning: storing/recall of new knowledge Psychomotor Learning: physical skills, integration of mental and muscular activity

A nurse who is working in a hospital setting uses value clarification to help understand the values that motivate patient behavior. Which examples denote "prizing" in the process of values clarification? Select all that apply. a. A patient decides to quit smoking following a diagnosis of lung cancer. b. A patient shows off a new outfit that she is wearing after losing 20 pounds. c. A patient chooses to work fewer hours following a stress-related myocardial infarction. d. A patient incorporates a new low-cholesterol diet into his daily routine. e. A patient joins a gym and schedules classes throughout the year. f. A patient proudly displays his certificate for completing a marathon.

b, f Prizing something one values involves pride, happiness, and public affirmation, such as losing weight or running a marathon. When choosing, one chooses freely from alternatives after careful consideration of the consequences of each alternative, such as quitting smoking and working fewer hours. Finally, the person who values something acts on the value by combining choice and behavior with consistency and regularity, such as joining a gym for the year and following a low-cholesterol diet faithfully.

A nurse manager is attempting to update a health care provider's office from paper to electronic health records (EHR) by using the eight-step process for planned change. Place the following actions in the order in which they should be initiated: a. The nurse devises a plan to switch to EHR. b. The nurse records the time spent on written records versus EHR. c. The nurse attains approval from management for new computers. d. The nurse analyzes all options for converting to EHR. e. The nurse installs new computers and provides an in-service for the staff. f. The nurse explores possible barriers to changing to EHR. g. The nurse follows up with the staff to check compliance with the new system. h. The nurse evaluates the effects of changing to EHR.

b, f, d, c, a, e, h, g 8 steps of Planned Change: (1) Recognize a need for change and collect data (2) Identify a problem to be solved (3) Determine and analyze alternative solutions (4) Select a course of action (5) Planning (6) Implementing (7) Evaluating (8) Stabilizing vs. Change Theory: (1) Unfreezing-recognizing need for change (2) Moving-initiating after careful planning (3) Refreezing-change becomes operational

A nurse is interviewing a newly admitted patient. Which question is considered culturally sensitive? a. "Do you think you will be able to eat the food we have here?" b. "Do you understand that we can't prepare special meals?" c. "What types of food do you eat for meals?" d. "Why can't you just eat our food while you are here?"

c

A nurse is teaching a novice nurse how to provide care for patients in a culturally diverse community health clinic. Although all these actions are recommended, which one is MOST basic to providing culturally competent care? a. Learning the predominant language of the community b. Obtaining significant information about the community c. Treating each patient at the clinic as an individual d. Recognizing the importance of the patient's family

c

During an interaction with a patient diagnosed with epilepsy, a nurse notes that the patient is silent after communicating the nursing care plan. What would be appropriate nurse responses in this situation? Select all that apply. a. Fill the silence with lighter conversation directed at the patient. b. Use the time to perform the care that is needed uninterrupted. c. Discuss the silence with the patient to ascertain its meaning. d. Allow the patient time to think and explore inner thoughts. e. Determine if the patient's culture requires pauses between conversation. f. Arrange for a counselor to help the patient cope with emotional issues.

c, d, e The nurse can use silence appropriately by taking the time to wait for the patient to initiate or to continue speaking. During periods of silence, the nurse should reflect on what has already been shared and observe the patient without having to concentrate simultaneously on the spoken word. In due time, the nurse might discuss the silence with the patient in order to understand its meaning. Also, the patient's culture may require longer pauses between verbal communication. Fear of silence sometimes leads to too much talking by the nurse, and excessive talking tends to place the focus on the nurse rather than on the patient. The nurse should not assume silence requires a consult with a counselor.

A nurse practicing in a primary care center uses the ANA's Nursing's Social Policy Statement as a guideline for practice. Which purposes of nursing are outlined in this document? Select all that apply. a. A description of the nurse as a dependent caregiver b. The provision of standards for nursing educational programs c. A definition of the scope of nursing practice d. The establishment of a knowledge base for nursing practice e. A description of nursing's social responsibility d. The regulation of nursing research

c, d, e The ANA Social Policy Statement (2010) describes the social context of nursing, a definition of nursing, the knowledge base for nursing practice, the scope of nursing practice, standards of professional nursing practice, and the regulation of professional nursing.

A nurse caring for patients in a long-term care facility uses available resources to help patients achieve Maslow's highest level of needs: self-actualization needs. Which statements accurately describe these needs? Select all that apply. a. Humans are born with a fully developed sense of self-actualization. b. Self-actualization needs are met by depending on others for help. c. The self-actualization process continues throughout life. d. Loneliness and isolation occur when self-actualization needs are unmet. e. A person achieves self-actualization by focusing on problems outside self. f. Self-actualization needs may be met by creatively solving problems.

c, e, f

A nurse works with families in crisis at a community mental health care facility. What is the BEST broad definition of a family? a. A father, a mother, and children b. A group whose members are biologically related c. A unit that includes aunts, uncles, and cousins d. A group of people who live together and depend on each other for support

d

During rounds, a charge nurse hears the patient care technician yelling loudly to a patient regarding a transfer from the bed to chair. Upon entering the room, what is the nurse's BEST response? a. "You need to speak to the patient quietly so you don't disturb the other patients." b. "Let me help you with your transfer technique." c. "When you are finished, be sure to apologize for your rough demeanor." d. "When your patient is safe and comfortable, meet me at the desk."

d

A nurse incorporates the "five values that epitomize the caring professional nurse" (identified by the American Association of Colleges of Nursing) into a home health care nursing practice. Which attribute is best described as acting in accordance with an appropriate code of ethics and accepted standards of practice? a. Altruism b. Autonomy c. Human dignity d. Integrity

d Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice. Altruism is a concern for the welfare and well-being of others. Autonomy is the right to self-determination, and human dignity is respect for the inherent worth and uniqueness of individuals and populations.

A nurse is counseling a 19-year-old athlete who had his right leg amputated below the knee following a motorcycle accident. During the rehabilitation process, the patient refuses to eat or get up to ambulate on his own. He says to the nurse, "What's the point. My life is over now and I'll never be the football player I dreamed of becoming." What is the nurse counselor's best response to this patient? a. "You're young and have your whole life ahead of you. You should focus on your rehabilitation and make something of your life." b. "I understand how you must feel. I wanted to be a famous singer, but I wasn't born with the talent to be successful at it." c. "You should concentrate on other sports that you could play even with prosthesis." d. "I understand this is difficult for you. Would you like to talk about it now or would you prefer me to make a referral to someone else?"

d This answer communicates respect and sensitivity to the patient's needs and offers an opportunity to discuss his feelings with the nurse or another health care professional. The other answers do not allow the patient to express his feelings and receive the counseling he needs.

A patient states, "I have been experiencing complications of diabetes." The nurse needs to direct the patient to gain more information. What is the MOST appropriate comment or question to elicit additional information? a. "Do you take two injections of insulin to decrease the complications?" b. "Most health care providers recommend diet and exercise to regulate blood sugar." c. "Most complications of diabetes are related to neuropathy." d. "What specific complications have you experienced?"

d Requesting specific information regarding complications of diabetes will elicit specific information to guide the nurse in further interview questions and specific assessment techniques

A pediatric nurse is assessing a 5-year-old boy who has dietary modifications related to his diabetes. His parents tell the nurse that they want him to value good nutritional habits, so they decide to deprive him of a favorite TV program when he becomes angry after they deny him foods not on his diet. This is an example of what mode of value transmission? a. Modeling b. Moralizing c. Laissez-faire d. Rewarding and punishing

d When rewarding and punishing are used to transmit values, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. Through modeling, children learn what is of high or low value by observing parents, peers, and significant others. Children whose caregivers use the moralizing mode of value transmission are taught a complete value system by parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different values. Those who use the laissez-faire approach to value transmission leave children to explore values on their own (no single set of values is presented as best for all) and to develop a personal value system.

A nurse is practicing as a nurse-midwife in a busy OB-GYN office. Which degree in nursing is necessary to practice at this level? a. LPN b. ADN c. BSN d. MSN

d A master's degree (MSN) prepares advanced practice nurses. Many master's graduates gain national certification in their specialty area, for example, as family nurse practitioners (FNPs) or nurse midwives.

Nurses today complete a nursing education program, and practice nursing that identifies the personal needs of the patient and the role of the nurse in meeting those needs. Which nursing pioneer is MOST instrumental in this birth of modern nursing? a. Clara Barton b. Lilian Wald c. Lavinia Dock d. Florence Nightingale

d Florence Nightingale elevated the status of nursing to a respected occupation, improved the quality of nursing care, and founded modern nursing education. Clara Barton established the Red Cross in the United States in 1882. Lillian Wald was the founder of public health nursing. Lavinia Dock was a nursing leader and women's rights activist instrumental in establishing women's right to vote.