Nurse 260 Chapters 3/17/19, 20/22/23, 24/25/26

The nurses at Community General Hospital are concerned about violence involving children in their community. They wish to propose to the city government that drug-free and weapons-free zones and corridors be instituted near each school. The nurses send liaisons to the city school board and the parent-teachers association to ask them to join the effort. What is the term for this type of strategy?A.)Forming a coalition B.)Displaying legitimate power C.)Collective bargaining D.)Seeking compromise

A.) A coalition is formed when individuals or organizations that share a common interest in a single issue work together toward a goal.

How would a nurse determine the political views regarding health care issues of those individuals who are running for public office? A.)Call the state or national political action committee of the American Nurses Association. B.)Talk with the administration of the institution to determine who is supporting health care issues. C.)Call the party headquarters of the candidates and ask them to share the views of the candidate with you. D.)Call the National League for Nursing (NLN) and obtain the political action reports.

A.) A political action committee should have the information regarding the views of specific candidates. It is the purpose of the committee to determine and collectively endorse candidates that support nursing and health care issues. The NLN does not participate in political action activities.

What is a characteristic of a situational mentoring relationship? A.)It occurs only one time. B.)It is established by the organization. C.)Both mentee and mentor mutually accept it. D.)It is structured to ensure situational success

A.) Characteristically, a situational mentoring relationship is a one-time event. Organizations usually establish formal relationships. Acceptance by the mentee and mentor is characteristic of an informal relationship. A structured relationship is formal.

Mentoring is considered to be a: A.)Partnership B.)One-way street C.)Static relationship D.)Method of gaining more experience

A.) Mentoring is a partnership and a two-way street with both parties freely contributing to the relationship as equals working together, based on mutual respect.

What element in health care is most responsible for the ethical dilemma of whether health care is a privilege or a right? A.)Cost B.)Technology C.)Consumerism D.)Worker shortage

A.) Variables of the justice principle involve the allocation of scarce and/or expensive health care resources. The following questions are a few examples illustrating this principle: What kind of access to health care should illegal immigrants receive—preventive care or only more costly emergency care? How should the health care of children be allocated? Should all children receive the same health care regardless of ability to pay?

A nurse plans to lobby a state senator regarding a particular health care bill. Which action would be appropriate? A.)The nurse should be specific about what action she wants the senator to take early in the contact or letter.T B.)The nurse should tell the senator that she will vote for him or her only if her advice is followed. C.)The nurse should use a form letter to express her opinion and encourage as many as possible to mail in the form letter. D.)The nurse should avoid making contact by phone and only submit her views in writing.

A.) The structure and content of a visit or a written contact are very similar. That is, know your issue, keep it short, identify the issue by its bill number and title, and communicate exactly what action you want the lawmaker to take.

What ethical principle is implemented, or supported, when the nurse encourages a patient to be involved in planning and implementing his or her own care? A.)Autonomy B.)Fidelity C.)Justice D.)Veracity

A.) A patient's right to self-determination implies the freedom to make choices and decisions about one's own care without interference, even if those decisions are not in agreement with those of the health care team.

Which of the following could be a component of e-mentoring? Select all that apply. A.)Distance mentoring B.)Mentoring by instant messaging C.)Contact between mentee and mentor via electronic mail D.)A mentoring program for first-year nursing students E.)Using a videoconferencing system such as Skype to meet virtually F.)Planning a meeting at a coffee shop to discuss progress of the preceptorship

A.) B.) C.) E.)

After the September 11, 2001, attack on the United States, numerous federal acts have been ratified that have created which agencies:Select all that apply. A.)The Hospital Emergency Incident Command System (HEICS) B.)Health Resources and Services Administration (HRSA) C.)The Office of Emergency Response (OER) D.)The Federal Emergency Management Agency (FEMA) E.)The Department of Security (DoS) F.)National Incident Management System (NIMS)

A.) B.)F.) Among those federal acts that have been ratified since the September 11, 2001, terrorist attacks, the most important outcomes have been the implementation of the Health Resources and Services Administration (HRSA), the Hospital Emergency Incident Command System (HEICS), and the National Incident Management System (NIMS). President George W. Bush created the Department of Homeland Security (DHS) in 2001. FEMA was created in 1979 to coordinate federal disaster assistance. The ICS was adopted by FEMA to coordinate responses to a disaster. The OER was an office existing before 2001 that was moved to the DHS.

Review the following characteristics. Which best describe the role of the mentor? Select all that apply. A.)Requires a primary focus on the needs of the new nurse B.)Assists the new nurse with difficult nursing procedures C.)Serves as a primary resource on the nursing unit for the new nurse D.)Is assigned to the new nurse for the orientation period E.)Is interested in the new nurse's personal growth and nursing goals F.)Is available to the new nurse after hours to discuss problems and needs

A.) E.) F.) The preceptor acts in a formal role and functions during a defined period of time. The primary focus of the preceptor is to serve as a role model during the specified period. A mentor is more interested in a nurturing role with the new nurse and frequently shares personal time. The other options are characteristic of a preceptor.

What is the best definition of politics? A.)Influencing the allocation of scarce resources B.)Identifying those in a public office that can be influenced C.)Attempting to get people in government positions to think the way you want them to D.)Lobbying for state and federal legislation to improve the quality of nursing care

A.) Involvement of nurses in politics helps the nurse to augment nursing power by influencing the nursing care provided to patients—determining who will receive (allocation) scarce resources (nursing care/health care). This is politics.

Which of the following would best represent the definition of a political action committee (PAC)? A.)A vehicle for nurses across the country to organize collectively to endorse and support candidates for national offices B.)A group of individuals or organizations who share a common interest in a single issue C.)An organizational structure established for the purpose of supporting and fostering changes in the health care system D.)A group that identifies special needs and raises funds to influence politicians to vote in a manner that supports the special needs

A.)PACs are a method by which a special-interest group can collectively endorse and support a candidate without the donation of large sums of money. ANA-PACs, as well as state PACs, enable nurses to organize and support candidates that have the ability to influence legislation on health care issues. A PAC can be active in any area of interest, not just health care.

Which statement best describes the Code of Ethics of the American Nurses Association? A.)A moral statement of accountability for practicing nurses and for student nurses B.)A legal document describing the responsibilities of the nurse C.)A statement regarding nursing care that outlines principles for the hospital to use to evaluate quality of care D.)A document that is used as a guide for the nurse to consider in the decision-making process in legal situations

A.)The code is a statement to society that outlines the values, concerns, and goals of the profession, thereby addressing accountability. The code provides direction for ethical decisions and behavior by repeatedly emphasizing the obligations and responsibilities that the nurse-patient relationship entails.

An emergency department nurse should suspect a possible bioterrorist agent if, during the Fourth of July weekend, the nurse notices which of the following? a.Three patients arrive complaining of abrupt onset of severe myalgia, fever, sore throat, and headache. b.Four patients, all from the same family picnic, arrive complaining of abdominal pain and nausea, vomiting, and diarrhea. c.Two patients arrive from the local lake complaining of tiredness, weakness, dizziness, muscle cramps, and headache. d.Two patients arrive from a local concert with superficial burns on the faces, necks, arms, and legs and complaining of pain in these areas. They are tachycardic and appear dehydrated.

ANS: A Symptoms of influenza in July are not a normal occurrence and should be investigated further. Bioterrorist agents are usually not endemic to an area (patients coming from the same location [e.g., local lake or local concert]). Having GI symptoms after a picnic more than likely is a foodborne pathogen.

Which of the following statements by the nurse indicates understanding of legal actions? a."A misdemeanor is a less serious crime resulting in a fine." b."A felony is a less serious crime that can result in a fine." c."Civil actions are serious and often result in prison time." d."The defendant is the victim."

ANS: A A misdemeanor is a less serious crime resulting in a fine. A felony is a serious crime that often results in prison time. In court cases, the victim is the plaintiff.

The primary barrier to the implementation of quality improvement processes is: A.)Expense B.)Resistance to change C.)Complacency with the status quo D.0Not identifying the correct problem

ANS: A A primary barrier to implementing effective quality improvement (QI) programs is the cost. The cost of providing health care has greatly increased over the past few decades. However, through quality improvement measures, overall health care costs can be reduced. Other barriers (but not the primary one) to QI are nurses' loyalty to old practices and failure to recognize that changes are needed. Hospital administrators often oppose change of any kind because they may value traditional practices, have an authoritative management style, or may not value innovators. Nurses are often unaware or unwilling to change their practice from the way they have always done things—complacency with the status quo. Many practicing nurses remain resistant to change because it seems threatening and because it requires effort, retraining, and restructuring of habits, but cost still remains the primary barrier to implementing QI.

A nurse is interested in becoming credentialed as a Certified Professional in Health Care Quality. Which action would the nurse take to achieve this? a. Take an exam. b. Complete a 6-week internship. c. Have at least a bachelor's degree. d. Have at least 1 year of experience in quality management.

ANS: A Although there is no longer a minimum education requirement, those who test should have worked in quality management for a minimum of 2 years. Approximately 75% of those who apply to test actually achieve certification.

Which of the following would be considered a criminal action? a.A nurse who steals narcotics from the hospital b.A nurse who gets into a verbal disagreement with a visitor c.A nurse who restrains a patient who is considered a threat to himself d.A nurse who refuses to allow a visitor onto the unit who appears intoxicated

ANS: A An example of a criminal action is the nurse who steals narcotics from the hospital. Verbal disagreements, restraining a patient who has the potential to harm themselves, and refusing visitors who appear intoxicated are not examples of a criminal action.

A nurse is being sued for assault and battery. What does this mean? A.)The nurse, without consent, touched the patient in an offensive, insulting, or injurious way. B.)The nurse threatened to put the patient in restraints if he did not stay in bed. C.)The nurse told the patient he could not leave until his bill was paid. D.)The nurse failed to perform an act expected of a reasonable nurse.

ANS: A Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Permission to do this touching is usually implied when the patient seeks medical care. Using restraints or threatening to use them on competent patients to make them do what you want them to do against their wishes is an example of false imprisonment. Failure to perform an act expected of a reasonable, prudent nurse can constitute negligence.

An emergency department nurse should suspect a possible bioterrorist agent if, during the Fourth of July weekend, she notices which of the following? A.)Three patients arrive complaining of abrupt onset of severe myalgia, fever, sore throat, and headache. B.)Four patients, all from the same family picnic, arrive complaining of abdominal pain and nausea, vomiting, and diarrhea. C.)Two patients arrive from the local lake complaining of tiredness, weakness, dizziness, muscle cramps, and headache. D.)Two patients arrive from a local concert with superficial burns on the faces, necks, arms, and legs and complaining of pain in these areas. They are tachycardic and appear dehydrated.

ANS: A Bioterrorist agents are usually not endemic to an area. Symptoms of influenza in July are not a normal occurrence and should be investigated further.

Which action takes place during the design phase of the DMAIC process? a. A charter is developed. b. Key performance indicators are agreed upon. c. Analyze baseline data. d. Determine whether measures reflect the true problems.

ANS: A During the design phase of the DMAIC process, a charter is developed. Key performance indicators are agreed upon during the measure phase, baseline data are analyzed during the analyze phase, and it is determined whether measures reflect the true problems during the improve phase.

A nurse is explaining to another nurse about the contributions of Edward Deming. The nurse judges that the explanation is effective when the nurse states: a. "Quality is the responsibility of everyone within an organization." b. "Quality is the responsibility of the quality control inspector." c. "Quality is the responsibility of the CEO of the organization." d. "Quality is the responsibility of the manager of the organization."

ANS: A Edward Deming embraced the philosophy that quality is the responsibility of everyone within an organization.

Which of the following can result in a civil action against the nurse? a.Failure to monitor b.Enforcing strict compliance with contact precautions against the family's wishes c.Refusing to discuss the patient's medical history with the family per patient request d.Assisting the physician in a bedside procedure after obtaining informed consent

ANS: A Failure to monitor can result in a civil action against the nurse. Enforcing strict compliance with contact precautions against the family's wishes, refusing to discuss the patient's medical history with family per the patient's request, and assisting the physician in a bedside procedure after obtaining informed consent are not examples that could lead to civil action.

What is the major function of the National Institute of Nursing Research? A.)Serves as a major source of federal grants to fund nursing research B.)Provides direction to nurses interested in research utilization C.)Collects data about the major nursing schools in the country D.)Provides money to fund the education of nurses

ANS: A Federal grants fund nursing research and also support education in research methods, research career development, and excellence in nursing science.

During the define phase of the define-measure-analyze-improve-control (DMAIC) process, the team members: A.)Identify the stakeholders. B.)Agree on the key performance indicators. C.)Identify gaps between performance and goals. D.)Identify those responsible for data collection.

ANS: A In the define phase, a charter is developed; goals, team leaders, membership, and team roles and responsibilities are identified; and the stakeholders affected by the process are identified. In the measurement phase, everyone within the team needs to agree on what is to be measured, which are called key performance indicators (time, costs, distance, numbers of incidents, or items). The analyze phase is usually a short phase, but it can be longer depending on the issue because analysis of baseline data is collected. It is important to be objective in identifying where the real problems exist during this phase. The improve phase is a good place to determine whether measures reflect the true problems. The problem statement and goal statement may need to be revised based on the findings. The data collected may have shown that no real problem exists or that the problem involves other issues. During the control phase, controls are established to keep things going in the right direction. Controlling and sustaining the improvement is not easy and requires the development, documentation, and implementation of an ongoing monitoring plan.

Which of the following represents a Level II disaster? A.)A building collapse that fills the local emergency room with patients B.)A freeway accident that involves multiple vehicles C.)Flooding of a three-state area affecting food and water resources D.)Earthquake that destroys homes and transportation facilities

ANS: A Level II disasters require the community health nurse to respond in a greater capacity using larger casualty practices in coordination with regional response agencies (such as state health and emergency management agencies). Level I disasters are small-scale, local disasters that do not require an outside agency response. Level III disasters consume local, state, and federal resources to the fullest extent and will require an extended response time by the community health nurse that can extend into weeks or months

Which of the following is a Level III disaster? Select all that apply. A.)Car accident B.)Train derailment C.)Hurricane D.)Tsunami E.)House fire F.)Tornado

ANS: A Level II disasters require the community health nurse to respond in a greater capacity using larger casualty practices in coordination with regional response agencies (such as state health and emergency management agencies). Level I disasters are small-scale, local disasters that do not require an outside agency response. Level III disasters consume local, state, and federal resources to the fullest extent and will require an extended response time by the community health nurse that can extend into weeks or months.

Which of the following represents a Level II disaster? a.A building collapse that fills the local emergency room with patients b.A freeway accident that involves multiple vehicles c.Flooding of a three-state area affecting food and water resources d.An earthquake that destroys homes and transportation facilities

ANS: A Level II disasters require the community health nurse to respond in a greater capacity using larger casualty practices in coordination with regional response agencies (such as state health and emergency management agencies). Level I disasters are small-scale, local disasters that do not require an outside agency response. Level III disasters consume local, state, and federal resources to the fullest extent and will require an extended response time by the community health nurse that can extend into weeks or months.

Occupational Safety and Health Administration (OSHA) guidelines protect health care workers from needlesticks by requiring employers to: A.)Purchase safety devices. B.)Provide a safe working environment. C.)Work with the local health department. D.)Establish guidelines for safe nursing practice.

ANS: A OSHA has established guidelines that employers must follow to protect their workers. The Needlestick Safety and Prevention Act became law in November 2000, requiring the use of safer devices to protect workers from sharps' injuries

A student asks the nurse manager, "When I was reading an article about research utilization I ran across the phrase 'practice context.' What does that mean?" What is the best response? A.)"It is made up of the factors and systems that contribute to delivery of nursing care in a particular setting." B.)"It refers to the specific group of patients who are to receive care in a particular setting." C.)"It describes the type of health care delivery system that is currently in place in a particular setting." D.)"It refers to the policies, procedures, and staffing patterns of a nursing unit."

ANS: A Practice context determines to what degree you can use the findings from nursing research. It is a blending of all those factors and systems that contribute to the delivery of nursing care. This blend includes the health, social, and cultural characteristics of the patient population served; the type of practice setting; the economic resources of the setting; the type of health care delivery system; the existing policies and procedures; the staffing pattern; and the administrative structure. Each factor or system can be either enabling or inhibiting, but it is the practice context as a whole that is evaluated to determine the applicability of nursing research findings. The other options are components or part of the practice text. The answer includes all of the factors, not just the specific ones listed in the distracters.

Which of the following statements by the nurse indicates an understanding of Quality and Safety for Nurses (QSEN)? a. "QSEN helps prepare future nurses for improving patient safety." b. "QSEN helps prepare future nurses for working mandatory overtime." c. "QSEN helps train nurses in the clinical setting." d. "QSEN provides nurses with strategies for passing the NCLEX exam."

ANS: A Quality and Safety for Nurses (QSEN) was developed to help prepare future nurses who will be needed in their health care environment to improve patient safety. QSEN does not prepare nurses to work mandatory overtime, train them in the clinical setting, or provide them with strategies to pass the NCLEX exam.

Which of the following chemical agents is classified as a nerve agent? A.)Sarin gas B.)Mustard gas C.)Ricin D.)Chlorine gas

ANS: A Sarin gas is an organophosphate ester classified under nerve agents. The nerve agents inhibit the uptake of acetylcholine. Mustard gas is classified as a vesicating (skin) agent. Ricin is a biological agent. Chlorine gas is classified as a choking agent

After completing a crisis intervention course, the nurse recognizes the signs of escalating violence as: A.)Pacing and cursing B.)Repeatedly pushing the call bell C.)Crying and complaining of no pain relief D.)Staring out the window and not responding to questions

ANS: A Signs of escalating violence include pacing, using foul language, cursing, raising of fists, and threats.

A nurse is educating students on the history of quality improvement. The teaching has been effective when one of the students states that the historically, quality improvement focused on a. "controlling process by inspection so that errors were prevented." b. "quality improvement did not begin until recently." c. "proactive approaches to lessen errors." d. "error prevention strategies."

ANS: A Teaching is effective when the student states that historically, quality improvement focused on controlling process by inspection so that errors were prevented. Later, the emphasis changed from inspection to proactive approaches to error prevention.

What are examples of regulatory agencies that will affect health care policy with regard to informatics? a. Health Insurance Portability and Accountability Act (HIPAA) b. American Nursing Credentialing Center (ANCC) c. American Nurses Association (ANA) d. Medicare/Medicaid authorization

ANS: A The Joint Commission (TJC) and the Health Insurance Portability and Accountability Act (HIPAA) are two regulatory and governmental agencies instituting health care policy.

Which action can the nurse expect in the preutilization step in nursing research utilization? a. Recognition that some aspect of nursing care could be done in a different way b. Recognizing that nurses need shortcuts in order to manage their workload c. Critical evaluation of published research d. Using electronic databases to search current literature

ANS: A The action that the nurse can expect in the preutilization step is the recognition that some aspect of nursing care could be done in a different way. This step is not meant to create shortcuts for nurses to manage their workload. Critical evaluation of published research and using electronic databases to search current literature occurs in the second step, assessing.

A graduate nurse is preparing to start a first nursing job. What action would be the best legal safeguard for the graduate nurse to take? A.)competent practice B.)A valid license C.)A legal contract D.)Following management policies

ANS: A The best legal safeguard is competent practice. Practicing within the parameters of the state's Nurse Practice Act, performing care based on established policies and procedures, and performing as a reasonable nurse are the best ways for a nurse to safeguard against legal action. It is important to maintain a current license and follow management policies; however, the best safeguard is being competent. A legal contract is not necessary for all situations and is not necessarily the best legal safeguard.

The nurse understands that computer monitoring on a telemetry unit: A.)Provides continuous streaming of data that allows nurses to respond to patient changes quickly B.)Provides for continuous around-the-clock direct observation of patients C.)Improves documentation of patient care D.)Reduces the need for additional nurses to provide patient care

ANS: A The continuous flow of data from a computer allows nurses to respond to client changes very quickly. Timely nursing responses and actions are crucial in leading to positive outcomes when caring for critically ill clients. Computer monitoring is not a substitute for client observation. The number of nurses required to care for clients is not reduced because of computer monitoring, nor does it improve documentation, but rather provides a means to document data

During a malpractice suit, how can the standard of "what the wise and prudent nurse would do" best be established? a.From the testimony of an expert nurse b.By consulting with nursing faculty regarding standards of care c.Conferring with a lawyer regarding malpractice parameters d.By consulting the standards of The Joint Commissions

ANS: A The most common way to establish the duty owed by a nurse is by the testimony of a registered nurse—usually, but not always, with training and background similar to the nurse being sued. This expert witness will then testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. The Joint Commission standards may reflect on hospital policies and procedures, not the nurse's practice. A lawyer provides legal advice but cannot attest to the standards of nursing practice that a nurse can. Faculty can be knowledgeable about standards of care, but the testimony of a nurse with similar training and background can determine what the wise and prudent nurse would have done.

A nurse places a heating pad on the lower leg of a patient with peripheral vascular disease. When the heating pad is removed, it is apparent that the patient has sustained partial-thickness burns to the area covered by the pad, and the nurse is sued for malpractice. Which statement is true? a.All elements are present to find the nurse liable for damages. b.Proximate cause cannot be established, so the nurse will not be found liable. c.The standard of care in such a situation cannot be established, so the nurse will not be found liable. d.No duty to the patient exists, so the nurse will not be held liable.

ANS: A The nurse had a duty, that duty was breached, the injury was foreseeable, and the patient suffered harm (partial-thickness burn). All four elements for a malpractice suit are present. The other options do not show that all elements are present and are therefore incorrect.

A nurse has just administered a medication when suddenly realizing that more medication was given than was ordered. Which action should the nurse take? a.Call the patient's physician and report the error. b.Say nothing about the medication error and continue to monitor the patient. c.Document the dose that was supposed to be given in the medical record. d.Document the amount given in the medical record but keep the error quiet.

ANS: A The nurse should call the physician and report the error after assessing the patient's condition. The nurse should never falsify a document in the medical record or keep the error to them self.

The nurse manager has an adequate understanding of Six Stigma when making which of the following statements? a. "The primary goal of Six Stigma is to increase profits and reduce problems." b. "The primary goal of Six Stigma is to attract physicians to an organization." c. "The primary goal of Six Stigma is advertisement of the organization." d. "The primary goal of Six Stigma is to attract nursing to an organization."

ANS: A The primary goal of Six Stigma is to increase profits and reduce problems. The primary goal is not to attract physicians or nurses to an organization or advertise.

What is the correct sequence of activities in the research utilization process?A.)Identification of practice problem, evaluation of related published research, planning, implementation, evaluation B.)Planning, implementation, evaluation, review of published research, application to practice problem C.)Evaluation of published research, decision to identify practice problem, planning, implementation, evaluation D.)Determining question to be answered, determining data-gathering methods, data evaluation, plan for utilization, evaluation

ANS: A The proper sequence in the research utilization process must begin with the identification of a practice problem (preutilization), which in turn sets the stage for the step-by-step approach incorporating critical thinking and decision making, including evaluation of published research (assessing), planning, implementing, and evaluating.

How does the federal government affect environmental safety in the hospital setting?A.)Requires employers to provide a safe working environment B.)Identifies those nurses who are not implementing standard precautions C.)Works with the state boards of nursing in disciplining nurses D.)Requires employers to establish guidelines for safe nursing practice

ANS: A The purpose of the Occupational Safety and Health Administration (OSHA), a federal agency, is to establish safety and health standards in the work environment. OSHA requires employers to provide a safe work environment for employees

The stage or mode of a disaster that integrates the nurse's work and operations after a disaster has occurred is commonly known as: A.)Recovery B.)Response C.)Preparedness D.)Operations

ANS: A The recovery mode of a disaster deals with operations that occur after the disaster. During the recovery stage the nurse may be confronted with unexpected or sudden loss of key personnel and clients and the management of mental health issues related to the disaster. The preparedness mode of a disaster deals with operations done before a disaster. The response mode of a disaster deals with operations during a disaster

What elements must be present for a malpractice claim? A.)Duty, breach of duty, patient injury B.)Negligent nursing care, failure to follow standards C.)Failure to report, defamation, discrimination D.)Error in judgment, invasion of privacy

ANS: A There are three elements that must be present for a malpractice claim: (1) You must have a duty—there must be a professional nurse-patient relationship. (2) You must have breached a duty that was foreseeable—you must have fallen below the standard of care. (3) Your breach of duty caused patient injury or damages. The other options do not indicate the nurse's understanding of malpractice.

Which federal program provides a "push-pack" that, when requested, can be transported within 12 hours to an affected community and consists of medical assets such as medications, medical equipment and supplies, and personal protective equipment? A.)Strategic National Stockpile (SNS) B.)CHEMPACK federal program designed to supplement the medical response. C.)Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) D.)National Incident Management System (NIMS)

ANS: A This federally funded program under the auspices of the Centers for Disease Control can aid any stricken community within the U.S. or its territories within 12 hours by delivering critical medical assets to assist the emergency medical and public health response. The SNS is primarily stored for biological acts of terrorism or large-scale natural disasters. CHEMPACK is a similar program but is specifically targeted for chemical agents and/or chemical exposures on a large scale. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medical and clinical professionals (retired, non-licensed, etc.) during an emergency response. The National Incident Management System(NIMS) provides a consistent nationwide template to establish federal, state, tribal, and local governments and private sector and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism

How can nurses being to define their practice context? a. Identify characteristics that are specific to the group of people who will receive nursing care. b. Specify all types of settings that nursing occurs in. c. Determine all characteristics of the setting that contribute to nursing care. d. Determine all characteristics of the setting that inhibit nursing care.

ANS: A To define their practice context, nurses should do the following: identify characteristics that are specific to the group of people who will receive nursing care, specify the type of practice setting that the care will occur in, and determine characteristics of the setting that contribute to or inhibit nursing care.

The sorting of patients according to medical need when resources are unavailable for all persons to be treated is known as: A.)Triage B.)Delegating C.)Task assignment D.)Prioritizing

ANS: A Triage can be used by lightly trained ED personnel and is not to supersede or instruct medical techniques. A common triage system used is known as START (Simple Triage and Rapid Treatment). Triage is used during natural disasters and mass casualty events

A patient is tagged as "Minor" during a mass casualty event. An example of a "Minor" triage is a patient with: A.)A strained right shoulder B.)A large laceration to the right leg C.)An obstructed airway D.)Who is unconscious

ANS: A Under the START triage system, those tagged "Minor" are injured persons who can be assisted after those who are tagged as "Immediate" and "Delayed" have been medically tended to. Persons tagged as "Minor" will not need medical care for at least several hours and can usually walk with assistance (usually consisting of bandages and acute first aid).A client with a large laceration to the right leg would be classified under Delayed triage. Clients with obstructed airway or who are unconscious would be classified under Immediate triage

The staff nurse, in her tenth hour of a 12-hour shift, is told by the house supervisor that her replacement will be 2 hours late and she must work these extra 2 hours. The best option for this nurse, who is tired, is to: A.)Talk to the person over the house supervisor. B.)Refuse and go home on time because she is too tired to work. C.)Fix some strong coffee and call home to explain the situation. D.)Ask the supervisor if she could work a double because she needs the money.

ANS: A When nurses are concerned that their clients require more care than they can provide, they must report this. If you do not get an adequate direction or answer from your immediate supervisor then you should follow the chain of command and report it to the person above your supervisor

The nurse has an adequate understanding of evidence-based practice when the nurse states which of the following? (Select all that apply.) a. "Evidence-based practice is similar to research utilization." b. "Evidence-based practice is becoming important in all areas of health care." c. "Evidence-based practice incorporates many additional sources of data that may contribute to improved nursing care." d. "Evidence-based practice is not accepted as best research evidence." e. "Evidence-based practice is not used in nursing care."

ANS: A, B, C Evidence-based practice is similar to research utilization, is becoming important in all areas of health care, and incorporates many additional sources of data that may contribute to improved nursing care. It is also accepted as best research evidence and used directly in nursing care.

A nurse is educating a coworker on the similarities between conducting research and research utilization. The nurse judges the teaching to be effective when the coworker states: (Select all that apply.) a. "Both are a step-by-step process." b. "Both involve critical thinking." c. "Decision making must occur in both processes." d. "Knowledge generation is essential in both processes." e. "Collecting new data occurs in both."f. "Reviewing published research studies is part of both processes."

ANS: A, B, C Using nursing research in practice is a step-by-step process incorporating critical thinking and decision making to ensure that a change in practice has a sound basis in nursing science. Collecting new data is primarily done in conducting research, and research findings can generate new knowledge. Reviewing published research studies is a component of research utilization.

Conducting research and research utilization are alike in that they both incorporate which of the following? Select all that apply. A.)A step-by-step process B.)Critical thinking C.)Decision-making D.)Knowledge generation E.)Collecting new data F.)Reviewing published research studies

ANS: A, B, C Using nursing research in practice is a step-by-step process incorporating critical thinking and decision making to ensure that a change in practice has a sound basis in nursing science. Collecting new data is primarily done in conducting research, and reviewing published research studies is a component of research utilization

Which of the following are considered nursing practice classification systems? Select all that apply. a. North American Nursing Diagnosis Association International (NANDA-I)Approved List of Diagnostic Labels b. Nursing Interventions Classification (NIC) System c. Nursing Outcomes Classification (NOC) System d. Nursing Management Minimum Data Set (NMMDS) e. Omega Systemf. Client Care Data Set (CCDS)

ANS: A, B, C, D The ANA approved the establishment of the Nursing Information and Data Set Evaluation Center (NIDSEC) to review, evaluate against defined criteria, and recognize information systems from developers and manufacturers that support documentation of nursing care within automated nursing information systems (NIS) or within computer-based patient record systems (CPR). They recognized the following 13 nursing practice classification systems:North American Nursing Diagnosis Association International (NANDA-I) Approved List of Diagnostic LabelsNursing Interventions Classification System (NIC)Nursing Outcomes Classification System (NOC)Nursing Management Minimum Data Set (NMMDS)Clinical Care Classification (CCC, formerly Home Health Care Classification [HHCC])Omaha System Patient Care Data Set (PCDS)Peri-Operative Nursing Dataset (PNDS)SNOMED CTNursing Minimum Data Set (NMDS)International Classification of Nursing Practice (ICNP)ABC codesLogical Observation Identifier Names & Codes (LOINC)

Which steps can the nurse take to apply evidence-based research into nursing practice? (Select all that apply.) a. Identify, review, and evaluate the data applicable to the problem. b. Define the problem. c. Design a practice change based on the data. d. Implement the change in nursing practice. e. Continue to work around the problem.

ANS: A, B, C, D The nurse should begin by defining the problem. Next, the nurse should identify, review, and evaluate the data applicable to the problem. The next steps are to design a practice changed based on the data and implement the change in nursing practice. The nurse should not continue to work around the problem.

A nurse is listening to a pharmacist lecture about factors that contribute to medication errors. The teaching has been effective when the nurse states: (Select all that apply.) a. "Problems within the system contribute to medication errors." b. "Human factors contribute to medication errors." c. "Work-design problems contribute to medication errors." d. "Environmental factors contribute to medication errors." e. "The nurse alone contributes to medication errors."

ANS: A, B, C, D The teaching has been effective when the nurse states that contributions to medication errors include problems within the system, human factors, work-design problems, and environmental factors.

The American Hospital Association and Congress have identified which of the following as major barriers to the full integration of health information technology? Select all that apply. A.)Lack of standardization across point-of-care areas B.)Funding issues C.)No single set of privacy laws D.)Lack of a unique patient identifier number E.0Lack of e-health facilities F.)Insurance reimbursement problems

ANS: A, B, C, DResearch data support that the use of the computerized physician order system (CPOE),computerized decision support systems, medication administration record (MAR), and bar-codes on client identification bands can limit errors and improve care. Both organizations identify barriers as: Lack of standardization across point-of-care areas—Laboratory data and pharmacy systems need to be integrated with the client's health record. Funding—Information technology is costly, and often the major costs are borne by hospitals rather than shared by other providers, payers, and employers. Privacy laws—A single set of privacy laws is needed to simplify the task of communicating across agencies and local, state, and federal governments, which can make compliance difficult and interfere with client care. Lack of a uniform approach (identifier number) to match the client to his or her record—A single authentication number is needed to reduce safety risks and provide a uniform access to a client's data. Items e and f have not been specifically identified as barrier

A nurse manager is educating unit staff about HCAHPS. The manager judges the teaching to be effective when a staff nurse states that the HCAHPS survey contains rating about (Select all that apply.) a. communication. b. pain management. c. responsiveness. d. cost of hospital stay. e. discharge information.

ANS: A, B, C, E Teaching has been effective when the nurse states that HCAHPS survey contains rating about communication, pain management, responsiveness, and discharge information. HCAHPS does not include the cost of the hospital stay.

Which of the following are considered core measures and monitored by The Joint Commission? (Select all that apply.) a. Code arrests infection rates b. Advance directives c. Medication error rates d. Nurse staffing and vacation patterns e. Restraint usef. Numbers of hospital admissions

ANS: A, B, C, E The Joint Commission mandates that organizations continuously track certain core measures in order to monitor quality care. Some of these include advance directives, autopsy rates, leaving against medical advice (AMA) and elopement rates, blood product use rates, blood transfusion reaction rates, code blue rates, conscious sedation complication rates, fall rates, medication error rates, mortality rates, pain management effectiveness, restraint use, perinatal care, rates of deep vein thrombosis, and surgical-site infection rates. Nurse staffing and vacation patterns and tracking hospital admissions are not core measures.

A public health nurse is discussing disaster planning with family. What suggestions can be made to help them be prepared? (Select all that apply.) a.Discuss probable disasters in the area. b.Create a family disaster preparedness kit. c.Establish family emergency communication. d.Only prepare if there is a imminent threat of a disaster in the area. e.Create an evacuation plan.

ANS: A, B, C, E The nurse can suggest that the family discuss probable disasters in the area, create a family disaster preparedness kit, establish family emergency communication, and create an evacuation plan. The family should not wait until there is a guarantee of disaster because the goal is to be prepared in advance.

Which actions take place in organizations to monitor quality improvement? (Select all that apply.) a.Evaluation of what nurses are doing for patients b.Development of policies and procedures c.Employee evaluations d.Intermittent monitoring e.Continuing education

ANS: A, B, C, E There are many actions that take place in organizations to monitor quality improvement. These include evaluation of what nurses are doing for patients, development of policies and procedures, employee evaluations, ongoing monitoring, and continuing education.

If the nurse had an adequate understanding of continuous quality improvement, which of the following statements would the nurse? (Select all that apply.) a. "The accountability for quality is vested in quality circles that function along service lines to improve patient care." b. "After quality standards are achieved, the nurse strives to maintain that standard of care." c. "Quality standards must incorporate the expectations of patients and their families." d. "Systems within the hospital must be reviewed to determine how care can be enhanced." e. "Reducing costs to provide for substantial pay increases for nursing staff is an example of continuous quality improvement." f. "Computerized electronic documentation systems that provide continuous assessment of patient charges are an example of continuous quality improvement."

ANS: A, B, D Quality improvement (QI) refers to the process or activities that are used to measure, monitor, evaluate, and control services so that nurses can provide some measure of confidence to health care consumers. It includes reports that must be generated to track progress. This approach emphasizes continually looking for opportunities to improve. QI looks not only at what the nurse does in the pursuit of quality but also at how the systems of the units in the hospital can be improved to provide better care at lower cost. Reducing costs by providing for pay increases for nursing staff and computerized documentation systems are not examples of QI. Although quality improvement affects patients, their expectations and their family members' expectations are not necessarily incorporated into quality circles and the work that they do. Nurses must monitor quality care compliance; otherwise, people tend to go back to their old ways of doing things. The QI department is typically the department that receives data, analyzes trends, and recommends actions to facilitate improvement in the organization. However, there should also be a continuous quality improvement (CQI) council as a primary decision-making nursing team, as well as quality circles (QCs) that function along service lines, collaborating to improve care for a group of patient types.

A nurse is preparing a presentation on core measures. Which medical diagnosis should the nurse plan on presenting during the lecture? (Select all that apply.) a. Myocardial infarction b. Congestive heart failure c. Diabetes d. Pregnancy-related conditions e. Deep vein thrombosis

ANS: A, B, D, E Core measures include those for patients admitted with myocardial infarction, congestive heart failure, pregnancy-related conditions, and deep vein thrombosis. Diabetes does not fall under these core measures.

The nurse has an adequate understanding of risk management when stating which of the following? (Select all that apply.) a."Risk management becomes involved when incidents occur." b."Risk management becomes involved when untoward events occur." c."Risk management becomes involved to discipline the nurse." d."Risk managers gather evidence surrounding the event." e."Risk managers will interview those involved in an event."

ANS: A, B, D, E Risk management becomes involved when incidents and untoward events occur. Risk managers gather evidence surrounding the event and interview those involved. Risk management does not become involved to discipline the nurse.

The nurse understands the function of The National Institute of Nursing Research (NINR) when stating: (Select all that apply.) a. "The NINR is a major source of federal funding for nursing research." b. "The NINR supports education in research methods." c. "The NINR funds local hospitals." d. "The NINR supports education in research career development." e. "The NINR establishes National Nursing Research Agenda."

ANS: A, B, D, E The NINR has several functions, including acting as a major source of federal funding for nursing research, supporting education in research methods and research career development, and establishing the National Nursing Research Agenda. Funding local hospitals is not a function of the NINR.

A patient has been exposed to chlorine gas. What symptoms can the nurse expect the patient to have? (Select all that apply.) a.Nose and throat irritation b.Eye redness c.Ear pain d.Cough e.Suffocation

ANS: A, B, D, E The nurse should expect the patient to have the following symptoms: nose and throat irritation, eye redness, cough, and suffocation. Ear pain is not a symptom of exposure to chlorine gas.

A nurse manager is educating a staff nurse on the four top agents for potential bioterrorism. The nurse manager judges that the teaching has been effective when the staff nurse states that the top agents include (Select all that apply.) a.smallpox. b.anthrax. c.flu virus. d.botulism.e.plag

ANS: A, B, D, E The teaching is effective when the staff nurse identifies the following as the top four agents for potential bioterrorism: Smallpox, anthrax, botulism, and the plague. The flu virus is not considered one of the four agents.

Which action would be occurring if a group of nurses were in the analyze phase of the DMAIC process? (Select all that apply.) a. Identify gaps between current performance and the goal. b. Identify possible sources of variation. c. Determine the goal. d. Write the problem statement. e. Determine where to begin making a change.

ANS: A, B, E If the nurses were in the analyze phase of the DMAIC process, they would identify gaps between current performance and the goal, identify possible sources of variation, and determine where to begin making a change. Determining the goal and writing the problem statement occur in the define phase.

A nurse is completing an incident report. The nurse demonstrates an adequate understanding of the report when refraining from putting which of the following on the form. (Select all that apply.) a.Conclusions about the incident b.The name of the patient c.Blame of othersd.Judgment e.The nurse's opinion about what happened

ANS: A, C, D, E The nurse should avoid putting conclusions, blame, judgment, and opinions on the incident report. The nurse should only relay facts. It would be appropriate for the nurse to list the patient's name.

A nurse has an adequate understanding of barriers to quality improvement when stating which of the following? (Select all that apply.) a. "Cost is a barrier in quality improvement." b. "There are no barriers to quality improvement." c. "Nurses' loyalty to old practices is a barrier." d. "Failure to recognize that change is needed is a barrier." e. "Being unwilling to change is a barrier."

ANS: A, C, D, E There are several barriers to quality improvement. These barriers include cost, loyalty to old practices, failure to recognize that change is needed, and being unwilling to change.

A nurse is receiving education on disaster levels. The teaching has been sufficient when the nurse states that a Level III disaster includes (Select all that apply.) a.earthquakes. b.house fires. c.tsunamis. d.train derailment. e.hurricanes.

ANS: A, C, E The teaching has been effective when the nurse identifies Level III disasters as earthquakes, tsunamis, and hurricanes. House fires are considered Level I disasters, and train derailments are considered Level II disasters.

The CDC CHEMPACK cache contains which of the following items? Select all that apply. A.)MARK-1 Kits B.)Doxycycline C.)Potassium iodine D.)Diazepam E.)Ciprofloxacin F.)Quinine

ANS: A, D MARK-1 kits are the core of the chemical antidote kits provided in CHEMPACK caches. Diazepam is also provided in CHEMPACK caches for use in clients stricken with a nerve agent. Doxycycline and ciprofloxacin are antibiotics used primarily in the Strategic National Stockpile push-packs. Potassium iodine is a prophylaxis used in the prevention of radiation poisoning. Quinine is not appropriate in this context (antimalarial drug)

Which of the following are considered core measures and monitored by the Joint Commission? Select all that apply. A.)Code arrests infection rates B.)Advance directives C.)Medication error rates D.)Nurse staffing and vacation patterns E.)Restraint use F.)Numbers of hospital admissions

ANS: A.) B.) C.) E.)

Ergonomic hazards are a major safety risk for nurses, causing serious musculoskeletal injuries. To reduce the risk, nurses should: A.)Use assistive devices. B.)Take up weight lifting. C.)Never lift or move patients. D.)Stretch out after pulling or reaching.

ANS: AThe current recommendations by the American Nurses Association (ANA) include the use of assistive patient-handling devices for lifting, transferring, and turning patients. According to the ANA, there is no safe way to manually lift or turn a physically dependent person (i.e., proper lifting techniques or good body mechanics) without risking back and shoulder injuries

The Joint Commission publishes a Sentinel Event Alert every month. Which of the following is the best example of a sentinel event? a. Tylenol #3 is given to a patient when plain Tylenol was ordered. b. Code pink is called after a newborn is discovered missing from the nursery. c. After receiving the correct medication, the patient complains of itching all over, and a rash is noted on the patient's trunk. d. During a blood transfusion, the patient's temperature increases to 100.4° F, and the patient complains of generalized pruritus.

ANS: B A sentinel event is an unexpected occurrence involving death or loss of limb or function. Examples of sentinel events include serious medication errors, significant drug reactions, surgery performed on the wrong body site, blood transfusion reactions, and infant abductions.

Endemic diseases can occur in clusters of people from the same geographically distinct area. The biological agents that can be disseminated by airborne release are: A.)Anthrax and plague B.)Botulism and anthrax C.)Plague and smallpox D.)Botulism and smallpox

ANS: B Both anthrax and botulism can be aerosolized and inhaled

Which would not be a barrier to research utilization? A.)Too few studies reported in the literature relating to the identified problem B.)Obtaining consensus to implement a new approach to resolve the care problem C.)Staff suggesting there is too little time to learn a new approach to the care problem D.)Staff asking, "Why fix it if it isn't broken?"

ANS: B Consensus building constitutes a second phase of step 1 that is used to identify the specific practice to be changed. In this phase, the incorporation of the principles of change theory will increase the possibility of success. A change will be more acceptable if those affected are included in the decisions related to the change. Clear communication and teamwork are essential elements of this process. Group consensus is crucial for the successful application of research findings. Barriers include those who are resistant to the change, budgetary and personnel constraints, too few research studies related to the practice problem, the lack of replication of the findings, and the time lag from the completion of a research project until the project report is published may make the research findings obsolete.

What does the "scope of nursing practice" refer to?A.)Acts that permit some overlap between nursing and medicine B.)The activities legally permissible for a nurse to perform in a particular state C.)The specific duty the nurse owes to a patient D.)Those activities for which a nurse can be held liable for malpractice

ANS: B Defining the scope of nursing practice is part of the responsibility of the state board of nursing. This involves determining the specific activities for each level of nursing and who can perform what functions. The duty that a nurse owes to a patient is part of the professional nurse-patient relationship. Any nursing activity that is outside the scope of nursing practice can be grounds for malpractice or negligence.

How does evidence-based practice (EBP) differ from research utilization? A.)EBP has similar steps to the nursing process, which differ from research utilization. B.)EBP is a systematic method of applying research findings to nursing practice that incorporates many additional sources of data that may contribute to improved nursing care. C.)Research utilization is a component of nursing practice that involves the collection of data to answer a specific research question and EBP uses the data to make protocols. D.)EBP uses a nursing theoretical framework for implementation of practice guidelines, which is essential for the continued development of nursing theories

ANS: B Evidence-based practice is similar to research utilization in that it is a systematic method of applying research findings to nursing practice that incorporates many additional sources of data (not just nursing and nursing theory) that may contribute to improved nursing care. A brief definition of evidence-based practice that is generally accepted is the integration of the best research evidence with clinical expertise and patient values. EBP implies internal decision making on the nurse's part. The steps in applying evidence-based practice include defining the problem; identifying, reviewing, and evaluating the data applicable to the problem; designing a practice change based on the data; implementing the change in nursing practice; and evaluating the implementation. All three processes—research utilization, nursing research, and the nursing process—have the same five major steps. However, the specific tasks for each process are different. The collection of data to answer a research question is the research process, not research utilization.

The American Nurses Association recommends the use of assistive devices for safe patient handling. What was the research that initiated this recommendation? A.)Patients were being injured by falls during transfers. B.)Back injuries in staff nurses were occurring even with good body mechanics. C.)Increased number of lawsuits resulted from patient falls. D.)Reports from state boards of nursing showed increased back injuries.

ANS: B In many situations, proper body mechanics are not adequate to protect the nurse. The nurse cannot adjust in a way that fully protects the back. Teaching nurses to use proper body mechanics to lift and turn clients has not resulted in fewer injuries. The current recommendations by the ANA include the use of assistive patient-handling devices for lifting, transferring, and turning clients

Which of the following potential bioterrorism agents has three routes of exposure to humans? A.)Smallpox B.)Anthrax C.)Botulism D.)Tularemia

ANS: B Infection with Bacillus anthracis, the cause of anthrax, can occur via three routes of exposure: cutaneous, gastrointestinal, and inhalation. Botulism can be transmitted via ingestion of toxin-contaminated food. The toxin can be aerosolized and inhaled (man-made). Tularemia is not known to be spread from person to person and is caused by the bacterium Francisella tularensis, which is found in animals (especially rodents, rabbits, and hares).

A nurse is discussing the Pareto principle (80/20 rule), which leads to the idea of total quality management. Which statement indicates an adequate understanding of this principle? a. Peter Pareto c. Phillip Crosby b. Joseph Juran d. Edward Deming

ANS: B Joseph Juran is one of the forefathers of quality initiatives. He stressed the meaning of the Pareto principle and how it applies to improving quality in all organizations.

What would National Institute of Nursing Research (NINR) activities include? A.)Providing financial support for any worthy nursing research study B.)Channeling federal money into nursing research related to the national nursing research agenda C.)Publishing information detailing successful research utilization projects D.)Arranging traineeships in development of research proposals

ANS: B One function of the NINR is to establish the National Nursing Research Agenda, which is composed of priority topics for nursing research. These topics may be related to a national health need, or they may be in an area that requires research for the development of nursing science. The NINR is a major source of federal funding for nursing research. The NINR also supports education in research methods, research career development, and excellence in nursing science. It does not arrange nursing research traineeships or publish information on the success of research utilization projects.

What is the definition of nursing informatics? A.)A specialty area of hospital nursing in which management of patient care is done via computers B.)The specialty practice of nursing integrating nursing science with computer science and information science C.)The input and retrieval of a patient's complete medical history via electronic data D.)An area of computer system design and analysis to provide and retrieve patient health data during the period of hospitalization

ANS: B The ANA has defined informatics as "the activities involved in identifying, naming, organizing, grouping, collecting, processing, analyzing, storing, retrieving or managing data and information.

A nurse who commits an infraction of the Nurse Practice Act is always subject to discipline by what group? A.)A court of law B.)The state board of nursing C.)The local chapter of the state nurses association D.)The National League for Nursing

ANS: B The Nurse Practice Act is regulated and enforced by the state board of nursing. State Nurse Practice Acts regulate nursing by controlling the scope of practice and determining the specific activities for each level of nursing. Some states control who may use the titles registered nurse (RN) and licensed practical nurse (LPN) or licensed vocational nurse (LVN). The Nurse Practice Act is regulated and enforced by the state board of nursing. The National League of Nursing is involved with nursing program accreditation. The local state nurses association does not provide discipline for infarctions to the Nurse Practice Act. Only if the infarction is of a criminal nature will the state board of nursing refer the case to the local court of law.

When evaluating an Internet site, the nurse understands that: a. Internet information must go through careful screening before it can be posted b. Credibility, accuracy, and reasonableness of the information should be considered c. It is important to have the hospital librarian verify the authenticity of the site d. Most Internet information can be downloaded or beamed to a personal digital assistant (PDA)

ANS: B The credibility of the information that you obtain from Internet searches should be challenged. It is important to be skeptical, because not all information that is posted is accurate. Information should be evaluated and reevaluated on a regular basis. It is important to remember that Internet information is dynamic and fluid in nature, as compared with printed information

Which statement would indicate a unit nursing staff is entering the preutilization step of research utilization? A.)"We've found two studies that have explored methods for reducing violent behavior on psych units." B.)"We need a new approach to containing violence on the psych unit." C.)"This is the plan for implementing the new antiviolence strategies." D.)"This is a summary of the evaluation data we collected."

ANS: B The first step in using research in nursing practice is the recognition that some aspect of nursing practice could be done in a more efficient, a more beneficial, or simply a different way, so wanting a new approach to containing violence on a psych unit would be an example. Identifying studies about methods for reducing violent behavior would be step 2—assessing. Planning to implement new antiviolence strategies would be step 3 of the process. A summary of evaluation data would be included in the final step (step 5) of the process

At the time of admission, a patient gave a history of allergy to penicillin that was duly noted in all critical areas of the patient's record. While giving medications, a nurse accidentally administered penicillin to this patient. The patient had a severe reaction but recovered. What is the implication of the nurse's action? a.The nurse cannot be sued for malpractice because the patient did not directly the nurse of the allergy. b.The nurse failed to act in a reasonable and prudent fashion and thus is liable for malpractice. c.The nurse who gave the medication can bring a countersuit against the nurse who took the history. d.There is no cause for concern because the action did not result in the patient's death.

ANS: B The nurse failed to act in a reasonable and prudent fashion and thus is liable for malpractice. The most common errors include failure to administer the right drug to the right patient, in the right amount, by the right route, at the right time, and with the right documentation. Claims involving medication errors are augmented when the nurse fails to record the medication administration properly, fails to recognize side effects or contraindications, or fails to know a patient's allergies. There is no justification for the nurse to bring about a countersuit for the nurse who took the medication history because it was clearly noted in all critical areas of the chart

The nurse has an adequate understanding of smallpox when the nurse states which of the following? a."Smallpox does not exist because of vaccines." b."Smallpox can easily be spread from person to person." c."Smallpox must be ingested for a person to become sick." d."Smallpox is resistant to vaccines."

ANS: B The nurse has an adequate understanding when the nurse states that smallpox can easily be spread from person to person. Smallpox does still exist, does not need to be ingested for a person to become sick, and is not resistant to vaccines.

Which statement by the nurse indicates understanding of the nurse practice act? a."The nurse practice act defends any action the nurse may take." b."The nurse practice act defines the scope of practice for each level of licensure." c."The nurse practice act details pay raises for each year of service to an organization." d."The nurse practice act has language that grants nurses vacation time."

ANS: B The nurse practice act defines the scope of practice for each level of licensure. It is a type of state statutory law and can be obtained from the state board of nursing or online. It does not defend any action the nurse may take, detail pay raises, or discuss vacation time.

A nurse has relocated to another state and wants to find a full-time nursing job. What action should be taken first in order to provide care as a nurse? a.Begin applying for jobs at the local hospital. b.Contact the board of nursing in the nurse's new state to obtain licensure to practice. c.Begin practicing immediately, as the nurse is still licensed in the formerly lived in state. d.Begin practice on a part-time basis so that a new license is not needed.

ANS: B The nurse should contact the board of nursing in the state the nurse just moved to in order to determine what needs to be done to obtain licensure to practice in that state. The nurse should not begin practicing without an updated license even on a part-time basis. Each state may require a new license, and the nurse will not be covered by a license issued in another state unless the state is part of the nurse licensure compact. Either way, the nurse will need to contact the board of nursing first.

Which error in judgment would be the most serious for the nurse defendant in a legal case? a.Discussing the case with the plaintiff b.Tampering with the chart c.Hiding information from the plaintiff's attorney d.Being discourteous on the witness stand

ANS: B The patient's chart is a legal document. Changing or tampering with the chart would be in violation of the standards of practice, and the Nurse Practice Act and would not be considered "what a reasonable nurse would do." The nurse is expected to perform as a reasonable nurse would. If your actions are not those of a reasonable nurse and this causes someone to be injured, you can be sued. Being discourteous on the witness stand may not be professional. It is also not appropriate to discuss the case with the plaintiff or hide information; however, tampering with the chart is a more serious error in judgment.

The primary goal of the continuous quality improvement process of Six Sigma is to: A.)Identify errors. B.)Increase profits. C.)Keep standard policies and procedures consistent. D.)Improve patient-provider communication.

ANS: B The primary goal of Six Sigma is to increase profits and reduce problems by improving standard operating procedures, reducing errors (not just identifying them), and decreasing misuse of the system. Six Sigma methodology is based on strategies that focus on CQI and reducing variation in practice through the application of DMAIc. In other words, once a protocol is found to be effective, everyone is trained to do it the same way. The Six Sigma DMAIC process (define, measure, analyze, improve, control) is used primarily for improving existing processes that do not meet institutional goals or national norms. Although patient-provider communication is important, it is not the primary goal of Six Sigma.

Which of the following chemical agents has the clinical presentation of smelling like freshly-cut grass? A.)Chlorine gas B.)Phosgene gas C.)Cyanide gas D.)VX gas

ANS: B The residue from the choking agent known as phosgene gas on the clothes or skin of an affected client has the distinct odor of fresh cut grass. Chlorine gas has been described as smelling like bleach. Cyanide gas has been described as smelling like almonds. VX gas has been described as smelling like Vicks VapoRub or rotting fruit.

A nurse wants to avoid malpractice claims. What action can be taken to greatly reduce the risk of a lawsuit? a.Reduce work status to part time. b.Implement fall precautions on an older adult patient. c.Leave clutter on the floor in patient rooms. d.Leave the patient's bed in the highest position.

ANS: B To protect themself from a malpractice claim, the nurse can implement fall precautions on an older adult patient. These include supervising the patient when getting out of bed, keeping the floor clear, and placing the bed in the lowest position. Reducing work status to part time would not guarantee that the nurse wouldn't be named in a lawsuit.

A nurse is reviewing the technique used to identify the factors involved in an error. Which statement indicates the nurse has an adequate understanding? a. "The rapid cycle test is a technique that is widely used." b. "A root cause analysis is a process designed to investigate and categorize the root cause of the event." c. "A failure mode and effects analysis is a procedure to investigate the cause of the error." d. "Define, measure, analyze, improve, control prevents events from occurring."

ANS: B When an error is analyzed, the primary causes need to be determined so that a workable and effective solution can be developed. A root cause analysis is such a process designed to investigate and categorize the root cause of the event. The Six Sigma DMAIC process (define, measure, analyze, improve, control) is used primarily for improving existing processes that do not meet institutional goals or national norms. Rapid cycle tests are components of continuous quality improvement. A failure mode and effects analysis (FMEA) is a procedure in product development and operations management for analysis of potential failure modes within a system for classification by the severity and likelihood of the failures.

The most important goal in the management of a disaster such as one caused by a category 5 hurricane is to: A.)Rescue the victims. B.)To have a plan in place when a disaster strikes C.)Give immediate first aid and medical care to the victims. D.)Evacuate the injured to medical facilities.

ANS: B While all of the options are important, the most important aspect of any disaster management is to have a plan of prevention in place. Disaster prevention can eliminate or reduce tremendous pain, suffering, and loss of life that could occur if, for example, people were not evacuated from a coastal area before a hurricane

Violence in the health care setting: A.)Is a new problem B.)Can occur anytime and anywhere C.)Is a problem in the acute care setting D.)Occurs mostly in mental health settings

ANS: B Workplace violence is a growing risk and the second leading cause of occupational death in the United States. Health care workers are at risk for harm from coworkers, clients, families, and visitors

A nursing professor is educating students on barriers to incorporating nursing research into practice. The nurse professor judges the teaching to effective when a student states: (Select all that apply.) a. "Because of advances in research, there are no barriers." b. "A barrier is time lag from completion of research until the project report is published." c. "Resistance of individuals involved can cause a barrier." d. "Budget constraints are a barrier." e. "Personnel constraints are rarely a barrier."

ANS: B, C, D The teaching has been effective when the student lists the following as a barrier to incorporating nursing research into practice: Time lag from completion of research until the project report is published, resistance of individuals, and budget and personnel constraints.

A staff nurse recognizes the need for a change in practice regarding hand hygiene. How can the nurse implement a change in practice? (Select all that apply.) a. Ignore the problem until management enforces a change. b. Ask if the manager can hold a staff in-service. c. Implement the change on the unit.d. Monitor the change. e. Evaluate the effectiveness of the change.

ANS: B, C, D, E The fourth step of applying evidence-based practice is to implement the change in nursing practice. The nurse can accomplish this by asking if the manager can hold a staff in-service, implementing the change on the unit, monitoring the change, and evaluating the effectiveness of the change.

A nurse manager is educating a group of nurses on common medication errors. The manager judges the teaching to be effective when one of the nurses states that common medication errors include (Select all that apply.) a. good communication b. look-alike packaging c. wrong-dose errors d. inadequate monitoring e. rule violations

ANS: B, C, D, E The teaching has been effective when the nurse states that common medication errors include look-alike packaging, wrong-dose errors, inadequate monitoring, and rule violations. Common medication errors also include poor communication.

Which action by a group of nurses involves brainstorming? (Select all that apply.) a. List one solution to the problem. b. Identify stakeholders. c. Think about solutions to the problem. d. Write the problem statement. e. Write a goal statement.

ANS: B, C, D, E To brainstorm, the nurses should think about solutions to the problem, identify stakeholders, list solutions to the problem, and write the problem statement as well as the goal statement.

A nurse is caring for patients after a major disaster has occurred. What is the best action in caring for these patients? (Select all that apply.) a.Avoid discussing the disaster that has occurred. b.Encourage patients to talk about their experience. c.Empathize with patients and their emotions and experiences. d.Ask patients not to discuss the disaster until they are under the care of a psychologist. e.Reinforce their emotions and reactions as normal.

ANS: B, C, E The nurse should encourage patients to talk about their experience, empathize with patients about their emotions and experiences, and reinforce their emotions and reactions as normal.

The continuous quality improvement (CQI) committee has performed a retrospective chart audit to investigate whether outcomes recorded in each nursing care plan are patient centered and written in behavioral terms. The expected standard is 98% compliance. The sample size was 200. Results showed that 180 charts met the standard. What assessment can be made? a. The standard was met. No action plan is necessary. b. The standard was not met, but no action plan is necessary because the rate of compliance was close to the standard. c. The standard was not met. An action plan should be developed. d. The standard was not met. An immediate re-audit is necessary.

ANS: C A threshold, or cutoff point, is determined for each indicator. This example represents a 90% compliance rate (180 divided by 200 = 0.9 or 90%), but the threshold or expected standard was set at 98%. Therefore, the standard was not met, and an action plan needs to be developed.

No isolation precautions are necessary for patients with: A.)Tuberculosis (TB) B.)Plague C.)Botulism D.)Smallpox

ANS: C Botulism is transmitted by ingestion of toxin-contaminated food. It can be aerosolized and inhaled. The client needs supportive care only; no isolation precautions are necessary.

In understanding terrorist threats as they relate to public health and medical preparedness, the nurse understands the current acronym that categorizes the scope of threats is: A.)BOMB B.)THREAT C.)CBRNE D.)ESAR-VHP

ANS: C CBRNE is the current acronym used to classify the scope of terrorist threats. The acronym stands for Chemical, Biological, Radiological, Nuclear, and Explosive threat

Which unit's responsibilities include triage of victims at a disaster site, medical care at the site, and staging locations outside the disaster site for transportation of patients to alternative health care facilities? A.)Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) B.)Medical Reserve Corps (MRC) C.)Disaster Medical Assistance Teams (DMAT) D.)NIMS National Incident Management System (NIMS)

ANS: C DMAT units are composed of teams of various clinical health specialties that include, but may not be limited to, communications, logistics, maintenance, and security. These teams are locally based but can be deployed federally on request. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medical and clinical professionals (e.g., retired, non-licensed) during an emergency response. START is a form of triage care used during a mass casualty event. MRC is a registry of medical reserve corps persons who can be recruited for overall assistance with a health or hospital facility during an emergency response. NIMS is the national framework developed by the Department of Homeland Security and FEMA to standardize emergency response from a local through federal level.

Surveillance for the outbreak of disease in the hospital setting is primarily the responsibility of the: A.)Safety officer B.)Risk manager C.)Infection control nurse D.)Hospital surveillance officer

ANS: C In the hospital the infection control nurse is responsible for both passive and active hospital surveillance monitoring

What is the term used to describe a situation in which a patient agrees to have an invasive procedure performed after having the procedure and its consequences explained? A.)Contract B.)Incident report C.)Informed consent D.)Statute

ANS: C Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for it to be done. Informed consent is not a binding agreement, an incident report, or a written legal policy.

The nurse has an adequate understanding of nurse practice acts when stating which of the following? a."Nurse practice acts do not help guide nurses." b."Nurse practice acts describe how to prepare for the NCLEX exam." c."Nurse practice acts describe how and when to renew a nursing license." d."Nurse practice acts provide a list of job openings."

ANS: C Nurse practice acts are great resources that provide information to nurses, including how and when to renew a nursing license. The nurse practice acts do not describe how to prepare for the NCLEX exam or provide a list of job openings

What is the importance of using classification systems for nursing nomenclature to describe nursing practice? a. To provide a system to develop and use a client care management system b. To allow nursing administration to project, define, and implement nursing care policies and guidelines c. To assist the quality control team to survey and gather data that will reflect the acuity classification of clients d. To facilitate collection of consistent data that can be accurately manipulated in an electronic medical record

ANS: C Nursing nomenclatures offer a recognized systematic classification and consistent method of describing nursing practice. Without a common language, data cannot be aggregated into a useful language

The nurse manager has an adequate understanding of research utilization when stating which of the following? a. "In the process of research utilization, the emphasis is on finding new data." b. "A major component of the process is reviewing current nursing practices." c. "The process involves transferring research findings into practice." d. "The process is solely based on critical thinking."

ANS: C Research utilization involves transferring research findings into practice. Emphasis is based on using existing data. A major component is reviewing completed nursing research studies and is based on critical thinking and decision making.

Research utilization is the systematic: A.)Collection of data to answer a specific question B.)Analysis of the practice context C.)Process of integrating the findings of completed studies into practice D.)Application of the findings of one research study

ANS: C Research utilization is the process of systematically integrating the findings of completed nursing research studies into clinical nursing practice. The important aspect is using already existing research data and findings to modify nursing practice.

A nurse is providing care to a 6-year-old child with a broken arm. The nurse notices multiple bruises. The child says, "my father got mad because I was bad, and he hit and broke my arm so that I would remember to be good." What is the best nursing action? a.Chart that the child is a victim of abuse. b.Do nothing because the nurse cannot prove the child was abused. c.Report the situation to the appropriate authorities. d.Ignore what the child said because little children often lie.

ANS: C States have many statutes that require health care providers to report certain incidences or occurrences. If the provider fails to report as required and a person is injured, there can be negligence per se. It important for nurses to be aware of the reporting statutes in the state in which they are practicing. In most states, it is the law to report evidence of child or adult abuse. It is not appropriate to chart a decision that the child is a victim of abuse but rather to accurately describe injuries and comments that are made. Nurses should listen to what the patient has to say—whether the patient is a child or adult.

The Needlestick Safety and Prevention Act of 2000 was implemented to prevent health care workers from experiencing needlestick injuries. Which of the following is required documentation regarding a needlestick injury? A.)Notify the patient's physician. B.)Advise the hospital risk management department. C.)Document the department or work area in which the exposure occurred. D.)Send the injured staff person to the emergency room for documentation of the incident.

ANS: C The Act requires documentation of the department and work area in which the needlestick injury occurred. It also requires employers to maintain a sharps injury log to document the type and brand of device involved and an explanation of how the incident occurred. The information is to be recorded and maintained in a way that protects the confidentiality of injured employees

Hospitals are granted Magnet status by the: A.)National League of Nursing B.)American Nurses Association C.)American Nurses Credentialing Center D.)National Council of State Boards of Nursing

ANS: C The American Nurses Credentialing Center is responsible for judging whether hospitals achieve Magnet status.

Which form of standardized structure is implemented in hospitals during an emergency response to coordinate and standardize command and operations?A.)Emergency System for the Advance Registration of Volunteer Health Professionals (ESAR-VHP) B.)START system of triage C.)Hospital Incident Command System (HICS) D.)Initiation of the Medical Reserve Corps (MRC)

ANS: C The Hospital Incident Command System (HICS) is a standardized command structure that allows for coordination and collaboration across jurisdictions and professions within a hospital facility during an emergency response. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medical and clinical professionals (retired, non-licensed, etc.) during an emergency response. START is a form of triage care used during a mass casualty event. MRC is a registry of medical reserve corps persons who can be recruited for overall assistance with a health or hospital facility during an emergency response

The primary role of The Joint Commission (TJC) is a. granting magnet status to excellent hospitals. b. lobbying Congress on behalf of Medicare/Medicaid patients. c. ensuring medical facilities meet patient safety guidelines. d. inspecting hospitals for compliance of infection control standards.

ANS: C The Joint Commission (TJC) is the primary accrediting body for health care institutions. Its standards directly address patient safety issues. Magnet status is approved by the American Nurses Association. TJC does not lobby Medicare/Medicaid issues. The CDC is the agency that maintains standards regarding infection control for hospital compliance.

In a malpractice suit, how may a breach of duty be established? A.)Liability testimony of physician B.)Testimony from state board of nurses C.)Expert testimony D.)Testimony of coworkers

ANS: C The duty of a nurse is to act as a reasonable nurse would under the same or similar circumstances. An expert witness may testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. Testimony from a physician, the state board of nursing, or coworkers does not establish a breach of duty. The state board of nursing provides the statues and laws that govern nursing practice.

In transcribing orders for a patient, the nurse finds a new order for aspirin, 500 mg, qid. The patient has a long history of gastrointestinal bleeding. What is the best nursing action? A.)Give the medication. B.)Withhold the medication and chart why it was not given. C.)Call the physician and question the order in light of the patient's history. D.)Ask the patient whether he is allergic to aspirin.

ANS: C The nurse should call the physician and question the medication order for aspirin based on the patient's history of gastrointestinal (GI) bleeding. Claims involving medication errors are augmented when the nurse fails to recognize side effects or contraindications or fails to know a patient's allergies. The nurse would withhold the medication until the physician is notified and the order clarified. Giving the medication could cause the patient to start bleeding. Although asking for allergies is an important nursing action, the important aspect in this situation in the medical history of GI bleeding.

In a legal suit, what element is necessary to prove a tort has been committed? A.)Intent B.)Assault C.)Injury D.)Malpractice

ANS: C There are four elements that need to be present in a malpractice case, one of which is patient injury. The patient will have to prove that the specific nursing action caused injury or harm. The nurse, as a defendant, does not have a "burden of proof."

A nurse manager is brainstorming quality improvement methods. Which action would help implement these methods on the assigned unit? a. Continue without change. b. Resist change from upper management. c. Empower employees to carry out needed strategies for change. d. Agree to change what is directly beneficial.

ANS: C To implement and benefit from quality improvement methods, the nurse should encourage employees to carry out needed strategies for change. Continuing without change, resisting change, or only agreeing to change that is only directly beneficial would not be helpful.

During a life-threatening emergency, a nurse hurriedly gives the patient a medication by IV push. There is extravasation of medication. Later, necrosis and tissue sloughing take place. The nurse's behavior may be the basis for what action? A.)Felony charge B.)Misdemeanor charge C.)Tort suit D.)Defamation suit

ANS: C Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Civil, as opposed to criminal, actions are also called torts. Remember that civil actions occur when a plaintiff files a lawsuit to receive compensation for damages he or she suffered as a result of a perceived wrong. Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Defamation (libel and slander) refers to causing damage to someone else's reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander.

What is a significant action a nurse can take to prevent being named in malpractice suits? a.Refuse to care for suit-prone patients. b.Carry professional liability insurance. c.Maintain updated professional knowledge and skills. d.Check with a nursing supervisor before undertaking care

ANS: C When you become a registered nurse, you will have a license to practice nursing. This license sets certain standards, which you must follow as a nurse in the state. Should you not live up to these standards, your state can take away your ability to practice as a nurse. The best way to maintain those standards to practice professionally is to stay updated on skills and knowledge. Refusing to care for patients does not prevent you from being named in other malpractice suits. Carrying professional liability insurance does not prevent a malpractice suit but may provide assistance and monies in paying out claims. Although it is important to check with a supervisor about questions concerning nursing care, it may not prevent you from being named if you perform a procedure or intervention incorrectly.

The nurse interprets which of the following to be a Level III disaster? (Select all that apply.) a.Car accident b.Train derailment c.Hurricane d.Tsunamie.House firef.Tornado

ANS: C, D Hurricanes and tsunamis are large-scale disasters that consume local, state, and federal resources to the fullest extent and will require an extended response time by the community health nurse that can extend into weeks or months. Car accidents and house fires are Level I disasters, which are small-scale, local disasters that do not require an outside agency response. Train derailments and tornadoes are Level II disasters, which require the nurse to respond in a greater capacity using larger casualty practices in coordination with regional response agencies (e.g., state health and emergency management agencies).

Which statement by the nurse indicates understanding of the control phase of the DMAIC process? (Select all that apply.) a. "In the control phase, only the leader should be informed of changes." b. "Only those directly affected by the new process should be educated." c. "In the control phase, steps in the new process should be standardized." d. "Changes should be monitored to ensure compliance." e. "Standard operating procedures should be written."

ANS: C, D, E In the control phase of the DMAIC process, everyone should be kept informed of changes, standard operating procedures should be written, everyone should be educated about the new process, the steps in the new process should be standardized, and changes should be monitored to ensure compliance.

The nurse understands that a collection of various information technology applications that provides a centralized repository of information related to client care across distributed locations is called: a. A computer-based patient record (CPR) b. A computer processing of data (CPD) c. An online informatics system (OIS) d. A clinical information system (CIS)

ANS: D A clinical information system (CIS) is a repository that also encodes the status of decisions, actions underway for those decisions, and relevant information that can help in performing those actions. The database could also hold other information about the client, including genetic, environmental, and social contexts. Essentially, the CIS uses the computer to provide and store information and data about a client from departments that are client-focused or departmental-focused.

The nurse understands that the following statement is true about patient classification systems? a. "The systems measure all the needs of patients." b. "The systems provide an absolute formula for unit staffing." c. "The systems should not be used to make patient care assignments because acuity systems are more accurate." d. "The systems provide historical data of the usage of nursing time, which is helpful when developing the department budget."

ANS: D A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. It is helpful for developing a department budget. It is not a formula for unit staffing and does not measure all the needs of the patients.

What would be the most effective way for a nurse to validate "informed consent?" a.Check the chart for a completed and signed consent form. b.Determine from the physician what was discussed with the patient. c.Ask the family whether the patient understands the procedure. d.Ask the patient what he or she understand regarding the procedure.

ANS: D Asking the patient (not the family unless the patient is a minor child) what he or she understands regarding the procedure is an effective way to validate informed consent. Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for the procedure to be done. The piece of paper is simply evidence that the informed consent process has been completed. Determining from the physician what was discussed does not guarantee that the patient understands what was explained.

Which of the following biological agents does not have a chemoprophylaxis therapy and only allows for the nurse to provide supportive care? A.)Anthrax B.)Plague C.)Smallpox D.)Botulism

ANS: D Botulism is the only CDC Level A biological agent that has no known therapy or treatment. Because of the toxin that is released from the bacterium, there is methodology known to minimize or reduce the activation and metabolism of the toxin that causes flaccid paralysis within the patient. Standard isolation precautions are used for anthrax. Plague can be treated with antibiotics and droplet isolation precautions. For smallpox, droplet precautions are recommended, especially if pocks develop outside the buccal cavity.

What does research utilization on an inpatient unit require? A.)A nursing theoretical framework should be followed. B.)Orem's theory of self-care requisites should be followed. C.)Only the nurses should participate in the implementation. D.)The implementation should be consistent with the nursing framework in the practice context.

ANS: D Implementation of a new approach should follow a specific plan. It is also important that evaluation data be collected at the same time as the implementation to clearly determine the effect of the new approach. A major component of the research utilization process is reviewing completed nursing research studies that have been published in the literature. In contrast, conducting new research involves the collection of new data to answer a specific clinical practice question. Nursing research utilization is a step-by-step process incorporating critical thinking and decision-making to ensure that a change in practice has a sound basis in nursing science.

What is the best definition of malpractice? A.)A criminal act committed against society B.)Doing something a reasonable person or nurse would not do C.)An intentional professional act of negligence D.)A professional act or failure to act that leads to injury of a patient

ANS: D Malpractice may be defined as doing something outside your scope of practice or something that is unsafe for the patient and could cause injury. A criminal act committed against society may be a felony or a misdemeanor. Negligence is the failure to act as an ordinary prudent person when such failure results in harm to another.

Second- or third-degree burns that cover more than 50% of the body would be classified under what stage of triage?A.)Expectant B.)Delayed C.)Minor D.)Immediate

ANS: D Patients classified as "Immediate" require advanced medical care within 1 hour of trauma, such as a patient who has burns. Expectant patients are those who are deceased or beyond the scope of medical care and services. Delayed patients are those who can be assisted after Immediate- tagged patients are cared for first. Minor-tagged patients are those who can be cared for last; these persons can usually wait several hours before medical care and can walk with little to no assistance with minor bandages and first aid.

Which of the following nursing activities are necessary to provide evidence-based nursing care? A.)Maintaining self-directed practice and using the Internet to locate relevant research articles B.)Having an advanced degree (CNS or FNP) and providing clinical supervision for peers C.)Attending continuing education programs and working toward a graduate degree in nursing D.)Systematically integrating nursing research findings and applying relevant evidence to practice

ANS: D Providing evidence-based practice involves searching the research literature, critically synthesizing research findings, and applying relevant evidence to practice. The other activities are myths about what makes effective practitioners.

A nursing instructor is educating a group of student on research utilization. The teaching has been effective when a student states: a. "Research utilization is using the results of a single study in nursing practice." b. "Research utilization is the collection of data to answer a research question." c. "Research utilization is a review of nursing practice." d. "Research utilization is the process of transferring research findings into clinical practice."

ANS: D Research utilization is the process of transferring research findings into clinical practice. It is not using results of a single study in nursing practice, the collection of data to answer a research question, or a review of nursing practice.

What is a correct statement regarding a nurse who acts beyond the scope of practice? A.)Demonstrates what a good nurse she or he can be B.)Provides enriched services to patients who would not otherwise receive them C.)May make other nurses angry because of the increased expectations created D.)May be disciplined by the board of nursing

ANS: D States may regulate nursing practice by controlling the scope of practice and determining the specific activities for each level of nursing. In most states, the Nurse Practice Act provides definitions and scope of practice for each level of nursing practice. The power of the board to discipline can have an adverse effect on the nurse's ability to practice. Practicing beyond the scope of practice does not demonstrate what a good nurse the person is and does not provide enriched services. Other nurses would not be angry at increased expectations but at the foolishness of the nurse practicing beyond the scope of practice.

The Joint Commission mandates the use of continuous quality improvement and measurement of specific quality outcomes, including patients admitted with: A.)Acute MI and COPD B.)Congestive heart failure and brain attack C.)Acute renal failure and deep vein thrombosis D.)Community-acquired pneumonia and congestive heart failure

ANS: D TJC mandates outcome measures for patients admitted with a diagnosis of acute MI, congestive heart failure, community-acquired pneumonia, surgical infection prophylaxis, pregnancy-related conditions, and deep vein thrombosis. Keep in mind that each item in the option must be correct for the option to be correct, which is the reason acute MI and COPD as well as congestive heart failure and brain attack are incorrect.

The nurse manager has an adequate understanding of root cause analysis when stating which of the following? a. "Root cause analysis determines who to place the blame on." b. "Root cause analysis can identify some factors leading up to an error." c. "Root cause analysis is rarely conducted effectively." d. "Root cause analysis investigates the root causes of events that occur."

ANS: D The nurse manager has an adequate understanding of root cause analysis when they state it involves investigation of the root causes of events that occur. Root cause analysis does not determine who to blame, identifies all factors leading up to an error, and is conducted effectively by trained professionals.

Which of the following agencies oversees environmental hazards at ambulatory care centers? A.)National Council of State Boards of Nursing B.)American Nurses Credentialing Center C.)Ambulatory Care Nursing Administration and Practice D.)Occupational Safety and Health Administration

ANS: D The purpose of the Occupational Safety and Health Administration (OSHA) and the state health department is to establish safety and health standards in the work environment. OSHA requires employers to provide a safe work environment for employees. The other options refer to agencies that regulate professional nursing practice (NCSBN) and provide credentialing (ANCC).

Which of the following is not a step in research utilization? A.)Assessing B.)Planning C.)Implementing D.)Guessing

ANS: D The steps included in using nursing research in practice are preutilization, assessing, planning, implementing, and evaluation. The nurse does not guess during the research utilization process

Which of the following are agents listed by the Centers for Disease Control and Prevention as agents most likely to be involved in bioterrorism? Select all that apply. A.)Influenza B.)West Nile virus C.)Cryptosporidiosis D.)Anthrax E.)Plague F.)Smallpox

ANS: D, E, F Anthrax, smallpox, and plague are all bioterrorism agents that may be spread through the air and cause significant morbidity and mortality.

With regard to nursing informatics, what is meant by general systems theory? a. It organizes interdependent parts that, when working together, can produce a product that none used alone could produce. b. It provides theory support for a system that maintains confidentiality when handling client data and information. c. It incorporates external databases from state agencies to allow for performance comparison within a specific institution. d. It is a nursing theory regarding the use of nurse informatics to integrate the systems within health care for support of nursing education and practice.

ANS:A Nursing informatics uses a theoretical foundation. This theory organizes interdependent parts that, when working together, can produce a product that none of the interdependent parts used alone could produce.

Which strategy is least effective in formulating political action? A.)Ability to communicate information in concise terms B.)Living and practicing in several different states C.)Determining who should be contacted and for what political action D.)Having the ability to use different channels of information

B.) Communication, the ability to determine who should be contacted, and knowing how to use the different channels of information are all important in political action.

Mentoring can best be described as: A.)Solving an individual's problems B.)Focusing on the needs of someone else C.)Helping someone reach his or her long-term goals D.)Pairing of an experienced person with a novice

B.) Mentoring requires a primary focus on the needs of the mentee and an effort to fulfill the most critical of these needs. Meeting these needs first makes achievement of goals more realistic.

The health care team responsible for deciding whether to move a critically ill patient out of the ICU so that a new patient may be admitted to the unit is faced with what principle of an ethical dilemma? A.)Veracity B.)Justice C.)Autonomy D.)Deontology

B.) The principle of justice is involved in the allocation of scarce and/or expensive health care resources.

The ethical principle of autonomy is not applicable in which patient situation? A.)The patient does not speak or understand the English language. B.)The patient is unaware of who he is and where he is. C.)The patient has been in a long-term care facility for 10 years. D.)The patient has values that conflict with the caregiver's values.

B.) This principle assumes rational thinking on the part of the individual.

According to the American Hospital Association, what is a basic right of patients? A.)Choice of diet to be eaten during hospitalization B.)Considerate and respectful care from all care providers C.)Medical care regardless of ability to pay D.)Information from nurses about diagnosis and prognosis

B.) When you are a patient in the hospital, you have the right to receive considerate and respectful care.

Which of the following are characteristics of successful mentors? A.)They ensure that their mentees do not fail. B.)They push the mentees to a higher level. C.)They always ask a lot of questions of their mentees. D.)They encourage mentees to question their skills so that they can be improved.

B.) Mentors need to communicate high expectations to mentees and push them to meet or exceed these expectations.

You are a graduate nurse in search of a mentor. To find a good "match," what should you look for?A.)Choose an experienced nurse who is successful. B.)Look for things you and the potential mentor have in common. C.)Be very specific with the questions you ask of the possible mentor. D.)Be careful not to disclose too much personal information.

B.) When considering establishing a mentoring relationship, look for commonalities in nursing education, areas of expertise/practice, or interests. Feeling comfortable and building trust are crucial for a successful mentoring relationship.

One of the five laws of power is that "power fills a vacuum." Which statement best describes that type of power? A.)An individual who provides leadership and power to create a strategy that will address a problem and get people to contribute to the effort B.)People who are willing to give power to someone in order to restore comfort or handle a dilemma C.)An individual who takes action to speak and act on behalf of a group D.)A state nursing association that acts on behalf of the nurses within the respective state

B.)When there is not a designated leader, someone will step forward to fill the void or vacuum—power law 1.

The mentee needs to understand his or her role early in the relationship. What is a characteristic or example of the mentee's role? A.)Not interrupting the mentor B.)Absorbing what the mentor explains in detail C.)Establishing personal short-term and long-term goals D.)Finding out what the mentor has to offer in terms of experience

C.) Establishing your goals early will help you get exactly what you need from the mentoring relationship.

The clinical nurse leader makes out the daily assignments. One staff nurse tells another, "Last week the clinical nurse leader asked me to change my days off so that she could go to a play in another city. I told her I couldn't do it. Ever since then, she's given me the most difficult patients on the unit for my assignment." If the observations of the staff nurse are accurate, the clinical nurse leader may be making use of the type of power called _____ power. A.)Inherent B.)Referent C.)Legitimate D.)Expert

C.) Legitimate power is the power or the influence that comes with role and position. In this situation, the clinical nurse leader has legitimate power and authority because of her position to make the patient assignments. Referent power is power a person has because others closely identify with that person's personal characteristics. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Inherent power is not a specific type.

What is an example of the weakest source of power?A.)Several nursing students talk with a head nurse regarding a problem they are having on the unit. The head nurse then discusses this problem with the chief nursing officer. B.)The clinical nursing instructor sends a student to the skills lab for further practice. C.)A nurse shares knowledge regarding nursing in a confident manner and style. D.)The head nurse tells staff members that as soon as all the care plans are completed, they may have some additional compensation time.

C.) Option C represents expert power, which is the weakest in the power structure. Option A is referent power, option B is legitimate power, and option D is reward power.

What is the purpose of the nurse's Code of Ethics? A.)To assist in clarifying the individual nurse's personal values and goals B.)To differentiate between moral and immoral acts C.)To guide the behavior of the professional nurse D.)To identify acts that are legal for the nurse to perform

C.) The American Nurses Association (ANA) Code of Ethics (2001) is a statement to society that outlines the values, concerns, and goals of the profession. It should be compatible with the values and goals of each nurse.

A nurse has recently moved from one state to another and wishes to write lawmakers to urge them to vote against a change in the Nurse Practice Act that would replace individual licensure with institutional licensure. What lawmakers should the nurse contact? A.)The city council members B.)The county (parish) legislators C.)The state legislators from the district D.)The federal legislators from the district

C.) Each state's Nurse Practice Act is regulated by state laws. It would be important for the politically active nurse to contact state lawmakers and advise them of the pending legislation and the ramifications that would occur if institutional licensure replaced individual licensure—for instance, lack of regulation of safe nursing practice.

A new graduate is looking for a mentor. Which staff nurse would be the best choice? A.)Louise, a skilled clinician, who appears hurried, curt, and occasionally sarcastic B.)Jill, a new graduate, who worked 2 years as an LPN and seems confident C.)Juan, who has 3 years of experience, good skills, and a sense of humor D.)Kim, who has 6 years of experience and is highly intellectual, but is aloof and self-centered

C.) The mentor not only serves as a role model or counselor for the new graduate but also actively advises, guides, and promotes the graduate's career. It is important to select someone who will work with you and has nursing experience as an RN. Frequently nurses with 3 to 5 years of experience remember their own role transition and can relate to what the new graduate is experiencing.

Which of Sanford's laws of power is relevant to the following situation? The state nurses association writes a new version of the Nurse Practice Act, secures a sponsor in the legislature, and lobbies legislators to adopt the bill. A.)Power is invariably personal. B.)Power invariably fills any vacuum. C.)Power is exercised through and depends on institutions. D.)Power is best exercised via large financial donations to individual legislators.

C.) Through a nursing service organization, a state nurses association, or a similar organization, an individual can garner the resources needed to magnify their power (Law 4—Power Is Exercised Through and Depends on Institutions).

According to the ANA Code of Ethics, which action is unethical for a nurse? A.)Joining unions or bargaining units B.)Engaging in lobbying related to health care issues C.)Reporting an incompetent or impaired colleague D.)Refusing to care for a patient who is diagnosed as HIV-positive

D.) ANA Code 1: The nurse provides services with respect for human dignity and the uniqueness of the patient unrestricted by considerations of social or economic status, personal attributes, or the nature of the health problem.

The nurse is very busy caring for a large case load. A patient mentions that because he is slow, people just do things for him rather than allowing him to do as much as he is able. To solve the dilemma of needing to conserve time versus supporting the patient's involvement in his care, what principle may help the nurse? A.)Veracity B.)Fidelity C.)Justice D.)Autonomy

D.) Autonomy implies the freedom to have choices and make decisions about one's own care without interference. Just because this patient says he is slow does not mean he cannot make choices and participate in his own care.

Advance directives such as the health care proxy and living will support what ethical principle? A.)Veracity B.)Advocacy C.)Beneficence D.)Autonomy

D.) Autonomy implies the freedom to make choices and decisions about one's own care without interference, even if those decisions are not in agreement with those of the health care team.

The "honeymoon" is a specific phase of reality shock. What should the mentor do during this phase? A.)Share personal transition experiences with the mentee. B.)Reinforce the need for the mentee to problem solve. C.)Encourage the mentee to try new things. D.)Act as the intermediary for the mentee with all staff members.

D.) During the "honeymoon" phase, the mentor should be supportive (by listening and understanding), act as an intermediary with other staff members, and be a role model.

Which of the following is a good example of a mentoring relationship? A.)A coach and a player B.)A teacher and a learner C.)An intern and a resident D.)An advisor and a partner

D.) In nursing, mentor is synonymous with trusted advisor, and mentoring is a partnership between two people.

Confidentiality will be maintained by a nurse who believes in and values the ethical principle of: A.)Veracity B.)Autonomy C.)Justice D.)Fidelity

D.)Fidelity involves keeping information confidential and maintaining privacy and trust.

Which ethical principle is applied when the nurse acts to safeguard the patient and the public by reporting poor nursing practice? A.)Autonomy B.)Fidelity C.)Justice D.)Veracity

D.)Veracity—the duty to tell the truth—is represented in this situation.