Exam 2 Nursing Management

The nurse understands the role of the National Institute of Nursing Research (NINR) in the American Recovery and Reinvestment Act of 2009 when stating: (Select all that apply.) a. "The NINR was not involved in the recovery act." b. "The act was created to assist with the economic recovery of the country." c. "The act includes measures to modernize our national infrastructure, including health care." d. "The act was created to take control away from Americans." e. "The act was created to modernize our national infrastructure excluding health care."

?? 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.

Which element of health care is most responsible for the ethical dilemma as to whether health care is a privilege or a right? a. Cost b. Technology c. Consumerism d. Worker shortage

A

1. Which of the following best describes the ethical concept of values? A. Values are an individual's feelings about situations. B. Values are learned through family systems. C. Values are organized ways of thinking about the meaning of life. D. Values determine the rightness or wrongness of behavior.

A Page: 15 Feedback A. This is correct. Values are how individuals feel about ideas, situations, and concepts. B. This is incorrect. Morals, springing from an individual's conscience, are learned through family systems, instruction, and socialization. C. This is incorrect. Belief systems are organized ways of thinking about why people exist. D. This is incorrect. Ethics deal with the rightness or wrongness of human behavior.

5. A registered nurse (RN) is caring for a patient who is one of Jehovah's Witnesses and has refused a blood transfusion even though her hemoglobin is dangerously low. After providing information about all the alternatives available and risks and benefits of each, the health-care provider allows the patient to determine which course of treatment she would prefer. The RN knows this is an example of which ethical principle? A. Autonomy B. Nonmaleficence C. Beneficence D. Distributive justice

A Page: 19 Feedback A. This is correct. Autonomy is an individual's right to make his or her own decisions. B. This is incorrect. Nonmaleficence is the responsibility of the nurse to do no harm either intentionally or unintentionally and to protect those who cannot protect themselves. C. This is incorrect. Beneficence is the principle of doing good to others. D. This is incorrect. Distributive justice is the responsibility to fairly allocate scarce resources regardless of gender, sexual orientation, religion, ethnicity, disease, social standing, or any other criteria.

9. A recent ethical issue has resulted in uneasiness and discomfort for several nurses on a unit. The unit manager has decided to discuss the issues at the next team meeting. The situation has resulted in which of the following for some of the nurses? A. Moral suffering B. Moral distress C. Ethical dilemma D. Veracity

A Page: 24 Feedback A. This is correct. Moral suffering occurs when a situation results in a feeling of uneasiness or concern because of behaviors or circumstances that challenge one's own morals and beliefs. B. This is incorrect. Moral distress occurs when nurses know the action they should take, but are unable to take that action. C. This is incorrect. An ethical dilemma occurs when a situation forces a nurse to choose between two ethical principles. D. This is incorrect. Veracity is an ethical principle that requires nurses to be truthful.

13. An RN recognizes which of the following as a primary goal of nursing? A. Assist patients to achieve a peaceful death. B. Improve personal knowledge and skill in order to improve patient outcomes. C. Advocate for quality of life over quantity of life. D. Work to control costs so that patients can live the best quality of life possible.

A Page: 28 Feedback A. This is correct. The primary goal of nursing is to keep people alive and well, or if this is not possible to at least assist them to live as comfortably as possible and achieve a peaceful death. B. This is incorrect. Improving nursing knowledge and skills assists nurses in achieving their primary goal. C. This is incorrect. Although nurses seek to provide their patients with the best quality of life possible, this is not the primary goal of nursing. D. This is incorrect. Although controlling costs may lead to improved quality of life, this is not the primary goal of nursing.

A nurse manager is lecturing staff nurses on the barriers to the full integration health information technology. The nurse manager judges the teaching to be effective when a staff nurse states: (Select all that apply.) a. "Barriers include lack of standardization across care areas." b. "A barrier to the full integration is funding." c. "Currently there are no barriers." d. "A current barrier is privacy laws." e. "Barriers to full integration are not likely to be overcome."

A, B, D "Barriers include lack of standardization across care areas." "A barrier to the full integration is funding." "A current barrier is privacy laws."

How does the IN/INS use HIPPA regulations and TJC requirements in daily practice? (Select all that apply.) a. Investigation of violations b. Writing of policies c. Involvement in the discipline process d. Writing of procedures e. Managing the nursing unit

A, B, D Investigation of violations Writing of policies Writing of procedures

A nurse is preparing to graduate with a degree in nursing informatics. The nurse is explaining career options to friends. The nurse understands the options when stating: (Select all that apply.) a. "I can work alongside engineers as they create new products." b. "I can work for a consulting firm and specialize in workflow improvement." c. "I cannot work for third-party payers." d. "I do not have the option of working for the government." e. "I am excited to work for an educational institution."

A, B, E "I can work alongside engineers as they create new products." "I can work for a consulting firm and specialize in workflow improvement." "I am excited to work for an educational institution."

Which action by the nurse incorporates standard practice for protecting patient privacy on mobile devices? (Select all that apply.) a. Keep careful physical control of the device at all times. b. Avoid use of mobile devices. c. Use a password and a time-out to authenticate the re-activation. d. Enable encryption. e. Keep security software up to date.

A, C, D, E Keep careful physical control of the device at all times. Use a password and a time-out to authenticate the re-activation. Enable encryption. Keep security software up to date.

The nurse has adequate understanding of HIPAA when stating that the major impact from this privacy regulation is in (Select all that apply.) a. "health information privacy law." b. "bedside nursing care." c. "nursing report communication." d. "data security standards." e. "electronic transaction standards."

A, D, E "health information privacy law." "data security standards." "electronic transaction standards."

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."

A,B,C,D

. 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.

A,B,C,E

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

A,B,C,E

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."

A,B,D

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

A,B,D,E

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.

A,B,E

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."

A,C,D,E

A nurse is assigned to a unit where 95% of all patients required total care. Most days the assistive personnel are able to complete their assignments and provide high-quality care. A patient returning from a procedure was somehow "skipped" when daily baths were performed and requests that her care now be provided. The nurse discovers the bed is rumpled and damp. The RN joins with some other staff to bathe the patient, change the bed, and help make the patient comfortable. These staff members are demonstrating: a. altruism. b. veracity. c. autonomy. d. whistle blowing.

A.

A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of his/her own values as they relate to this issue. The nurse must: a. know his/her own values and how these values relate to beliefs and the philosophy of nursing. b. rid the impurities in his/her value system. c. ignore his/her own values. d. realize that values do not change and that they cannot be influenced by others.

A.

A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were associated with a survey of college sophomores. The researcher was applying the principles of: a. beneficence. b. human dignity. c. justice. d. human rights.

A.

During a seminar on ethics, the educator realizes that more information is needed when a participant describes which situation as a violation of the ethical principle of autonomy? a. An older person with advanced stages of Alzheimer's disease is denied the right to ambulate in the hallway. b. A mentally competent adult refuses medical treatment for the autoimmune disease lupus erythematosus, stating that this condition reflects the will of a higher power. c. A mentally competent visitor fell during visiting hours but refused to be examined by the physician on call. d. A mentally competent adult with a broken wrist refuses to be given a local anesthetic prior to a procedure.

A.

The nurse who admits making a medication error and immediately files an incident report is demonstrating: a. accountability. b. individuality. c. an injustice. d. values clarification.

A.

When assessing an ethical issue, the nurse must first: a. ask, "What is the issue?" b. identify all possible alternatives. c. select the best option from a list of alternatives. d. justify the choice of action or inaction.

A.

The nurse manager is teaching a new nurse about computer monitoring on a telemetry unit. The nurse manager judges the teaching to be effective when the new nurse states: a. "Computer monitoring provides continuous streaming of data that allows nurses to respond to patient changes quickly." b. "Computer monitoring provides for continuous around-the-clock direct observation of patients." c. "Computer monitoring improves documentation of patient care." d. "Computer monitoring reduces the need for additional nurses to provide patient care."

A. "Computer monitoring provides continuous streaming of data that allows nurses to respond to patient changes quickly."

A nurse manager is providing education to a new nurse on barriers to the implementation of quality improvement processes. The manager judges the teaching to be effective when the new nurse states: a."Expense is a primary barrier." b."Resistance to change is a primary barrier." c."One of the primary barriers is complacency with the status quo." d."Not identifying the correct problem is a primary barrier."

A. "Expense is a primary barrier."

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

A. "General systems theory organizes interdependent parts that, when working together, can produce a product that none used alone could produce."

A nurse is self-educating on the role of the informatics nurse/informatics nurse specialist. The nurse has an adequate understanding when listing which as a primary success indicator? a. "Making sure that information technology did no harm to the patient." b. "There were no primary success indicators listed for the IN/INS." c. "There are not enough data on primary success indicators for the IN/INS role." d. "Primary success indicators include excellence in bedside patient care."

A. "Making sure that information technology did no harm to the patient."

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."

A. "QSEN helps prepare future nurses for improving patient safety."

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."

A. "Quality is the responsibility of everyone within an organization."

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."

A. "The primary goal of Six Stigma is to increase profits and reduce problems."

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."

A. "controlling process by inspection so that errors were prevented."

Which statement by the nurse is true regarding the focus of nursing informatics? The focus of nursing informatics a. "is to improve patient care with health care technology." b. "is to improve patient care by increasing health care expertise." c. "is to improve patient care by improving nursing performance." d. "is to improve patient care by allowing the patient access to medical records."

A. "is to improve patient care with health care technology."

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.

A. A charter is developed.

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

A. Health Insurance Portability and Accountability Act (HIPAA)

A nurse is a team member assisting with the define-measure-analyze-improve-control (DMAIC) process. Which action would the nurse take during the define phase? 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.

A. Identify the stakeholders.

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.

A. Take an exam.

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"

A: "QSEN helps prepare future nurses for improving patient safety" --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.

A nurse is caring for a patient who just consented to an elective abortion and is unsure of the patient's values related to this issue. When attempting to examine one's system of values, the nurse must first do which of the following? a. Clarify his or her own values and how these values are related to beliefs and philosophy of nursing b. Remove any biases in their own values c. Ignore his or her own values d. Recognize values do not change and cannot be influenced by others

A: Clarify his or her own values and how these values are related to beliefs and philosophy of nursing

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

A: Identification of practice problem, evaluation of related published research, planning, implementation, evaluation --The proper sequence in the research utilization process must begin with the identification of a practice problem (pre-utilization), 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.

What ethical principle is implemented, or supported, when the nurse encourages a patient to be involved in planning and implementing self-care? a. Autonomy b. Fidelity c. Justice d. Veracity

ANS: 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. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity is the duty to tell the truth.

A nurse manager is providing education to a new nurse on barriers to the implementation of quality improvement processes. The manager judges the teaching to be effective when the new nurse states: a. "Expense is a primary barrier." b. "Resistance to change is a primary barrier." c. "One of the primary barriers is complacency with the status quo." d. "Not identifying the correct problem is a primary barrier."

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 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 statement by the nursing professor shows understanding of 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.

20. The nurse knows that in this culture the older adult is respected and makes the decisions. a. Asian c. Native American b. Hindu d. African American

ANS: A In the Asian ethnic group, older family members are honored and respected, and their authority is unquestioned. The oldest man is the decision maker and spokesman. Native Americans have strong tries to family and tribe. African Americans and Hindus do not have any specific practices related to the importance of older family members. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 495 OBJ:Assess spiritual needs of patients in the health care setting. TOP:Cultural and spiritual beliefs affecting nursing MSC: NCLEX®: Psychosocial integrity

A nurse is a team member assisting with the define-measure-analyze-improve-control (DMAIC) process. Which action would the nurse take during the define phase? 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.

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.

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.

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 nurse is educating a group of nursing on the deontological model of ethical reasoning. The nurse determines that the teaching has been effective when a student states: a. "All life is worthy of respect." b. "Abortions are ethical." c. "Euthanasia is acceptable in certain situations." d. "Lying is acceptable if it benefits the patient."

ANS: A The deontological model of ethical reasoning states that all life is worthy of respect. Abortions and euthanasia are never acceptable because they violate the duty to respect the sanctity of all life. Lying is never acceptable because it violates the duty to tell the truth.

What action can the nurse take to uphold the ethical principle of fidelity? a. Report unscrupulous billing practices. b. Disclose the results of an HIV test to a patient's family. c. Make health care decisions for a patient. d. Accept an assignment that is unsafe.

ANS: A The nurse can uphold the ethical principle of fidelity by reporting unscrupulous billing practices. Disclosing the results of an HIV test to a patient's family would violate fidelity. Making health care decisions would violate autonomy. Accepting an assignment that is unsafe violates nonmaleficence.

Which action by the nurse shows an understanding of the ethical principle of autonomy? a. Allowing a patient the right to make decisions regarding his health care even if the nurse does not agree with his decisions. b. Making decisions for the patient regarding his care c. Disregarding the patient's decisions because they are not "normal" according to society d. Consulting the attending physician to make decisions for the patient

ANS: A The nurse shows understanding of the ethical principle of autonomy by allowing patients the right to make their own health care decisions even if the nurse does not agree with their decisions. It is not up to the nurse or the attending physician to make health care decisions for patients.

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.

A nurse is educating nursing students on the teleological model of ethical reasoning. The nurse judges that the education has been effective when a student states: a. "Abortion is acceptable because it results in fewer unwanted babies." b. "Abortion is never acceptable because it violates the sanctity of life." c. "Euthanasia is never acceptable because it violates the sanctity of life." d. "The rights on individuals should not be sacrificed for the good of the majority."

ANS: A The teleological model of ethical reasoning is interpreted as meaning "the end justifies the means." The rights of some individuals may be sacrificed for the majority. Therefore, abortion may be acceptable because it results in fewer unwanted babies. Euthanasia may be acceptable because it results in decreased suffering.

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.

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

ANS: A Variables of the justice principle involve the allocation of scarce 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 and a patient are discussing the patient's wishes regarding resuscitation. The patient decides that resuscitated is not wanted under any circumstances. What action can the nurse take to identify the ethical issues of the situation? a. Encourage the patient to discuss his wishes with his family. b. Encourage the patient to change his mind. c. Coerce the patient into changing his mind by calling his physician to the bedside. d. Continue to treat the patient as a "full code."

ANS: A When identifying the ethical issues of the situation, the nurse should encourage the patient to share his wishes with his family. It is not the position of the nurse to try to change the patient's mind or force him to remain a "full code." The nurse should respect the patient's wishes and document them accordingly.

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.

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.

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 use f. 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.

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 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.

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 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.

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.

A patient with cancer has decided to end treatment and is discussing end-of-life care with family. The nurse notices that the attending physician has just ordered another dose of chemotherapy. What would be the best action for the nurse to take as an advocate for the patient? a. Send the order to pharmacy so that the chemotherapy can be prepared. b. Call the attending physician and request a meeting so that there can be open communication between the physician, patient and family. c. Tell the patient that because the chemotherapy has been ordered, it must be given. d. Request a meeting with the attending physician, patient, and family so the attending physician can convince the patient to receive the chemotherapy.

ANS: B As an advocate for the patient, the nurse should advocate for the patient with the attending physician and family by facilitating communication. It would be best for all parties to be in a room together so that a discussion can take place. It would not be appropriate to send the order to pharmacy, try to convince the patient to receive chemotherapy, or to tell the patient that the drug must be given because it was already ordered.

The nurse is educating a coworker on the ethical principle of beneficence. The nurse judges the teaching to be effective when her coworker states: a. "Beneficence involves allowing patient to make their own health care decisions." b. "Beneficence is the duty to actively do good for patients." c. "Beneficence is the duty to do no harm." d. "Beneficence involves treating all patients equally."

ANS: B Beneficence is the ethical principle of actively doing good for patients. Allowing patients to make their own health care decisions is autonomy. Doing no harm to the patient is nonmaleficence. Justice involves treating all patients equally.

Which statement by the nurse shows understanding of what 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.

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.

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.

A nursing professor has just joined the National Institute of Nursing Research (NINR). Which activities should the professor anticipate being a part of? 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.

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

ANS: B The Code of Ethics is a moral statement of accountability for practicing nurses and for student nurses. It 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. It lacks legal enforceability and is not a legal document like licensure laws

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.

The nurse manager has an adequate understanding of the continuous quality improvement process of Six Sigma when doing which of the following? a. "Uses Six Sigma to identify errors" b. "Uses Six Sigma to increase profits" c. "Uses Six Sigma to keep standard policies and procedures consistent" d. "Uses Six Sigma to 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.

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 or where he or she 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.

ANS: B This principle assumes rational thinking on the part of the individual, and being unaware of who and where the patient is, is not indicative of the ethical principle of autonomy. Autonomy is 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. In the other situations, the patient has rational thinking even though he or she may not understand or speak English because an interpreter could assist.

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.

A nurse is educating an adult patient on patient rights, according to the American Hospital Association. The teaching has been effective when the adult states that the patient's rights include: 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."

ANS: B When you are a patient in the hospital, you have the right to receive considerate and respectful care. The American Hospital Association published a Patient's Bill of Rights, which is now revised and called The Patient Care Partnership. This document reflects acknowledgment of patients' rights to participate in their health care and was developed as a response to consumer criticism of paternalistic provider care. The statements detail the patient's rights with corresponding provider responsibilities. This document reflects the increasing emphasis on patient autonomy in health care and defines the limits of provider influence and control. It does not contain information on diets, nursing diagnosis, or the ability to pay for medical care.

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 educating students on physician-assisted suicide (PAS). The nurse judges that the teaching has been effective when a student states: (Select all that apply.) a. "PAS does not violate any ethical principles." b. "PAS threatens to destroy the fundamental relationship between physician and patient." c. "PAS does not involve nurses." d. "Quality of life advocates support PAS as an example of personal autonomy and control." e. "Nurses should be aware of the legal and ethical implications of administering legal dosages of medications."

ANS: B, D, E The American Medical Association opposes physician-assisted suicide (PAS) because it violates the most basic ethical principle: First, do no harm. Physicians have traditionally cared for living patients, and PAS threatens to destroy this fundamental relationship. On the other hand, quality of life advocates support PAS as an example of personal autonomy and control. Nurses working with physicians involved in PAS should be aware of the legal and ethical implications of administering legal dosages of medications.

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.

A nurse is caring for a patient who has just been diagnosed with cancer. The patient's family has requested that the patient not be told at this time because it would be devastating. The patient asks the nurse if the diagnosis is cancer. If the nurse were to uphold the ethical principle of veracity, what would the response be? a. "No, you do not have cancer." b. "The physician is unsure of your diagnosis at this time." c. "Yes, that is the diagnosis. Let me call the doctor so that we can have a discussion." d. "Yes, but your family told me that I could not talk to you about the diagnosis."

ANS: C If the nurse were to uphold the ethical principle of veracity, the nurse would inform the patient of the diagnosis and involve the physician in the discussion. The nurse should not lie to the patient or withhold information at the family's request; the patient has a right to know information regarding his or her health care.

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.

A nurse educator is teaching a nurse about research utilization. Which statement by the nurse indicates understanding? a. "Research utilization is the collection of data to answer a specific question." b. "Research utilization is the analysis of the practice context." c. "Research utilization is the process of integrating the findings of completed studies into practice." d. "Research utilization involves 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 manager is teaching the purpose of the nurse's Code of Ethics to a group of high school students. Which statement by one of the students indicates that the teaching has been effective? The purpose of the nurse's Code of Ethics is 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."

ANS: 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. It does not outline moral or immoral acts or make statements regarding legal aspects of nursing.

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.

A nurse is caring for a young patient recovering from a traumatic car accident. The patient has lost a lot of blood and is in need of a blood transfusion. The patient states< "I'm a Jehovah's Witness," and will not accept the blood. The nurse knows the patient will likely not survive if they do not receive the blood. What action should the nurse take? a. Administer the blood anyway; the patient will die without it. b. Try to talk the family into signing the consent for the blood. c. Call the physician and report the patient's decision. d. Stop all care for the patient to respect their wishes.

ANS: C The nurse should immediately call the physician to report the patient's decision. The nurse should not administer the blood against the patient's wishes or try to talk the family into signing the consent. The nurse should continue all care for the patient except administration of the blood.

A young woman has come to the hospital requesting medication to induce an abortion. The nurse assigned finds it too hard to provide care to this patient because it violates the nurse's ethical principles. Which action would be the best for the nurse to take? a. Continue to provide care for the patient but refuse to administer the medication. b. Administer the medication because the doctor ordered it. c. Find another nurse to provide care for the patient. d. Try to talk the patient out of taking the medication.

ANS: C To ensure care for the patient without violating the nurse's ethical principles, the nurse should find another nurse to care for the patient. Because the patient has rights, it would be inappropriate to try to talk the patient out of receiving the medication or to deny the patient's access to the medication.

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.

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 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.

A nurse is educating themself on the ANA Code of Ethics. Which action by the nurse would be unethical, according to the ANA Code of Ethics? 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

ANS: 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. Nurses have the right to engage in collective bargaining and lobbying for health care issues. Nurses have a legal responsibility based on the Nurse Practice Act in their states to report an incompetent of impaired colleague.

The nurse is very busy caring for a large case load. An adult patient mentions that by having slow mobility, "people just do things for me rather than allowing me to do as much as possible on my own." To solve the dilemma of needing to conserve time versus supporting the patient's involvement in self- care, what principle may help the nurse? a. Veracity b. Fidelity c. Justice d. Autonomy

ANS: D Autonomy implies the freedom to have choices and make decisions about one's own care without interference. Just because this patient is slow does not mean he or she cannot make choices and participate in self-care. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Veracity is the duty to tell the truth. Fidelity involves keeping information confidential and maintaining privacy and trust.

Advance directives such as the health care proxy and living will support what ethical principle? a. Veracity b. Advocacy c. Beneficence d. Autonomy

ANS: 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. Veracity is the duty to tell the truth. Beneficence is the duty to actively do good for patients. Speaking out on behalf of the patient is an essential part of the advocacy role of the nurse.

A patient who has a terminal illness wants to be able to take a prescription medication to end life when suffering becomes unbearable. The patient asks the nurse for advice. Operating from a deontological point of reference, what action does the nurse take? a. Advises the patient about local providers willing to participate b. Assesses the patient for more information about the situation c. Determines what kind of insurance the patient has before acting d. Tells the patient that they cannot participate in this action

ANS: D Deontology is rule-bound and inflexible, obtaining moral authority from absolutes revealed by God. To preserve the sanctity of life, the nurse cannot participate in this situation. Advising the patient of providers to see is working from a teleological viewpoint because the end (patient death) might be seen as outweighing the means (helping the patient find a provider to provide a lethal prescription of drugs). Assessing the situation to see how the patient is affected (versus how some other patient would be affected) is situational. Determining financial status is not related to a specific philosophical outlook but might violate the principle of justice.

A nurse is educating a nurse aide on patient confidentiality. The nurse believes the teaching to be effective when the nurse aide states that confidentiality will be maintained by a nurse who believes in and values the ethical principle of a. veracity. b. autonomy. c. justice. d. fidelity.

ANS: D Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity means to tell the truth. Autonomy involves the patient making an informed decision and 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. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables.

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.

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.

The nurse manager is educating a new hire on The Joint Commission (TJC). The manager tells the new hire that TJC mandates the use of continuous quality improvement and measurement of specific quality outcomes for patients with certain diagnoses. The teaching has been effective when the new hire states: a. "These mandates include patients admitted with Acute MI and COPD." b. "Outcomes measures are mandated for patients with a diagnosis of congestive heart failure and brain attack." c. "Acute renal failure and deep vein thrombosis have mandated outcomes by The Joint Commission." d. "Outcome measures are mandated for patients admitted with 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.

The nurse understands the process of research utilization when the nurse does not complete which of the following steps? a. Assessing patient care c. Implementing a plan of care b. Planning for the patient's needs d. Guessing the extent of care needed

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.

A nurse manager is educating a group of staff nurses about genetics and genomics. The nurse manager judges that the teaching has been effective when one of the staff nurses states: a. "Health outcomes and treatment of disease processes have not increased with the study of genetics and genomics." b. "Only researchers benefit from the study of genetics and genomics." c. "This area of study has nothing to do with nurses." d. "Genetics and genomes have increased the ability of health care professionals to assist patients in improving health outcomes."

ANS: D The study of genetics and genomes has increased the ability of health care professionals to assist patients in improving health outcomes. Nurses involved in this area of health care educate patients; provide support and treatments based in the most current research.

The nurse has an adequate understanding of ethical issues regarding transplantation when stating which of the following? a. "There are few Americans on the transplantation list." b. "Everyone on the transplantation list receives the organ they need." c. "There is an overabundance of organ donors." d. "The majority of individuals on the transplantation list will die because of the shortage of organs."

ANS: D There are almost 110,000 Americans on the transplantation list, and the majority of them will die without a transplant because of the shortage of available organs.

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

ANS: D Veracity—the duty to tell the truth—is represented in this situation. Autonomy is the right of the patient to make an informed decision. Fidelity means to act in a way that is loyal, such as keeping information private and confidential. Justice requires the nurse to treat all patients fairly without regard to age, socioeconomic status, or other variables.

8. Determine which of the following situations would be a provider barrier to the nurse developing cultural competence? a. A nurse who is unaware of personal biases to other ethnic groups b. No family rooms to accommodate a critically ill patient's family c. A nurse who seeks encounters with individuals from other cultures d. A health care provider who incorporates alternative therapies in health care

ANS:A A nurse who is unaware of personal biases to other ethnic groups represents a provider barrier. "No family rooms" is an example of a system barrier. Nurses who seek encounters with individuals from other cultures and incorporate alternative therapies into health care have a developed sense of cultural competence. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 490 OBJ: List practice issues related to cultural competence. TOP: Culture MSC: NCLEX®: Psychosocial integrity

5. Based on assessment data, the nursing diagnosis for a patient is spiritual distress related to loneliness or social alienation. What would be included in spiritual nursing interventions? a. Participate in active listening. c. Assist with activities of daily living. b. Identify level of functioning. d. Evaluate ability to understand events.

ANS:A Active listening is an example of a spiritual nursing intervention. Other interventions include the following: prayer, presence, scripture reading, peaceful environment, meditation, music, pastoral care, inspiring hope, validation of the patient's thoughts and feelings, values' clarification, sensitive responses to patient beliefs, and developing a trusting relationship. Identifying level of functioning and ADLs address basic human needs. Evaluating the ability to understand events is addressing cognitive function. PTS: 1 DIF: Cognitive Level: Application REF: p. 493 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Spiritual nursing interventions MSC: NCLEX®: Psychosocial integrity

3. Which of the following actions cause health care disparities? a. Refusal of treatment b. Provider-patient relationships c. Trust in the health care system d. Provider bias and discrimination

ANS:A Disparities in health care can include both provider and patient variables. Patient variables are mistrust of the health care system and refusal of treatment. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 491 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Health care disparities MSC: NCLEX®: Psychosocial integrity

11. A nurse is attending a lecture on health disparities. The education has been effective when the nurse states: a. "Inequalities in income and education are the root of many health disparities." b. "Today, there are no longer inequalities preventing access to health care." c. "Low education and low income levels are related to lower rates of health disparities." d. "Higher income is associated with more health disparities then lower income."

ANS:A Inequalities in income and education are the root of many health disparities. Individuals with low education and low income levels often have higher rates of health disparities, and higher income is associated with less health disparities. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 491 OBJ: List practice issues related to cultural competence. TOP: Health disparities MSC: NCLEX®: Psychosocial integrity

4. Which of the following actions would have little to no impact in helping resolve health care disparities? a. Research on life stressors b. Access to basic health care c. Increasing diversity of health care workers d. Health promotion and wellness programs

ANS:A Some solutions to help resolve health care disparities include the following: increasing the diversity of health care providers; ensuring that all people have access to affordable, basic health care; promoting wellness and a healthy lifestyle; strengthening provider-patient relationships; increasing cultural competency of health care providers; and conducting research to determine why certain diseases affect minorities so greatly and to discover effective intervention strategies. Research on life stressors does not have an impact on resolving health care disparities. PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Resolving health care disparities MSC: NCLEX®: Psychosocial integrity

6. The nurse has an adequate understanding of Japanese culture when stating which of the following? (Select all that apply.) a. "The Japanese believe that contact with blood, skin diseases, and corpses causes illness." b. "The Japanese believe in healers and herbalists." c. "The Japanese have high regard for physicians." d. "The Japanese tend to not question the care of the physician." e. "The Japanese verbally express pain."

ANS:A, B, C, D The nurse has an adequate understanding of Japanese culture when stating that the Japanese believe that contact with blood, skin diseases, and corpses causes illness; have high regard for physicians; and often do not question their care. The Japanese do not express pain, believing that it is a virtue to bear pain. PTS: 1 DIF: Cognitive Level: Application REF: p. 494

4. Which statement by the nurse shows understanding of the Vietnamese culture? (Select all that apply.) a. "Vietnamese are slow to trust authority figures." b. "Vietnamese have a very patriarchal society." c. "Vietnamese will try home remedies before seeking Western medicine." d. "Vietnamese are often compliant with Western treatment one sought." e. "Vietnamese are generally noncompliant with health care."

ANS:A, B, C, D The nurse shows understanding of Vietnamese culture by stating that the Vietnamese are slow to trust authority figures, a very patriarchal society, will try home remedies before seeking Western medicine, and are often compliant with Western treatment once sought. PTS: 1 DIF: Cognitive Level: Application REF: p. 495 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

5. A nurse is educating a student nurse on African American culture. The nurse judges the teaching to be effective when the student nurse states that African Americans (Select all that apply.) a. "have extended family that has a great influence on the patient." b. "honor and respect older family members." c. "have the oldest woman as the decision maker." d. "do not disagree with health care recommendations." e. "don't always follow up with health care recommendations."

ANS:A, B, D, E The teaching has been effective when the student nurse states that African Americans have extended family that has a great influence on the patient, older family members are honored and respected, do not disagree with health care recommendations, and don't always follow up with health care recommendations. The oldest man is the decision maker. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 494 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

1. The nurse is creating a plan of care for a patient. Which would be important for to consider before implementing the plan? (Select all that apply.) a. The patient's lifestyle b. The patient's insurance coverage c. The patient's value system d. The patient's religious beliefs e. The patient's ability to pay for services

ANS:A, C, D When creating a plan of care for the patient, the nurse should consider the patient's lifestyle, value system, and religious beliefs. PTS: 1 DIF: Cognitive Level: Application REF: p. 494 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity

6. By asking, "How has being sick affected your spiritual practices?" the nurse is trying to determine the need in what spiritual dimension? a. Sources of hope and strength b. Spirit-enhancing practices or rituals c. Involvement in spiritual community d. Experience of God or transcendence

ANS:B According to Taylor in Spiritual Care: Nursing Theory, Research, and Practice (2002), asking the following assessment question helps determine the patient's spirit-enhancing practices or rituals: "How has being sick affected your spiritual practices?" As a testing strategy, note that the answer has the spiritual practices and so does the question. Other questions would assess sources of hope and strength, involvement in the spiritual community, and their experience of God or transcendence. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 494 OBJ:Assess spiritual needs of patients in the health care setting. TOP: Spiritual dimension MSC: NCLEX®: Psychosocial integrity

19. In what culture is it very important for females to be evaluated by female health care providers? a. Asian c. Hispanic b. Muslim d. Native American

ANS:B Muslims have a respect for modesty and avoid nakedness. Having a same-gender health care provider will help meet their spiritual needs. Native American, Asian, and Hispanic culture individuals do not have specific issues related to nakedness and modesty. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 495 OBJ:Assess spiritual needs of patients in the health care setting. TOP:Cultural and spiritual beliefs affecting nursing MSC: NCLEX®: Psychosocial integrity

14. A nurse is caring for a diabetic patient who frequently uses alternative medicine to manager ailments. The feels nauseous and requests ginger tea. What should the nurse be aware of before giving the patient ginger tea? a. Nothing; natural remedies do not cause unwanted side effects. b. Ginger can cause blood glucose levels to decrease. c. Ginger causes blood glucose levels to rise. d. Ginger can cause a diabetic patient to become more nauseous.

ANS:B Nurses should be aware of natural remedies and their interactions because more patients turn to these remedies as opposed to medication for management of ailments. In this scenario, the nurse should be aware of the fact that ginger can cause blood glucose levels to decrease, possibly causing harm to the diabetic patient. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 496 OBJ: Identify challenges in defining spirituality. TOP: Cultural/spiritual assessment MSC: NCLEX®: Psychosocial integrity

18. The nurse understands that the following organization believes that cultural competence in nursing is necessary? a. Nurse Practice Acts of state boards of nursing b. Code of Ethics of the American Nurses Association c. Accreditation standards of the National League of Nursing d. Accreditation standards of The Joint Commission (TJC)

ANS:B The American Nurses Association indicates in its Code of Ethics the necessity of the nurse to be sensitive to individual needs. State boards of nursing are involved in the regulation and licensure of nursing practices. The National League of Nursing is involved with accreditation of nursing programs. TJC is involved with hospital accreditation. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 490 OBJ:List practice issues related to cultural competence. TOP: Necessity of cultural competence MSC: NCLEX®: Psychosocial integrity

12. A nurse is working in a disaster area as a volunteer with the local ambulance agency. The nurse is providing care to a Spanish-speaking patient. What actions can be taken to properly care for this patient? a. Use gestures to emphasize what he is saying. b. Obtain an interpreter. c. Provide wound care instructions written in English. d. Treat the patient without speaking to her.

ANS:B The Office of Minority Health and Disaster Preparedness launched an initiative in 2009 to help first responders better manage disaster and crises in diverse populations. The nurse can use this initiative by obtaining an interpreter and providing wound care instructions written in English. The nurse should not rely on gestures to get his point across or treat the patient without speaking to her. PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ:List practice issues related to cultural competence. TOP:Office of minority health and disaster preparedness MSC: NCLEX®: Psychosocial integrity

15. A nurse manager is looking for ways to improve the cultural competency of unit staff. Which action would help the manager accomplish this? a. Propose voluntary cultural competence training. b. Hire bicultural clinical and administrative staff. c. Hire staff from the same ethnic background. d. Avoid issues pertaining to cultural competence.

ANS:B The nurse manager can improve the staff's cultural competence by hiring bicultural clinical and administrative staff to improve education, care delivery, and outcomes. The nurse manager should also propose mandatory cultural competence training and hire staff from different ethnic backgrounds. PTS: 1 DIF: Cognitive Level: Application REF: p. 490 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

2. A nurse manager is educating unit staff on cultural competence. The manager knows that the teaching has been effective when one of the staff members states that cultural competence is (Select all that apply.) a. "not important in health care." b. "accepting and respecting cultural differences." c. "demonstrating knowledge of the patient's culture." d. "demonstrating an understanding of the patient's culture." e. "adapting care to be congruent with the patient's culture."

ANS:B, C, D, E Purnell and Paulanka (2009) define cultural competence as accepting and respecting cultural differences, demonstrating knowledge of the patient's culture, demonstrating an understanding of the patient's culture, and adapting care to be congruent with the patient's culture. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 490 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity

3. Which action by the nurse shows cultural competence of Native American culture? (Select all that apply.) a. Refuse to allow rituals to be practiced at the bedside. b. Allow the family to bring in a medicine man for healing. c. Allow the family and patient time for prayer. d. Provide space for rituals. e. Work hard to gain trust.

ANS:B, C, D, E The nurse can show culturally competent care of an American Indian patient by allowing the family to bring in a medicine man, allowing time for prayer, providing space for rituals, and working hard to gain trust. PTS: 1 DIF: Cognitive Level: Application REF: p. 495 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

13. A nurse is caring for a patient experiencing spiritual distress. What nursing intervention would be appropriate for this patient? a. Asking the patient to reserve prayer for the hospital chaplain b. Placing the patient by the nurses' station because it is busy and will keep the patient entertained c. Developing a trusting relationship with the patient d. Allowing the patient's roommate to have visitors late into the night

ANS:C It is important that the nurse develop a trusting relationship with the patient, as well as being supportive of the patient's needs. The nurse should allow the patient a quiet environment that allows time for prayer and meditation. PTS: 1 DIF: Cognitive Level: Application REF: p. 493 OBJ: Identify challenges in defining spirituality. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

9. A manager is educating a group of nurses on the importance of cultural competence. The manager knows that the teaching has been effective when one of the nurse's states: a. "Cultural competence does not impact patient care." b. "Cultural competence is not important in health care." c. "Lack of cultural competence leads to suboptimal patient outcomes." d. "Lack of cultural competence does not cause active harm to the patient."

ANS:C Lack of cultural competence is extremely important in health care because it directly impacts patient care. Lack of cultural competence leads to suboptimal care and can cause active harm to the patient. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 489 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity

7. Using a spiritual assessment tool helps the nurse gain more understanding of the patient. What would be the best question to assess a patient's inner strengths? a. What gives your life meaning? b. Are you motivated to get well? c. What do you do to show love for yourself? d. What brings you joy and peace in your life?

ANS:D Asking what brings joy and peace to a person's life is an example of a reflective question to help increase the awareness of the inner strengths of a patient's spiritual process. Such a question assesses a person's ability to manifest joy. Asking about what gives meaning could address family and career and not necessarily a patient's inner strength. Asking about motivation and what a person does to show love for themself does not encourage reflection on inner strengths but asks a question that could be briefly answered. PTS: 1 DIF: Cognitive Level: Application REF: p. 494 OBJ:Assess spiritual needs of patients in the health care setting. TOP: Spiritual assessment MSC: NCLEX®: Psychosocial integrity

10. A nurse has an adequate understanding of the barriers to cultural competence when making which of the following statements? a. "Barriers to cultural competence no longer exist in today's society." b. "The barriers to cultural competence cannot be broken down." c. "Provider barriers include having knowledge about a custom's culture regarding health care." d. "Systems barriers exist when an agency's structure and policies are not designed to support cultural diversity."

ANS:D Barriers to cultural competence exist in today's society and can be broken down with the help of health care providers. Provider barriers include having a lack of knowledge about a custom's culture regarding health care. Systems barriers exist when an agency's structure and policies are not designed to support cultural diversity. PTS: 1 DIF: Cognitive Level: Application REF: p. 490 OBJ: Define cultural competence. TOP: Barriers to cultural competence MSC: NCLEX®: Psychosocial integrity

16. A nurse is educating a patient's family on holistic nursing. The nurse judges the teaching as effective when the family states all of the following except: a. "Holistic nursing is an attitude." b. "Holistic nursing is a way of being." c. "Holistic nursing focuses on healing the person as a whole." d. "Holistic nursing focuses on healing the system causing ailment."

ANS:D Holistic nursing is an attitude, a way of being and is focused on healing the person as a whole. It is not focused on the system causing the ailment. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 496 OBJ:Assess spiritual needs of patients in the health care setting. TOP: Holistic nursing MSC: NCLEX®: Psychosocial integrity

. What action by the nurse would indicate cultural competence? a. Displays no favoritism b. Tries to treat all patients the same c. Prioritizes care based on cultural needs d. Wants to learn more about other ethnic groups

ANS:D One model of cultural competence has five aspects. They include cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural knowledge is seeking and obtaining information regarding different cultural and ethnic groups. The other options are applicable to quality nursing care. PTS: 1 DIF: Cognitive Level: Application REF: p. 489 OBJ:Define cultural competence.TOP:Cultural competence MSC: NCLEX®: Psychosocial integrity

2. What is an example of a system barrier to cultural competence? a. No kosher diet options on menu b. No sinks in every patient room c. No privacy curtains in exam rooms d. A strict and enforced policy against more than one visitor in the ICU

ANS:D System barriers are due to the agency's structure and policies that do not support cultural diversity. A strict and enforced ICU visitor policy, for example, will impact those cultures with a strong emphasis on the extended family. Provider barriers are those such as a nurse may have, including lack of information about a culture. Including kosher diet options on the menu and making changes to room environments (including privacy curtains and sinks in every room) are provider barriers that can be addressed. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 491 OBJ:List practice issues related to cultural competence. TOP:System barriers to cultural competence MSC: NCLEX®: Psychosocial integrity

17. A nurse is gathering data on a patient of a different culture. Which action can the nurse take to enhance communication while gathering cultural data? a. Ignore the patient's culture and focus on the reason for hospital admission. b. Use hand gestures to get points across to a patient with poor English. c. Use close-ended questions to gather information. d. Determine the patient's level of fluency in English.

ANS:D The nurse should determine the patient's level of fluency in English to enhance communication. The nurse should not avoid the patient's culture during the assessment. Hand gestures should not be used because they could be offensive to the patient. The nurse should use open-ended questions or questions phrased in different ways as a method to gather data. PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ: List practice issues related to cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity

2. Which of the following best describes intrinsic values? A. Intrinsic values are often abstract ideas. B. Intrinsic values are basic needs for sustaining life. C. Intrinsic values are qualities patients consider to be important in their private lives. D. Intrinsic values are qualities patients consider important for nurses to have.

B Page: 15 Feedback A. This is incorrect. Extrinsic values are not essential to sustaining life and may include physical or abstract objects or meanings. B. This is correct. Intrinsic values are related to sustaining life, such as food and water. C. This is incorrect. Personal values are qualities people consider important in their private lives. D. This is incorrect. Professional values are qualities a professional group consider to be important.

6. An RN cared for a state senator during the day shift. Later that day he was having dinner with friends when the news mentioned the senator had been hospitalized. The RN's friends asked if he knew what was wrong with the senator. Which ethical principle should the RN consider when replying? A. Fidelity B. Confidentiality C. Veracity D. Accountability

B Page: 21 Feedback A. This is incorrect. The principle of fidelity requires nurses to fulfill all commitments they make and all responsibilities of professional practice. B. This is correct. The principle of confidentiality requires nurses to hold health-care information and anything patients tell them in the strictest confidence. C. This is incorrect. The principle of veracity requires nurses to be truthful. D. This is incorrect. The principle of accountability requires nurses to accept responsibility for their own answers.

10. An RN's current patient and family have presented her with an ethical dilemma. What is the first step the RN should take to find a workable solution to the problem? A. Planning B. Assessment C. Evaluation D. Implementation

B Page: 26 Feedback A. This is incorrect. Planning occurs after all relevant information is collected. Planning involves establishing goals, identifying decision makers, and reviewing all options. B. This is correct. The nursing process can be used to find a solution to an ethical dilemma. The first step is assessment and identification of the problem. C. This is incorrect. Evaluation is the last step of the nursing process, requiring nurses to evaluate the outcomes of the decision made. D. This is incorrect. Implementation is the mutually acceptable plan of action that decision makers agree upon.

14. Although technology has seen many advances, which two ethical principles may be in conflict because of technology? A. Beneficence and justice B. Beneficence and nonmaleficence C. Beneficence and veracity D. Beneficence and confidentiality

B Page: 29 Feedback A. This is incorrect. The principle of justice requires nurses to treat all patients the same. Technology usually does not cause dilemmas between beneficence and justice. B. This is correct. Beneficence is the principle of doing good to benefit others. Nonmaleficence is the principle of doing no harm to others. Technological advances can cause the principles of beneficence and nonmaleficence to develop into an ethical dilemma. C. This is incorrect. Veracity is the ethical principle that requires nurses to tell the truth. Technology usually does not cause dilemmas between beneficence and veracity. D. This is incorrect. Confidentiality is the ethical principle requiring nurses to hold their patient's statements in the strictest confidence. Technology usually does not cause dilemmas between beneficence and confidentiality.

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

B,C,D,E

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.

B,C,D,E

A 13-year-old female is brought to the family planning clinic by her enraged father, who has just learned that she is pregnant. The pregnant client states, "I want to have this baby and give it up for adoption." However, the father is adamant that she will disgrace the family and demands that the health care providers tell his daughter that she has a physical condition that would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a conflict that involves the ethical principle of: a. deontology. b. veracity. c. autonomy. d. beneficence.

B.

A family requests that no additional heroic measures be instituted for their terminally ill mother who has advance directives in place. The nurse respects this decision in keeping with the principle of: a. accountability. b. autonomy. c. nonmaleficence. d. veracity.

B.

An older adult client is comatose and had one electroencephalogram that indicated no activity. The daughter is very distraught and notices her mother's hand moves when she is talking to her. The daughter asks the nurse, "Is mother responding to my voice?" The nurse, attempting to console the daughter, knows the movement was involuntary but states, "It does appear she did." The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Deontology

B.

In which case does the nurse act as "whistle blower"? a. One staff member on the unit covers for another nurse, who leaves the premises to purchase illegal substances and signals her friend when she must return. b. The nurse reports that another nurse is taking medications out of stock medicine for her/himself. c. A nurse informs respiratory therapy that a patient is now due a treatment. d. The nurse delegating care to unlicensed assistive personnel makes rounds to ensure all care was rendered properly.

B.

The Health Care Reform Act provides insurance for all U.S. citizens and legal residents presenting far reaching ethical considerations related to diverse individual patient health care beliefs for those delivering nursing care. Nurses must consider their civil rights under the Rights of conscience and how new health care agendas such as the Patient Protection and Affordable Care Act (PPACA) could affect their practice in situations that may conflict with their own belief system. Today's practicing nurse must: a. remember it is one's professional duty to render patient-centered care—even when it is in direct conflict with the nurse's own beliefs—or be held liable for withholding treatment. b. consider whether the right to act according to one's inner beliefs will continue to be permissible when federal health insurance becomes fully enacted. c. discuss with the patient and family different options in hopes they will accept the nurse's health care beliefs. d. suggest to the hospital administration that they not accept federal funding to prevent controversial health practices.

B.

Three illegal immigrants with no health insurance or money sustained life-threatening injuries during an automobile accident. Two of these individuals had head trauma and lacerated internal organs. The decision was made to provide extended care in the trauma center after emergency surgery was performed to save their lives. The third individual received only minor injuries, which were treated in the emergency department. The care of the two critical clients was based on the ethical principle of: a. utilitarianism. b. deontology. c. autonomy. d. veracity.

B.

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."

B. "A root cause analysis is a process designed to investigate and categorize the root cause of the event."

The nurse understands the benefits of Computerized Provider Order Entry (CPOE) when stating: a. "CPOE does not change the process of patient care." b. "CPOE averts problems with hand-written orders." c. "CPOE benefits only the nurses in the health care system." d. "CPOE benefits only the pharmacists in the health care system."

B. "CPOE averts problems with hand-written orders."

A nurse is educating students on how to evaluate a website. The nurse judges the teaching to be effective when the students can state: 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 website." d. "Most Internet information can be downloaded or beamed to a smartphone or handheld device (personal digital assistant [PDA])."

B. "Credibility, accuracy, and reasonableness of the information should be considered."

Which statement by the nurse indicates an understanding of the definition of nursing informatics? a. "Nursing informatics is a specialty area of hospital nursing in which management of patient care is done via computers." b. "Nursing informatics is the specialty practice of nursing integrating nursing science with computer science and information science." c. "Nursing informatics includes the input and retrieval of a patient's complete medical history via electronic data." d. "Nursing informatics is an area of computer system design and analysis to provide and retrieve patient health data during the period of hospitalization."

B. "Nursing informatics is the specialty practice of nursing integrating nursing science with computer science and information science."

The nurse manager has an adequate understanding of the continuous quality improvement process of Six Sigma when doing which of the following? a."Uses Six Sigma to identify errors" b."Uses Six Sigma to increase profits" c."Uses Six Sigma to keep standard policies and procedures consistent" d."Uses Six Sigma to improve patient-provider communication"

B. "Uses Six Sigma to increase profits"

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.

B. Code pink is called after a newborn is discovered missing from the nursery.

Which action can the nurse take to evaluate an internet resource? a. Assume that the resource is credible if it is on an internet page. b. Determine if the resource provides evidence for claims made. c. Assess the popularity of the resource. d. Determine the date the resource was published; older material is more reliable.

B. Determine if the resource provides evidence for claims made.

"A root cause analysis is a process designed to investigate and categorize the root cause of the event." A. Peter Pareto B. Joseph Juran C. Phillip Crosby D. Edward Deming

B. Joseph Juran

A nurse is reviewing the technique used to identify factors involved in an error. Which statement by the nurse indicates the nurse has 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. "Define, measure, analyze, improve, control (DMAIC) prevents events from occurring" d. "A failure mode and effects analysis is a procedure to investigate the cause of the error"

B: "A root cause analysis is a process designed to investigate and categorize the root cause of the event" --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.

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 resources 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

B: EBP is a systematic method of applying research findings to nursing practice that incorporates many additional resources of data that may contribute to improved nursing care --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 ethical principle of autonomy is not applicable in which of the following situations? a. The patient does not speak or understand the English language b. The patient does not understand who or where she is c. The patient has been in a long term care facility for 10 years d. The patient has values that conflict with the caregivers values

B: The patient does not understand who or where she is --This principle assumes rational thinking on the part of the patient, and being unaware of who and where one is, is not indicative of the ethical principle of autonomy. Autonomy is a patient's right to self-determination that 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. In the other situations, the patient has rational thinking even though he or she may not understand or speak English because an interpreter could assist.

An older adult patient is comatose and had one electroencephalogram that indicated no activity. The daughter is very distraught and notices her mother's had moves when she is talking to her. The daughter asks the nurse, "Is mother responding to my voice?" The nurse, attempting to console the daughter, knows the movement was involuntary but states, "It does appear she did." The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Beneficence

B: Veracity

3. Values are learned through which of the following methods? A. Reading books B. Formal degrees C. Continuous reinforcement D. Meeting diverse individuals

C Page: 16 Feedback A. This is incorrect. Values can be taught directly through societal norms, not through reading books. B. This is incorrect. Values can be taught directly though modeling behavior, not through formal degrees. C. This is correct. Children learn values through continuous reinforcement by watching their parents, friends, teachers, and religious leaders. D. This is incorrect. Values are learned through continuous reinforcement, and not through meeting diverse individuals.

7. When considering virtue ethics, which of the following is true? A. Virtue ethics attributes behaviors to moral rules. B. Virtue ethics attributes behaviors to knowledge of consequences. C. Virtue ethics focuses on moral character, rather than rules for behavior. D. Virtue ethics is a formal statement of rules for behavior.

C Page: 23 Feedback A. This is incorrect. Deontology attributes behaviors to moral rules and duties. B. This is incorrect. Teleological theories derive rules for behavior from the consequences of the action. C. This is correct. Virtue ethics focuses on qualities and moral character rather than rules or duties. D. This is incorrect. A code of ethics is a formal statement of rules for ethical behavior.

11. An RN is working through an ethical dilemma involving a patient on his unit. He has just identified the decision makers involved. Which step best describes the current stage the RN is working through? A. Assessment B. Diagnosis C. Planning D. Implementation

C Page: 26 Feedback A. This is incorrect. Assessment occurs as nurses collect all necessary information about an ethical dilemma. B. This is incorrect. Nursing diagnosis is not a step in solving ethical dilemmas. C. This is correct. During the planning phase, goals of treatment are established, decision makers are identified, and all options are reviewed. D. This is incorrect. Implementation occurs when all stakeholders arrive at a mutually acceptable decision.

15. A unit director at a local hospital knows even leadership may face ethical dilemmas. Which of the following should the director take into consideration when dealing with an employee who is incompetent? A. The situation should be tolerated for as long as possible because of the amount of time and paperwork required to terminate an incompetent nurse. B. Incompetence only impacts the individual nurse. C. The director should follow her institution's formal process for reporting and handling practices that jeopardize patient safety. D. Most nurse practice acts direct how to handle incompetent nurses.

C Page: 30 Feedback A. This is incorrect. Although following regulations may require time and effort, patient safety is the top priority. B. This is incorrect. Incompetence can place patients and the entire staff at risk. C. This is correct. Incompetence jeopardizes patient safety. Therefore, the formal process for handling these practices should be followed. D. This is incorrect. Most nurse practice acts direct the reporting of impaired nurses, but do not address incompetence.

A nurse manager is educating a group of staff nurse on violation of HIPPA standards. The manager judges the teaching to be effective when one of the staff nurses states: (Select all that apply.) a. "Violations of HIPPA standards no longer occur because the consequences are so severe." b. "Violations of HIPPA standards can result in termination of employment." c. "Violations of HIPPA standards can result in an indictment." d. "Violations of HIPPA standards are waived if it is your first offense." e. "Violations of HIPPA standards can result in prison time."

C, E "Violations of HIPPA standards can result in an indictment." "Violations of HIPPA standards can result in prison time."

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."

C,D,E

A client is in extreme pain after he was involved in a motor vehicle accident, and morphine has been ordered every hour for pain. The nurse injects saline into the client's IV line and takes the morphine for herself. The nurse is violating which principle of ethics? a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas

C.

A nurse who is infected with human immunodeficiency virus (HIV) while working in the operating room seeks revenge by deliberately placing clients at risk by not adhering to universal precautions. This nurse is violating the ethical principle of: a. veracity. b. beneficence. c. nonmaleficence. d. autonomy.

C.

Ethics applied to nursing can best be defined as: a. doing what is best for the client. b. making good decisions about care. c. care based on what should be done in keeping with the values of the client. d. rules for providing competent care that is based on scientific principles.

C.

In attempting to decide which services should be offered to a community, the public health nurse decides to implement hypertension screening and treatment because most of the residents are hypertensive. This decision is based on the principle of: a. veracity. b. values. c. utilitarianism. d. autonomy.

C.

Which of the following statements indicates the nurses understanding of the difference between the electronic health record (EHR) and electronic medical record (EMR) is: a. "EHR provides nursing with a standardized nomenclature of taxonomy to record nursing care." b. "EMR is the inclusion of only data collected by the patient (personal health record (PHR)." c. "EHR is a longitudinal record of the patient's health information." d. "EMR allows nurses to document nursing care in a system that is intuitive to their level of computer literacy."

C. "EHR is a longitudinal record of the patient's health information."

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.

C. .The standard was not met. An action plan should be developed.

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.

C. Empower employees to carry out needed strategies for change.

How can the nurse expect to be impacted by nursing informatics? a. The nurse would not be directly impacted unless he or she worked in nursing informatics. b. Nurses at the bedside are minimally impacted. c. Nurses are impacted by the use of barcode medication administration. d. Nurse managers are the only hospital staff who are impacted.

C. Nurses are impacted by the use of barcode medication administration.

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.

C. ensuring medical facilities meet patient safety guidelines.

The nurse 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"

C: "The process involves transferring research findings into practice" --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. New data are generated during research studies. Reviewing current practice is part of the process.

The health care team responsible for deciding whether to move a critically ill patient out of the critical care unit so that a new patient may be admitted to the unit is faced with what principle of an ethical dilemma? a. Veracity b. Autonomy c. Justice d. Deontology

C: Justice

A patient with cancer has decided to end treatment and is discussing end of life care with the family. The nurse notices that the attending physician has just ordered another dose of chemotherapy. What would be the best action for the nurse to take as a advocate for the patient? a. Send the order to pharmacy so the chemotherapy can be prepared b. Tell the patient that because the chemotherapy has been order, it must be given c. Call the physician, and request a meeting so that there can be open communication between the physician and patient and family d. Request a meeting with the attending physician and the patient and family so the attending physician can convince the patient to receive the chemotherapy

C:Call the physician, and request a meeting so that there can be open communication between the physician and patient and family --As an advocate for the patient, the nurse should advocate for the patient with the attending physician and family by facilitating communication. It would be best for all parties to be in a room together so that a discussion can take place. It would not be appropriate to send the order to the pharmacy, try to convince the patient to receive chemotherapy, or tell the patient that the drug must be given because it was already ordered.

What is the best action for the nurse to take when faced with a moral problem that threatens to disrupt the delivery of patient care? a. refer the problem to the physician b. consult with colleagues c. ignore the situation d. solve the problem with moral decision making model

D

4. Which of the following statements about ethical principles and laws is true? A. The government holds the power to enforce ethics. B. Laws provide standards that assist in decision making. C. Ethics are very specific. D. As a standard for measuring actions, ethical principles may be the basis for laws.

D Page: 18 Feedback A. This is incorrect. The government holds the power to enforce laws. B. This is incorrect. Ethics provide standards for measuring actions, and therefore assist in decision making. C. This is incorrect. Laws are more specific than ethics. D. This is correct. Ethical principles are a standard for measuring actions. They may form the basis for laws, but are not laws themselves.

8. Which of the following statements is true regarding nursing ethics? A. Nursing ethics focus on the organizational level at the workplace. B. Nursing ethics focus on the duties and rules of behavior for professional nurses. C. Nursing ethics focus on the moral character of nurses. D. Nursing ethics focus on the experiences and needs of nurses.

D Page: 23 Feedback A. This is incorrect. Organizational ethics focus on the organizational level at the workplace. B. This is incorrect. Deontology focuses on the duties and rules of behavior. C. This is incorrect. Virtue ethics focus on virtues and moral character. D. This is correct. Nursing ethics not only focus on the experiences and needs of nurses, but also on the nurses' perceptions of these experiences.

12. An RN knows that sometimes, when working through an ethical dilemma, the decision makers are unable to arrive at a mutually agreed upon decision. Which of the following is a reason why an agreement cannot be reached? A. One or more of the parties may be able to reconcile their values. B. The patient's point of view is recognized as valuable. C. The dilemma involves two or more equally unpleasant choices. D. The institution is unable to honor the patient's request.

D Page: 27 Feedback A. This is incorrect. Inability to reconcile belief patterns or values is a reason why a solution to an ethical dilemma may not be reached. B. This is incorrect. If the caregivers do not recognize the worth of the patient's point of view, a solution to an ethical dilemma may not be found. C. This is incorrect. An ethical dilemma is a situation that involves two or more equally unpleasant choices, but this does not mean that an agreement cannot be reached. D. This is correct. A patient may make a request that is not possible within the institution. When this occurs, a solution may not be possible within the institution and the patient may need to be transferred to a different institution that may be able to honor the request.

A client and her husband used in vitro fertilization to become pregnant. The unused sperm was frozen so the couple could have more children later. The husband is killed while in combat, and the client journals her choices and the possible ramifications. She comes to the fertility clinic after looking at the situation from many perspectives and after considering many alternatives. She asks that the sperm be destroyed because her husband's faith prohibited remarrying, and allowing another person to use the sperm would conflict with her late husband's beliefs. The nurse realizes that: a. the client is in the second step of ethical decision making and that the client's value system is influencing her choices of alternative actions. b. a logical line of reasoning has led to validation of the decision to destroy the husband's sperm. c. the client has not been able to navigate the complicated issues inherent in this situation. d. a rational decision was reached that was based on reflection and on the value systems of the wife and the husband.

D.

The physician who insists on providing treatment in spite of the client's wishes because he "knows best" is reflecting: a. autonomy. b. beneficence. c. justice. d. paternalism.

D.

Which statement by the nurse indicates understanding of the General Systems Theory? a. "It is a 5-step process of an individual's decision to adopt an innovation." b. "It is known as a change theory." c. "It includes knowledge, persuasion, decision, implementation, and confirmation." d. "It organizes interdependent parts working together to produce a product that none used alone could produce."

D. "It organizes interdependent parts working together to produce a product that none used alone could produce."

The nurse manager is educating a new hire on The Joint Commission (TJC). The manager tells the new hire that TJC mandates the use of continuous quality improvement and measurement of specific quality outcomes for patients with certain diagnoses. The teaching has been effective when the new hire states: A. "These mandates include patients admitted with Acute MI and COPD." b."Outcomes measures are mandated for patients with a diagnosis of congestive heart failure and brain attack." c."Acute renal failure and deep vein thrombosis have mandated outcomes by The Joint Commission." d."Outcome measures are mandated for patients admitted with community-acquired pneumonia and congestive heart failure."

D. "Outcome measures are mandated for patients admitted with community-acquired pneumonia and congestive heart failure."

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."

D. "Root cause analysis investigates the root causes of events that occur."

The nurse has an adequate understanding of the informatics nurse (IN) and informatics nurse specialist (INS) when making which of the following statements? a. "The IN/INS does not require any computer or network knowledge on entry into the profession." b. "The IN/INS does not interact directly with clinical staff." c. ""The IN/INS does not need prior knowledge of software or hardware implementation." d. "The IN/INS should be prepared to help with system implementation."

D. "The IN/INS should be prepared to help with system implementation."

The nurse is educating a nursing student on the difference between the informatics nurse and the informatics nurse specialist. The teaching has been effective when the nursing student states: a. "The informatics nurse has a graduate degree." b. "The informatics nurse specialist has experience in informatics but no advanced degree." c. "The informatics nurse supports consumers." d. "The informatics nurse specialist has an advanced degree."

D. "The informatics nurse specialist has an advanced degree."

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."

D. "The systems provide historical data of the usage of nursing time, which is helpful when developing the department budget."

A nursing student is interested in the field of nursing informatics. What should the student do to prepare for a career in this specialty as a nurse leader? a. Obtain a baccalaureate degree in nursing, b. Complete 5 years on a medical-surgical unit, c. Obtain critical care experience, d. Obtain a graduate degree,

D. Obtain a graduate degree,

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 patient 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 patients d. To facilitate collection of consistent data that can be accurately manipulated in an electronic medical record

D. To facilitate collection of consistent data that can be accurately manipulated in an electronic medical record

Which of the following best represents an ethical issue in nursing? a. A 34-year old single female presents in active labor and requests her parents be contacted b A 58-year old patient with a history of cervical cancer is requesting a mammogram c. The mother of an infant who just died of sudden infant death syndrome informs you she is hoping to become pregnant again d. An 85-year old mother of the director of nursing is diagnosed as brain dead and the director refuses to stop cardiopulmonary resuscitation

D: An 85-year old mother of the director of nursing is diagnosed as brain dead and the director refuses to stop cardiopulmonary resuscitation

The nurse is very busy caring for a large case load. A patient mentions that because he moves 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 ethical principle may help the nurse? a. Veracity b. Fidelity c. Justice d. Autonomy

D: Autonomy --Autonomy implies the freedom to have choices and make decisions about one's own care without interference. Just because this patient is slow does not mean he/she cannot make choices and participate in self-care. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Veracity is the duty to tell the truth. Fidelity involves keeping information confidential and maintaining privacy and trust.

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 needed because the rate of compliance was close to the standard c. The standard was not met, an immediate re-audit is needed d. The standard was not met, an action plan should be developed

D: The standard was not met, an action plan should be developed --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.