intro exam 2

1. Practicing nurses participate in employer-sponsored professional development classes that provide case studies related to ethical situations and decision making. Ethical considerations are debated among teams, and an expert helps the class arrive at the "best practices." The nurses are experiencing ethics ______________.

ANS: acculturation. Ethics acculturation is the didactic and experiential process of developing ethical reasoning abilities as a part of ongoing professional education.

1. The basic ingredients of theory are ____________.

ANS: concepts A theory is defined as a group of related concepts that explain existing phenomena and predict future events.

1. When healthy, a patient had requested that all life-sustaining measures be implemented. Now the patient has Alzheimer's and had a deterioration in health that severely limits quality of life. The patient's only child is petitioning that the parent not be placed on life support again and be given only palliative care. The nurse assessing this ethical situation following the procedure would place the steps in what order? (Place in order of the Situation Assessment Procedure). Put a comma and space between each answer choice (for example: a, b, c, d). a. Discuss with the ethics committee possible alternatives that would be acceptable to the family while considering the patient's wishes. b. After the family presents two alternatives, work with the committee and family to agree on one alternative. c. Provide rationale for the selection made. d. Carefully assess the situation to identify the ethical issue and concerns.

ANS: d, a, b, c The steps to the Situation Assessment Procedure are as follows: 1. Identify the ethical issues and problems. 2. Identify and analyze available alternatives for action. 3. Select one alternative. 4. Justify the selection.

1. Development and validation of the body of knowledge and foundation on which practice is based is called ____________.

ANS: research Research refines and enhances new and existing knowledge and provides accountability for nursing practice.

9. 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.

ANS: A Correct: Accountability is an ethical duty that states that one should be answerable legally, morally, ethically, or socially for one's actions. Incorrect: b. Individuality is something that distinguishes one person or thing from others. c. Injustice is when a person is denied a right or entitlement. d. Values clarification is a tool that allows the nurse to examine personal values in terms of ethical situations.

17. 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.

ANS: A Correct: Altruism is concern for the welfare of others, including willingness to help others when they are unable to get their assignments completed to ensure that the patient receives high-quality care. Incorrect: b. Veracity is truth telling, in this situation the staff provided care demonstrating altruism and there was no concern that the truth was spoken. c. Autonomy is self-determination: the patient was demonstrating autonomy by asking for care, the staff was demonstrating altruism by providing requested care. d. The staff did not report unsafe or inappropriate, harmful care.

12. 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.

ANS: A Correct: Autonomy is defined as personal freedom, the right to make choices. However, in this case, the patient is not able to be fully informed so they can clearly understand the choices being offered. Incorrect: b. Allowing a mentally competent adult to refuse medical treatment is an example of autonomy. As long as the actions do not infringe on the autonomous actions of others, that person should be free to decide whatever he or she wishes. This freedom should be applied even if the decision creates risk to his or her health and even if the decision seems unwise to others. c. The visitor has the right to refuse treatment even if the decision creates a risk to his or her health or seems unwise to others. d. A mentally competent adult refusing anesthetic prior to a procedure demonstrates autonomy. The patient has the right to refuse the anesthetic even if it creates a risk to his or her health; in this case, the risk of pain.

7. 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.

ANS: A Correct: Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their good. Incorrect: b. Human dignity is the inherent worth and uniqueness of a person. c. Justice involves upholding moral and legal principles. d. Human rights are the basic rights of each individual.

19. A nurse is interested in studying the rituals of a tribe living in remote areas of Africa. The researcher is accepted into the tribe and observes firsthand the rituals practiced. Themes were analyzed to arrive at a description of the culture including rituals. The nurse is practicing which type of research? a. Qualitative, Ethnography b. Qualitative, Phenomenology c. Quantitative, Quasi-experimental d. Quantitative, Secondary data analysis

ANS: A Correct: Ethnography is a method used to study phenomena from a cultural perspective. Ethnographers spend time in the cultural setting with the research participants to observe and better understand their experience. Incorrect: b. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. c. Quasi-experimental is a type of quantitative research study design that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. d. Secondary data analysis is a research design in which data previously collected in another study are analyzed.

18. A nurse is reading an abstract about a study related to Rocky Mountain Spotted Fever. The purpose is stated as follows: "To examine the generalizability of two randomized placebo-controlled clinical trials in patients with Rocky Mountain Spotted Fever to determine whether steroid therapy resulted in the positive outcomes." The nurse knows generalizability refers to the: a. conclusion that findings can be generalized from the sample to the entire population. b. fact that the group of steroids used are from the same organic compounds. c. possibility the subjects were carefully selected and that outside influence is thus suspected. d. fact that the type of bacteria carried by ticks is universal.

ANS: A Correct: Generalizability is the deduction that findings from one study can be applied to other populations not involved in the actual research. Incorrect: b. The type of steroid used or not used does not pertain to generalizability. c. Homogeneous or selected subjects would not allow generalizability to the entire population. d. The type of bacteria is one variable but does not pertain to generalizability.

18. A nurse is assigned to a unit other than the one she is normally assigned due to increased census on the alternate unit. She is assigned to care for seven patients and participates in walking rounds where the patient's condition and needs are discussed between oncoming and off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall from her pocket, which contain the above information that contains patient sensitive data. The liabilities arising from this incident would be covered under: a. the Health Insurance Portability and Accountability Act. b. the ANA Scope and Practice Act. c. affirmative duty failing to question order. d. personal liability with floating and cross-training.

ANS: A Correct: HIPAA protects patient information and ensures confidentiality of data. Incorrect: b. The ANA Scope and Practice Act focuses on quality of care rendered rather than disclosure of patient information. c. Affirmative duty refers to nurses' responsibility to question physician orders when they have a concern about them. d. Although the nurse was floating to another unit, the issue is the accidental sharing of confidential data not whether the nurse had the skills and training to work on the unit.

13. A nurse who has practiced on an orthopedic unit for 10 years unexpectedly becomes pregnant. At delivery the physician informs the mother, "Your baby has Alport syndrome, but then I don't have to explain what that means with your medical background." The mother is unfamiliar with this disease and withdraws as a coping mechanism. Which nursing theory would provide a framework to guide nursing care for this mother?

ANS: A Correct: In Mishel's uncertainty of illness theory, the core position is that uncertainty in illness must be addressed. When uncertainties are not addressed, clients' negative perceptions will escalate and they will suffer. Nursing responsibility based on this theory consists of reframing the client's perceived loss of control, or uncertainty, and helping the client develop new skills of assimilation and accommodation. Incorrect: b. In Orem's self-care deficit model, nursing facilitates client self-care by measuring the client's deficit relative to self-care needs. c. Nightingale's canons of nursing is an environmental adaptation theory. d. Levine's conservation model identifies four conservation principles of client resources (energy, structural integrity, personal integrity, and social integrity).

5. A community health nurse has been visiting a postpartum client who suffered domestic violence throughout the pregnancy, and now the infant may be at risk. The nurse assisted the client in finding shelter and legal protection. The nurse's role and the conceptual framework involved are:

ANS: A Correct: In Roy's adaptation model, when the client incurs an insult that renders him or her in need of environmental modification, the nurse will be the change agent in assisting the individual with this adaptation. Incorrect: b. The role of translator is not needed. Leininger's theory of cultural care diversity and universality focuses on the concepts of diversity, universality, worldview, and ethnohistory, none of which is relevant in this situation. c. Peplau's interpersonal relations model explores the interpersonal relationship between the nurse and the client and identifies the client's feelings as a predictor of positive outcomes related to health and wellness. In this acute situation, the case manager conceptual model in not as pertinent as the change agent model. d. Rogers' science of unitary human beings theory is one in which the nurse, as caregiver, promotes synchronicity between human beings and their environment; it is not relevant to this acute situation.

11. A young child is having abdominal pain, and the doctor informs the parents that a computed tomography (CT or CAT) scan of the abdomen will be ordered. The doctor tells the child, "This CAT scan won't hurt you." The child is visibly upset because of a fear of cats. According to Mishel's uncertainty in illness theory, which stage of the framework is represented?

ANS: A Correct: In the stimuli frame the client reacts to some stimulus in a negative manner. The nurse at this stage should listen carefully and then initiate, seek, and clarify concerns and questions. Incorrect: b. The appraisal stage is when the client applies a negative value to environmental conditions. c. In the initiation of coping mechanisms stage, the individual uses coping skills to deal with negative environmental stimuli. d. Adaptation occurs as the nurse intervenes in the previous stage, and ideally, fear decreases.

18. A nurse is evaluating Levin's Theory of Conservation to determine if it can be applied to patients in the initial phases of chemotherapy treatment. During this phase of theory acceptance, the nurse wants to determine if all the concepts of energy, structural integrity, personal integrity, and social integrity are included in the care of cancer treatment. The nurse is applying which criteria of theory acceptance?

ANS: A Correct: Inclusiveness asks the question, "Does the theory include all concepts related to the area of interest?" Incorrect: b. Consistency asks the question, "Can the theory address new entities without having its founding assumptions changed?" c. Accuracy asks the question, "Does the theory explain retrospective occurrences?" d. Fruitfulness asks the question, "Does the theory generate new directions for future research?"

5. When differentiating between slander and libel, the nurse knows that libel: a. results from defamation caused by subjective comments written in the nurse's notes. b. results from negative subjective comments made to those who are not providing care. c. occurs when the nurse verbally describes to the oncoming nurse assigned to the client objective data that place the client in a negative light. d. consists of repeating prejudiced comments made by the primary caregiver to a neighbor at the local supermarket.

ANS: A Correct: Libel is defined as comments that are written about a person that are defaming. Nurses may be subject to a charge of libel for subjective comments meant to denigrate the client that are placed in the medical record or in other written materials read by others. Incorrect: b. "Negative subjective comments" represents a definition of slander, not libel. c. Objective data are appropriate to relate to other personnel, and this does not constitute defamation of character. d. Repeating a primary caregiver's prejudiced comments at a supermarket constitutes slander, not libel.

2. A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with: a. negligence. b. assault. c. defamation of character. d. tort.

ANS: A Correct: Negligence is defined as failure to act in a reasonable and prudent manner. The most frequent allegations of nursing negligence include failure to ensure client safety, improper treatment, failure to monitor the client and report significant findings, medication errors, and failure to follow the agency's policies and procedures. Incorrect: b. Assault is defined as action that causes a person to fear that he or she will be touched without consent. c. Defamation of character is defined as attacks on a person's reputation. d. A tort is a civil wrong or injury committed by one person against another.

5. 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.

ANS: A Correct: Nurses must make a deliberate effort to recognize their own values and must learn to consider and respect the values of others. Health care decisions are seldom made independently of other people. Decisions are made with the client, the family, other nurses, and other health care providers. Incorrect: b. There is no need to get rid of impurities in the value system; everyone's system is unique, and there really are no impurities. c. The nurse cannot ignore her own values; these are what shape the nurse's ethics and morals. d. Values can change as a person matures and passes through different life experiences. Values also are often influenced by those around us, especially authority figures.

13. A new nurse researcher is interested in tracing the history of nursing research. The researcher learns that nursing research began with: a. the work of Florence Nightingale during the Crimean War. b. studies between 1900 and 1940 following Nightingale's work. c. studies to improve patient care by doctorally prepared nurses. d. studies based on the naturalistic paradigm.

ANS: A Correct: Nursing research began with the Nightingale during the Crimean War—more can be read in Chapter 1: Evolution of Nursing. Incorrect: b. As nurses received formalized training, research focused on who entered nursing and nursing satisfaction. c. Doctorally prepared nurses began clinical studies to improve patient care. d. Studies based on the naturalistic paradigm were the focus of research in the 1980s. This was often qualitative research.

15. A nurse working in a privately owned hospital is charged with a negligent act after failing to check laboratory reports prior to giving a dose of digoxin (Lanoxin) resulting in the patient's condition becoming critical due to decreased cardiac output and falling leading to a broken hip and concussion. A nurse is brought in who testifies that a professional with the knowledge and skill of an RN should understand that, before administering this drug, potassium level and pulse level is always checked to prevent such an occurrence. The nurse's testimony as to what constitutes reasonable care is based on: a. the legal definition of standard of care. b. the legal definition of the informed consent process. c. the doctrine of res ipsa loquitur. d. governmental immunity.

ANS: A Correct: Standard of care is the legal criteria against which the nurse's (and physician's) conduct is compared to determine whether a negligent act or malpractice occurred. Nurses are specialists in hospital care who, in the final analysis, hold the well-being—in some instances, the very lives—of patients in their hands. Incorrect: b. Informed content refers to the physician or advanced practice nurse's duty to disclose information so that the patient can make intelligent decisions. c. Res ipsa loquitur means the "thing speaks for itself" and refers to situations that the jury is capable to judge using only common knowledge. In this instance, the jury would not have that knowledge. d. Governmental immunity refers to nurses employed in federal or some state facilities where laws have been enacted that shield these individual health care workers from personal responsibility for damages awarded in malpractice cases.

1. A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client is an immigrant and is uninsured. Which act would prevent the client from being transferred to another facility? a. Emergency Medical Treatment and Active Labor Law b. Health Insurance Portability and Accountability Act c. Patient Self-Determination Act d. The Patient Safety and Quality Improvement Act

ANS: A Correct: The Emergency Medical Treatment and Active Labor Law is a federal statute that was enacted in 1986 to prohibit the transfer of unstable clients, including women in labor, from one facility to another. This law also prohibits refusal of care for indigent and uninsured clients who seek medical assistance in the emergency department. Incorrect: b. The Health Insurance Portability and Accountability Act ensures the confidentiality of clients' personal health information. c. The Client Self-Determination Act is a federal statute that supports individuals in expressing their preferences about medical treatment and making decisions about end-of-life care. d. The Patient Safety and Quality Improvement Act allows nonidentifiable client data to be distributed to a qualified patient safety organization (PSO) for the purpose of analyzing medical errors.

5. Which organization provides federal funding for research? a. National Institute of Nursing Research b. Robert Wood Johnson Foundation c. W. K. Kellogg Foundation d. Sigma Theta Tau International

ANS: A Correct: The National Institute of Nursing Research is a federal agency that provides federal funding for health care research. Incorrect: b. Robert Wood Johnson is a private foundation. c. W. K. Kellogg Foundation is also a private foundation. d. Sigma Theta Tau International is a nursing organization.

16. A nurse practicing on a unit where domestic violence is common wants to learn how to apply nursing theory to practice on this unit. She considers the interrelatedness of the constructs of Watson's Theory of Caring and designs the above:

ANS: A Correct: The above conceptual models demonstrates how the concepts of compassion, commitment, conscience, confidence, and competence form a theme of caring (Watson). Incorrect: b. A hypothesis is the first step of scientific inquiry. c. A proposition is a statement rather than a model of how constructs are related. d. Theory of scientific inquiry uses set steps in figuring out how a phenomenon happens.

14. A nurse is charged with battery after helping an invalid patient back to bed and not calling for help due to a reduced staffing level. The patient sustained excessive bruising, sore joints, and extended stay. In this case, the: a. patient is the plaintiff. b. nurse can be charged with forcefully restraining the patient without orders. c. nurse is accountable due to the decreased level of staffing. d. charge of invasion of privacy may be withheld.

ANS: A Correct: The complaining person in a lawsuit is the plaintiff. Incorrect: b. The nurse was not restraining the patient but it could be said the nurse was acting against patient wishes if indeed the patient had stated he or she did not wish to return to bed. c. The agency could be held accountable if they were aware and approved of the decreased staffing level. d. Invasion of privacy occurs when a person's private affairs are made public without consent.

6. 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.

ANS: A Correct: The first step in the situational assessment procedure is to find out the technical and scientific facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and opinions. Assessment can be applied to all areas of patient care, including ethics. Trying to understand the full picture of a situation is time consuming and requires examination from many different perspectives, but it is worth the time and effort. Incorrect: b. Identifying alternatives is the second step in the situation assessment procedure. A set of alternatives cannot be established until an assessment has been completed. c. Selecting the best option is actually the third step in the situation assessment procedure. Options cannot be selected until an assessment has been done to define the issue. d. Justifying the action or inaction is the final step in the situational assessment procedure. No justification can be made until the assessment and action phases have been completed.

6. What are general explanations that scholars use to explain, predict, control, and understand commonly occurring events?

ANS: A Correct: Theories are a group of related concepts that explain existing phenomena and predict events. Theories provide us with a frame of reference, the ability to choose concepts to study, or ideas that are within one's practice. Incorrect: b. Constructs are the events, ideas, or objects that make up a theory. c. A system is an orderly collection of logically related principles, facts, or objects. d. Propositions are statements that propose the relationships between and among concepts.

3. The use of research to guide nursing practice is called: a. utilization. b. dissemination. c. generalizability. d. analysis.

ANS: A Correct: Utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process. Incorrect: b. Dissemination is defined as the spreading of information, generally through published reports or by word of mouth. c. Generalizability is when findings true for the sample are found to be true for the entire population. d. Analysis is the second step or phase of the nursing process.

1. Throughout their careers, nurses are in an ongoing state of acculturation, gaining experience from formal nursing school classes, clinical experiences, and the ethical issues they encounter in their clinical practice. The ideal outcomes of these ongoing experiences with cultural decision making include: (Select all that apply.) a. increased trustworthiness. b. enhanced ability to take into consideration many aspects of ethical situations. c. confidence to make decisions based on experience and ethical intelligence. d. improved clinical decision making and advocacy for patient autonomy. e. authority to make ethical decisions independently that meet personal moral beliefs.

ANS: A, B, C, D Correct: a. The desired outcomes of ethics acculturation across the years are integrity, personal growth, practical wisdom, and effective problem solving on behalf of patients and their families (Weaver et al, 2008). These are the qualities that are characteristic of an ethically sensitive and morally mature person. Trustworthiness is a characteristic of integrity. b. The ability to take into consideration many aspects of ethical situations is due in part to personal growth and practical wisdom. c. The confidence to make ethically sensitive decisions comes from experience founded on personal growth and personal wisdom. d. The ability to be the patient's advocate in ethical decision making is one test of cultural acculturation. Incorrect: e. Ethical decisions are often the produce of professionals who come together to consider right and wrong choices that affect society or patients as a whole rather than an independent decision based on the nurse's personal moral beliefs.

1. Which of the following are concepts related to nursing theory? (Select all that apply.) a. Environment b. Health c. Nursing d. Relevance e. Comfort

ANS: A, B, C, E Correct: a. Environment is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. b. Health is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. c. Nursing is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. e. Comfort is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory Incorrect: d. Relevance refers to one criterion for theory acceptance and how well the theory relates to the scientific foundation from which it was derived.

1. The informed consent documents must include: (Select all that apply.) a. an explanation of potential risks and benefits to participants in the study. b. medical terminology rather than lay terms to prevent misunderstanding of the study. c. a statement on how the anonymity and confidentiality of participants are protected. d. explanation of the cost of the study. e. details on how to contact the investigator.

ANS: A, C, E Correct: a. Informed consent explains the study to the participants and assures them of their rights, including their right to refuse to participate or to withdraw from the study. c. The informed consent must include protection of anonymity and confidentiality, voluntary participation, compensation, and alternative treatment. e. The informed consent must include specific information on how to contact the investigator. Incorrect: b. Informed consent is always written in lay terminology so that participants can clearly understand. d. The actual cost of the study is not included on the informed consent form.

3. A researcher seeks funding from an agency that limits studies to quantitative research. The researcher can select from which of the following study designs? (Select all that apply.) a. Survey b. Grounded theory c. Phenomenology d. Needs assessment e. Experimental

ANS: A, D, E Correct: a. Surveys collect demographics, social characteristics, behavioral patterns, and information bases. d. Needs assessments are used to determine what is most beneficial to aggregates. e. The experimental method establishes cause-and-effect relationships while also testing relationships Incorrect: b. Grounded theory explores and describes a social process such as adjusting to a chronic illness. c. Phenomenology describes the "lived experience" of abstract experiences.

2. When reading Peplau's theory, a nurse was unable to determine the relationships among concepts. The nurse listed each concept and drew lines denoting relationships to be able to understand the effect of each element. The nurse created a:

ANS: B Correct: A model is a group of concepts that are associated because of their relevance to a common theme. Incorrect: a. A hypothesis asks the question that is to be the main focus of a theory. c. A construct is similar to a concept; it is an idea or an object that can be "built" together with others into a theory. d. A variable is an object, event, or person that has an effect on a theory; a variable is usually manipulated or measured.

2. 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.

ANS: B Correct: Autonomy is the principle of respect for the individual person. Within the concept of autonomy, people are free to form their own judgments and perform whatever actions they choose. They are self-determining agents who are entitled to decide their own destiny. Incorrect: a. Accountability is inherent in the nurse's ethical obligation to uphold the highest standards of practice and care, assume full personal and professional responsibility for every action, and commit to maintaining quality in the skill and knowledge base of the profession. c. Nonmaleficence is a principle that implies a duty not to inflict harm. In ethical terms, it means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. d. Veracity means telling the truth as a moral and ethical requirement.

10. 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.

ANS: B Correct: Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and that compel them to do what is right. Deontological theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Incorrect: a. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. An attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma. c. Autonomy is the principle of respect for the individual person. People are free to form their own judgments and perform whatever actions they choose. d. Veracity is defined as telling the truth in personal communication as a moral and ethical requirement.

9. When the client is unable to make medical decisions for himself or herself, authorization that allows another person to make these decisions is called: a. living will. b. durable power of attorney. c. informed consent. d. immunity.

ANS: B Correct: Durable power of attorney involves preselection by the client of a person who has been authorized legally to make health care decisions once the client becomes incompetent to do so. Several states have enacted a Uniform Durable Power of Attorney Act, which sanctions a durable power of attorney for health care. Incorrect: a. A living will is a formal document in which a competent adult makes clear his or her wishes regarding care that will be provided in the final stages of a terminal illness. c. Informed consent describes a health care decision made by a client based on information provided by the physician or advanced practice. d. Immunity protects a person from a lawsuit for negligent acts or an institution from a lawsuit for the negligent acts of its employees.

20. A group of nurses are interested in the how to improve teaching effectiveness for patients who have a hearing impairment and lack family involvement while hospitalized. They believe "hearing loss decreases the teaching effectiveness while hospitalized." The group plans to evaluate teaching effectiveness using a 10-point Likert Scale pre-post teaching, perform a hearing test to determine degree of hearing loss on admission, and have social work evaluate the impact of hearing impairment on patient's ability to safely live alone prior to discharge. The group is working in which step of the scientific process?

ANS: B Correct: During the method step, the group decides what data will be collected to answer the question and identifies step-by-step procedures that will be used to collect these data. Incorrect: a. Hypothesis is the formation of the question, and the group has already completed this step. c. Results (outcomes) are identified or predicted based on data's significance. d. In the evaluation step, results are assessed to determine if they support the original hypothesis.

4. Einstein's theory of relativity laid the groundwork for theories of mathematics, and Freud and Jung provided the basis for a philosophy of man. Which nursing theory served as the foundation for nursing science?

ANS: B Correct: Florence Nightingale investigated the effect of the environment on healing, and this serves as the foundation for nursing science. Incorrect: a. Rogers in 1970 proposed the science of unitary human beings. c. Watson's theory of human caring is a holistic outlook, proposed in 1978, that addresses the effect and importance of altruism, sensitivity, trust, and interpersonal skills. d. King's theory of goal attainment, proposed in 1971, addresses client systems and includes society, groups, and the individual.

10. A qualitative researcher reviews data collected with a grief support group to develop a theory of how widows and widowers mourn. The researcher is using which qualitative research design? a. Phenomenology b. Grounded theory c. Case study d. Hypothesis generation

ANS: B Correct: Grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose. Incorrect: a. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. c. Case study design is a type of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or social unit. d. Hypothesis generation is the first step in the basic research process.

8. A client is hypertensive, and the doctor prescribes weight reduction. The client is excited about beginning the diet, but on arriving home the spouse states, "You have always been fat, and I am not going to starve because you can't control yourself." The client becomes anxious and is unable to participate in the diet plan, resulting in a weight gain of 5 pounds in 2 weeks. Which theorist could best be referred to for guidance regarding interventions in this situation?

ANS: B Correct: Hildegard Peplau's theory describes interpersonal relations as a nursing process. Nursing intervention in Peplau's model focuses on reducing related incapacitating stressors through therapeutic interpersonal interaction. Incorrect: a. Martha Rogers' theory is based on humans as energy fields that interact constantly with the environment. c. Florence Nightingale's theory of practice is based on environmental adaptation. d. Myra Levine proposed the conservation model, which comprises four conservation principles of inpatient resources: energy, structural integrity, personal integrity, and social integrity.

9. The research hypothesis is that aromatherapy reduces stress more effectively than does acupuncture. The researcher does not identify a control group. This study would be a(n) _________ design. a. experimental b. quasi-experimental c. survey d. meta-analysis

ANS: B Correct: In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing. Incorrect: a. An experimental design must have a control group. c. The purpose of a survey design is to collect information, not to compare groups. d. A meta-analysis is a process whereby multiple research studies are reviewed.

7. Which type of theory most often guides present nursing practice?

ANS: B Correct: Middle range theory is a nursing theory that refers to a specific population or to a specific situation, thereby making the theory easy to understand. An example is the theory of unpleasant symptoms (Lenz and Pugh), which examines symptoms that are influenced by physiologic, psychological, and situational factors as they relate to performance. Incorrect: a. Grand theory is broad in scope and may describe and explain large segments of human experience. c. Developmental theory is not a standard term applied to nursing theory. d. Values theory is not a standard term applied to nursing theory.

14. Nurses on a busy medical schedule want to reduce documentation time and improve order entry. Additionally, patient records from previous visits are often incomplete or do not include care from other providers. To improve patient care, a taskforce suggests using an Electronic Medical Record for 1 month to determine whether this provides the desired outcomes. This unit is participating in which type of study? a. Ethnography b. Pilot c. Secondary data analysis d. Phenomenology

ANS: B Correct: Pilot studies are small-scale studies often referred to as feasibility studies to determine if a larger more sophisticated research study is needed. Incorrect: a. Ethnography is the study of cultures where the research is immersed in the culture. c. Secondary data analysis is using data already collected to answer another research question. d. Phenomenology is qualitative research studying the "lived experience."

12. Although a hospital reversed all charges when a client was the victim of wrong site surgery, the court awarded the client $1.5 million. The client was able to return to work in 6 weeks and had no permanent damages. This monetary compensation is termed: a. res ipsa loquitur. b. punitive damages. c. vicarious liability. d. immunity.

ANS: B Correct: Punitive damages are monetary compensation to an injured client that is greater than amount of loss. Incorrect: a. Punitive damages refers to the actual compensation whereas res ipsa loquitur is a legal doctrine. c. Vicarious liability refers to a doctrine that makes a person or institution responsible for the acts of another due to a special relationship between parties. d. Immunity is a legal doctrine protecting a person or institution from lawsuits for negligence by its employees.

15. A researcher is interested in learning if elderly persons perceive their health to be satisfactory even with comorbidities and chronic illness. A large multisite assistive living facility will be the site. The researcher lists residents in alphabetical order and chooses every third person on the list. To ensure improved generalizability, the researcher is using: a. triangulation. b. randomization. c. informed consent. d. a meta-analysis approach.

ANS: B Correct: Randomization is a method of choosing subjects based on chance alone. Incorrect: a. Triangulation is the use of two or more research methods in the same study to add richness and depth to the data. c. Informed consent involves explaining the study to participants and assuring them of their rights, including their right to refuse to participate or to withdraw from the study. d. Meta-analysis is the quantitative merging of findings from several studies to determine what is known about a phenomenon.

4. A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. This type of research design is:

ANS: B Correct: Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. Incorrect: a. Quasi-experimental research design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. c. Case study designs are used to present an in-depth analysis of a single subject, group, institution, or other social unit. The purpose is to gain insight and provide background information for more controlled, broader studies. d. Ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection and description and analysis of data for the purpose of developing a theory of cultural behavior.

6. Which statement regarding informed consent is correct? Informed consent: a. is mandated by federal but not state law. b. must reveal expected benefits. c. requires concealing any known risks. d. allows the RN to communicate information needed so that informed consent can be provided.

ANS: B Correct: The information that constitutes informed consent for the client includes the nature of the therapy or procedure, expected benefits and outcomes of the therapy or procedure, potential risks of the therapy or procedure, alternative therapies to the intended procedure and their risks and benefits, and risks of not having the procedure. Incorrect: a. Informed consent is mandated by federal and state law and is grounded as well in common law. c. Informed consent must reveal, not conceal, any known risks of having or not having the procedure or therapy. d. The primary provider is responsible for informed consent, and this action cannot be delegated to the RN.

7. A nurse researcher who is seeking funding for a study should identify _____ of funding agencies. a. board members b. priorities c. budgets d. accreditation

ANS: B Correct: The priorities of funding agencies indicate their preferences for funding; these are more likely to be funded than are studies that are not aligned with funding preferences. Incorrect: a. Identifying the board members of funding agencies would give you information about the agencies, but would not be helpful in the preparation of a study proposal. c. Learning the budgets of funding agencies would provide descriptive information about the agencies but would not be helpful in the preparation of a study proposal. d. Identifying the accreditation of funding agencies would give you descriptive information about the agencies but would not be helpful in the preparation of a study proposal.

16. A researcher conducts a survey to determine the perceived health status of elderly persons living independently at home. The same subjects participate in a phone call in which they describe the lived experience of living with chronic illness. When writing up the research study, the nurse would describe using: a. a control group. b. triangulation. c. a pilot study. d. secondary data analysis.

ANS: B Correct: Triangulation is the use of a variety of methods to collect data on the same concept—in this situation, quantitative research through survey and qualitative research through phenomenology. Incorrect: a. A control group is a set of subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. c. Pilot studies are small-scale studies, often referred to as feasibility studies, to determine if a larger, more sophisticated research study is needed. d. Secondary data analysis use preexisting data to answer a research question.

11. 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.

ANS: B Correct: Veracity is telling the truth in personal communication as a moral and ethical requirement. Incorrect: a. Deontology is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. c. Autonomy is the principle of respect for the individual person. All persons have unconditional intrinsic value. People are self-determining agents who are entitled to decide their own destiny. d. Beneficence means promoting goodness, kindness, and charity.

3. 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

ANS: B Correct: Veracity is the principle of telling the truth in a given situation. Incorrect: a. Autonomy is the principle of respect for the individual person; this concept states that humans have incalculable worth or moral dignity. c. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Giving the daughter false reassurance is not a good consequence. d. Deontological theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Persons are to be treated as ends in themselves and never as means to the ends of others.

18. 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.

ANS: B Correct: Whistle blowing is the reporting of acts or situations that violate the principle of beneficence such as a chemical impairment, negligence, abusiveness, incompetence, or cruelty. Incorrect: a. The nurse is serving as an ally rather than reporting the violation. c. Informing another department that a treatment is due is not considered "whistle blowing." d. Accountability of delegation requires the RN to ensure all assignments were completed effectively.

16. 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.

ANS: B Correct: With federal funding, many controversial health care services will be covered and provided as part of patient care when desired by the patient; therefore, whether a nurse has autonomy to refuse to provide care may not be as clear even when one might request another patient. Incorrect: a. A nurse must analyze his/her health beliefs to ensure the best care can be rendered without prejudice and under the Right of Conscience (nurses' civil right allowing them to act according to their conscience). c. It is not the role of the nurse to attempt to persuade patients to accept another set of health care beliefs. d. Federal health insurance will cover many patients, and refusing funding, even if possible, would place the hospital in financial difficulty.

2. A patient asks, "What is an advance directive?" The nurse explains that examples of advance directives are: (Select all that apply.) a. preserving cord blood for possible future needs of a child. b. providing instructions that life-sustaining medical procedures should be withheld in the event of a terminal situation. c. giving someone the legal right to act on one's behalf when one becomes incapacitated. d. completing hospital admission paperwork before being admitted to the hospital.

ANS: B, C Correct: Advance directives document an individual's desires regarding end-of-life care. These wishes are generally stated through the execution of a formal document known as the living will. Right-to-die statutes vary from state to state; therefore, nurses must become familiar with their state-specific statute. Incorrect: a. Advance directives identify client wishes in terms of the right to die; they are not directives to help prevent illness or terminal illness. d. Completing hospital paperwork is part of the preadmission process. The client could bring his or her living will to the hospital on admission, but this document would have been prepared prior to the admission and is not part of the hospital documentation paperwork.

3. A nurse learns in orientation that an incident report does not "blame" anyone but concisely documents the events leading up to an occurrence. Which events would warrant completion of an incident report? (Select all that apply.) a. The client is crying and distraught when he learns of a diagnosis of cancer. b. An intravenous antibiotic given preoperatively does not infuse because of a faulty pump. c. The nurse is unable to carry out orders written by the specialist because of illegibility. d. A client falls while in the shower, although she was told not to get up alone. e. The registered nurse is not available to complete the preoperative checklist.

ANS: B, C, D, E Correct: Nurses are legally bound to report critical incidents to their nurse managers, agency administration, and risk manager through a formal intra-agency document generally titled the "incident report." Circumstances under which an incident report should be filed include malfunction or failure of medical equipment. Incorrect: A client's emotional reaction to a life-threatening illness would fall within an acceptable client response and therefore would not be recorded as an "incident" or an "unusual occurrence."

1. Which types of abuse are the nurse required to report or be subject to fines and imprisonment for not reporting? (Select all that apply.) a. Animal b. Child c. Alcohol d. Infant e. Emotional

ANS: B, D Correct: State laws have been created as a result of the 1973 Child Abuse Prevention and Treatment Act. These laws dictate that health professionals must report infant and child abuse and specified communicable diseases. Failure by the nurse to comply can result in fines and/or imprisonment. Incorrect: a. Animal abuse is not identified as reportable under federal or state law. c. Alcohol abuse is not identified as reportable under federal or state law. e. Emotional abuse is not identified as a required reportable type of abuse.

8. A nurse studied a community to determine if there were clients who would benefit from a hospice program if one were developed. This type of research is:a. a survey. b. quasi-experimental. c. a needs assessment method. d. a pilot study.

ANS: C Correct: A needs assessment method is a study in which the researcher collects data for the purpose of estimating the needs of a group; the method is commonly used to prioritize the needs of an organization or community. Incorrect: a. A survey is a research design that is used to collect demographic information, social characteristics, behavioral patterns, and other information. b. Quasi-experimental research is a type of quantitative research that lacks one of the components of an experimental design. d. A pilot study is a smaller version of a proposed study conducted to develop or refine methodology, such as treatment, instruments, or a data collection process, to be used in a larger study.

3. The statement, "Nursing is a caring profession that focuses on helping people be as healthy as possible," is an example of a:

ANS: C Correct: A philosophy is the values and beliefs of the discipline. Incorrect: a. A concept consists of labels given to ideas, objects, and events; it is a summary of thoughts or a way to categorize thoughts or ideas. b. A construct is a building part that combines with others to make up a theory. d. A model is a group of concepts that are associated because of their relevance to a common theme.

15. 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

ANS: C Correct: Beneficence is providing benefit to others by promoting their good. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the client's pain medication and substituting saline, the nurse did harm, not good, for this client. Incorrect: a. Autonomy is the principle of respect for the individual person; the nurse does not respect someone that he or she is inflicting harm upon. b. Utilitarianism is the principle that assumes that an action is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Because the client's pain medication was taken from him, the consequences were all bad. d. Dilemmas are not included as a principle of ethics.

17. A nurse in a rehabilitation unit plans activities of daily living to prevent excessive fatigue, helps the patient dress before the family visits, assists with range of motion, and allows the patient to decide which clothes to wear during the visit. This nurse is best applying which theory to practice?

ANS: C Correct: Certain parts of all the theories can be applied; however all the constructs of Levine's Model of Conservation are applied, including energy conservation, structural integrity, personal integrity, and social integrity. In this situation, the nurse conserved energy by planning ADLs, conserved structural integrity through ROMs, conserved social integrity by helping patient with appearance during family visits thus improving the milieu for social visits. Incorrect: a. Watson's Theory of Caring meets some of the criteria, but all concepts are not applied. b. The constructs—energy fields, openness, pattern, and organization—in Rogers' Theory of Unitary Humans are not all employed in this example. d. Leininger's Theory is not applied because no indication of cultural diversity is noted.

17. A physician shares with the patient's family that, while a central line was being inserted, the patient's lungs were inadvertently punctured, which required oxygen administration. The physician also explains that a chest x-ray indicated the lung remained intact and no additional treatment was required. The physician's role in this instance is based on the legal principle of: a. comparative negligence. b. gross negligence. c. disclosure. d. the Emergency Medical Treatment and Active Labor Act (EMTALA).

ANS: C Correct: Disclosure is a process in which the patient's primary provider (physician or advanced practice nurse) gives the patient, and when applicable, family members, complete information about unanticipated adverse outcomes of treatment and care. Incorrect: a. Comparative negligence is not a relevant issue in this case since two or more defendants are not involved in a malpractice case. b. Gross negligence is extreme carelessness, in which a provider shows willful or reckless disregard for the well-being of a person (patient), which was not evident in this case. d. The EMTALA prohibits the refusal of care for indigent and uninsured patients seeking medical assistance in an emergency department and prohibits the transfer of unstable patients.

4. A nursing student planning to apply for licensure knows that being charged with which offense would result in a minor criminal offense? a. Solicitation of illegal drugs b. Stealing a car c. Failing to report elder abuse d. Billing Medicare for services not rendered

ANS: C Correct: Failing to report elder abuse can lead to penalty of fine or imprisonment. Incorrect: a. Solicitation of illegal drugs is a major criminal offense punishable with imprisonment. b. Stealing a car is a major criminal offense punishable with imprisonment. d. Billing Medicare for services not rendered is a major criminal offense publishable with imprisonment.

10. A client involved in a motor vehicle accident is blinded. The nurse helps the client obtain a guide dog so the client may continue grocery shopping and visiting friends and family. This enables the client to cope with the handicap and perform activities of daily living. Which nursing theory can be applied to this scenario?

ANS: C Correct: In Orem's self-care deficit theory, the nurse implements measures to help clients meet self-care needs by matching them with an appropriate supportive intervention. Incorrect: a. Watson's model of human caring identifies 10 "carative" factors that are core to nursing. This holistic outlook addresses the impact and importance of altruism, sensitivity, trust, and interpersonal skills. b. Mishel's uncertainty in illness theory holds that negative perceptions due to the perceived illness will escalate and clients will suffer. The nurse's responsibility is to reframe the client's perceived loss of control and help the client develop new skills of assimilation and accommodation. d. Rogers' science of unitary human beings is one in which the nurse promotes synchronicity between human beings and their universe/environment.

16. On a nursing unit all assigned breaks including lunch/dinner breaks are assigned at the beginning of the shift. A nurse caring for a patient with anemia and heart failure prepares to hang a unit of packed red blood cells and realizes her break is in 5 minutes. She decides it is not necessary to have another nurse check the blood against the patient's information since the patient's blood type is O+ which she incorrectly remembered to be the universal donor. She hangs the blood, noting the patient is "reading and vital signs normal." She leaves the floor for her break and does not report leaving or ask anyone to perform required vital signs. Upon returning she meets a family friend who is visiting and time "just flies." She returns to the patient's room after admitting a new patient. The patient is hypotensive and color is cyanotic and anxious. She reports the findings to the charge nurse, who then contacts the physician. A blood reaction occurrence is noted. The nurse providing care is charged: a. with comparative negligence. b. with a preventable adverse event. c. with criminal negligence. d. under the doctrine of res ipsa loquitur.

ANS: C Correct: In this case, criminal negligence charges would be based on "reckless and wanton" disregard for the safety, well-being, or life of an individual; behavior that demonstrates a complete disregard for another, such that death is likely in the transfusion reaction. Type "O" is the universal donor rather than universal recipient; however, regardless of blood type, policy and procedures for assessing vital signs and patient status during blood transfusion must be followed. Incorrect: a. This does not represent comparative negligence since the charge nurse did not contribute to the patient's injury. b. A preventable adverse effect is not applicable since the injury was caused by medical management rather than the patient's underlying condition. d. The doctrine of res ipsa loquitur ("the thing speaks for itself") does not apply since lay persons would not possess the scientific and technologic knowledge necessary to determine the required standard of care.

12. A nurse interested in life satisfaction among patients receiving hemodialysis reviews databases and identifies relevant studies which are then statistically analyzed providing generalization through multiple studies. The nurse researcher is using which type of research? a. Quasi-experimental b. Secondary analysis c. Meta-analysis d. Survey

ANS: C Correct: Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization. Incorrect: a. The quasi-experimental method is research involving one study. b. Secondary analysis is the use of data from a previous study in which new questions are asked. d. A survey collects data from populations and is a single study.

13. 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.

ANS: C Correct: Nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. The nurse is definitely violating this principle through her actions. Incorrect: a. Veracity is telling the truth in personal communication. b. Beneficence is promoting goodness, kindness, and charity. d. Autonomy is the principle of respect for the individual person. This concept maintains that all persons have unconditional intrinsic value.

1. 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.

ANS: C Correct: Nursing ethics is a system of principles intended to guide the actions of the nurse in his or her relationships with clients, clients' family members, other health care providers, policy makers, and society as a whole. A nurse must make an attempt to understand what values are inherent in the situation. Incorrect: a. "Doing what is best for the client" is not a definition of ethics. b. "Making good decisions about care" is not a definition of ethics. d. "Rules for providing competent care that is based on scientific principles" is not a definition of ethics.

2. A nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes in order to understand the "lived experience." These characteristics are consistent with the qualitative research method known as:

ANS: C Correct: Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Incorrect: a. Grounded theory is a qualitative research design that is used to collect and analyze data with the aim of developing theories grounded in real world observations. This method is used to study a social process. b. Ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection, description, and analysis of data to develop a theory of cultural behavior. d. Case study is a method of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or other social unit.

6. Which type of data analysis results in the non-numerical organization of data? a. Descriptive b. Inferential c. Qualitative d. Quantitative

ANS: C Correct: Qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line in an effort to group common conceptual meanings. Incorrect: a. Descriptive statistics consist of numerical data. b. Inferential statistics consist of numerical data. d. Quantitative research is a formal, objective, systematic process in which numerical data are used.

13. A physician orders a drug for a patient with a known allergy resulting in anaphylactic shock. The nurse: a. realizes that disclosure of the error will result in more severe ramifications for the agency than if the negligence is discovered by the patient or family. b. should disclose the occurrence before speaking with the physician who ordered the drug or with hospital management. c. recognizes disclosure as an essential component of the national patient safety movement. d. should report the occurrence to the patient's insurance company to decrease patient costs.

ANS: C Correct: The National Quality Forum identified the process of disclosure as a key element of the national patient safety movement. Incorrect: a. Disclosure usually results in less severe ramifications for those involved. b. The nurse should not assume responsibility for disclosure before speaking with the physician who ordered the medication or hospital management. d. It is not the nurse's responsibility to inform insurance companies of errors.

10. All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a living will or a durable power of attorney. This act is known as the: a. Emergency Treatment and Active Labor Law. b. Americans With Disabilities Act. c. Patient Self-Determination Act. d. doctrine of res ipsa loquitur.

ANS: C Correct: The Patient Self-Determination Act of 1990 is a federal statute that was established to support individuals in expressing their preferences about medical treatment and making decisions about end-of-life care. Incorrect: a. The Emergency Treatment and Active Labor Law was enacted in 1986 to prohibit the refusal of care for indigent and uninsured clients who seek medical assistance in the emergency department and the transfer of unstable clients, including women in labor, from one facility to another. b. The Americans With Disabilities Act was instituted in 1990 to end discrimination against qualified persons with disabilities by removing barriers that prevent them from enjoying the same opportunities available to persons without disabilities. d. The doctrine of res ipsa loquitur is a legal term that is used to classify negligence; it is translated as "the thing speaks for itself."

15. A nurse develops a new nursing theory related to stress and viability. The nurse determines the theory accounts for historical events in which soldiers suffering from the stress of inadequate clothing to protect them from the cold and lack of correspondence from home had an increased mortality related to gunshot wounds. The theory will predict gunshot victims' need for proper clothing and letters from significant others as they serve in Iraq. Which criterion for theory acceptance is being validated?

ANS: C Correct: The accuracy of a theory is its ability to explain past occurrences while being useful in determining future outcomes. Incorrect: a. A theory can be validated as inclusive when it is found that it includes all concepts related to its field. b. The consistency of a theory is its ability to deal with new entities and situations without altering its original assumptions. d. The simplicity of the nurse's theory is not being examined in this example.

1. Institutional review boards determine whether research studies involving human subjects will: a. be published. b. add to the body of nursing knowledge. c. cause harm. d. receive funding.

ANS: C Correct: The institutional review board (also called the human subjects committee) examines research proposals to ensure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected. Incorrect: a. Research publication is not controlled by institutional review boards. b. Institutional review boards do not review the merit or significance of research to nursing knowledge. d. Institutional review boards do not award grants or allocate funds.

7. A client states, "I am leaving. No one here knows what they are doing." The nurse completing the Against Medical Advice form must: a. defer notifying the provider until the client has had ample time to leave. b. state in medical terms the risks of leaving. c. inform the client that leaving could result in complications and impairment. d. detain the person with the use of soft restraints until security arrives.

ANS: C Correct: The nurse must articulate to the client the dangers associated with leaving the facility if the primary provider is not present. The nurse's notes on this form should reflect the specific advice given to the client, which should include the fact that leaving the facility could aggravate the current condition and complicate future care, result in permanent physical or mental impairment or disability, or result in complications that can cause death. Incorrect: a. The nurse should act promptly to notify the provider if a client intends to leave the facility without a written order. b. All explanations should be made to the client in clear, nonmedical language. d. Use of restraints to deter a client from leaving is considered false imprisonment.

4. 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.

ANS: C Correct: Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. On the basis of this principle, an attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the situation. Incorrect: a. Veracity is defined as the moral and ethical requirement to always tell the truth in personal communication. Although the public health nurse did not lie, she did not use the concept of veracity to decide which health care issue to address with this group. b. Values account for our moral decisions and actions. The nurse based the decision on the needs of the group, not on her personal values. d. Respecting autonomy means respecting people's right to make decisions based on their values. The nurse did not base her decision for this group on her respect for them, but on what the needs of the majority were.

2. A researcher is interested in quality of life and after an extensive literature review quantitatively integrates data from identified studies and describes the findings. This researcher is using which approach? (Select all that apply.) a. Survey b. Triangulation c. Meta-analysis d. State of the science summary e. Quasi-experimental design

ANS: C, D Correct: c. Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. d. State of the science summary is a merging of findings from several studies that explored the same topic. Incorrect: a. Survey research design is used to obtain information regarding the prevalence, distribution, and interrelationships of variables within a population. b. Triangulation is defined as the use of a variety of methods to collect data on the same concept. e. Quasi-experimental design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design.

17. A nurse is interested in learning how reminiscence therapy can improve memory in cognitively intact persons over the age of 65 years. Findings from three groups are compared. Group 1 receives music therapy, Group 2 receives life review therapy, and Group 3 does not receive therapy, but data are collected from all three groups and compared. Group 3 is known as the: a. pilot study. b. survey. c. needs assessment. d. control group.

ANS: D Correct: A control group is a set subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. Incorrect: a. A pilot study is a small feasibility study. b. A survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants. c. Needs assessment is a study in which the researcher collects data for estimating the needs of a group, usually for resource allocation.

19. A nurse is heard making this comment, "I believe human dignity is based on perceived self-worth while caring is based on perceived role in society that forms the basis of nursing practice." This nurse is:

ANS: D Correct: A proposition is a statement that proposes the relationship between and among concepts. Incorrect: a. A model is a visual representation rather than a statement. b. Leininger's Theory is founded on transcultural nursing. c. Nothing related to the theory of disease uncertainty occurs in this scenario.

8. When can a nurse detain a client by using restraints? a. Staffing resources are insufficient to monitor a patient with hemiplegia. b. The client is confused. c. The family requests the restraints to prevent the client from leaving the facility. d. There are current physician orders following a medical evaluation.

ANS: D Correct: A written physician's order that is timed and dated is required for the use of restraints. Renewal of orders must be accompanied by evidence of medical evaluation and nursing reassessment. Incorrect: a. Clients may not be restrained physically or chemically because there is not enough staff to properly monitor them. b. A confused client does not require the use restraints to be kept safe. Other less restrictive strategies should first be used to provide safety for the confused client. c. The family's wishes for restraints must be substantiated by a physician's order.

14. 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.

ANS: D Correct: After completing all steps in the situation assessment procedure, the client is now ready to justify her selection. In this phase, the person will specify reasons for the action, will clearly present the ethical basis for these reasons, will understand the shortcomings of the justification, and will anticipate objections to the justification. Incorrect: a. The second step of ethical decision making is identification of hidden issues. b. Validation of the decision considers many factors and requires analysis of all possible alternatives. c. No situational decision can be made unless an individual begins with the first step of actually identifying and stating the actual issue.

11. A nurse who functions in the role of team leader can be held negligent for matters involving: a. inadequate training. b. lack of development of proper policies and procedures. c. failure to discipline unsafe workers. d. delegation of client care tasks.

ANS: D Correct: Delegation of client care tasks falls within the role of the team leader, and inappropriate delegation of client care tasks could result in negligence. Team leaders, charge nurses, and managers are held to the standard of care of the reasonably prudent nurse employed in that role. Incorrect: a. Providing adequate training is a responsibility of nurse managers or administrators and does not fall within the role of the team leader. b. Developing proper policies and procedures is a responsibility of nurse managers or administrators and does not fall within the role of the team leader. c. Disciplining unsafe workers is a responsibility of nurse managers or administrators and does not fall within the role of the team leader.

12. A nurse researcher determines whether findings are substantial by calculating the level of significance. Which aspect of the scientific inquiry is being conducted?

ANS: D Correct: During evaluation, results are examined with the goal of determining the relevance of outcome data in answering the hypothesis; the significance of the data and the potential for future research are also explored. Incorrect: a. The hypothesis asks the question that is to be the main focus. b. The method decides what data will be collected to answer the question. c. Data collection is a step-by-step procedure that is undertaken with the goal of answering the question.

1. Which nursing theory might a nurse use as a conceptual framework to determine how to meet the needs of immigrants while ensuring provision of high-quality and culturally sensitive care?

ANS: D Correct: Madeleine Leininger proposed the theory of cultural care diversity and universality. This theory of transcultural nursing comprises concepts involving caring and the components of a cultural care theory: diversity, universality, worldview, and ethnohistory. Incorrect: a. Martha Rogers' theory is based on the nurse's promoting synchronicity between human beings and the universe/environment. b. Dorothea Orem's self-care deficit model facilitates client self-care by measuring the client's deficit relative to self-care needs. c. Hildegard Peplau's theory identifies feelings of the client as a predictor of positive outcomes related to health and wellness.

14. If a nurse applies Nightingale's theory to current practice, the nurse's first step will be to evaluate the hospital room's air quality and, second, to:

ANS: D Correct: Nightingale believed the need for light was second only to the need for fresh air. Incorrect: a. Although she believed noise should be controlled, it was not the second most important consideration. b. Nightingale did believe food should do the work of healing the patient's ailing digestive system, but this was not second most important consideration. c. Nightingale did believe in variety, which included pets and beautiful objects, but the needs for light and air were more important to her.

8. 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.

ANS: D Correct: Paternalism is an action and an attitude wherein the provider tries to act on behalf of the client and believes that his or her actions are justified because of a commitment to act in the best interest of the client. Paternalism is a reflection of the "father knows best" way of thinking. Incorrect: a. Autonomy is the principle of respect for the individual person. b. Beneficence means promoting goodness, kindness, and charity. c. Justice states that like cases should be treated alike and equals ought to be treated equally.

11. Which statement about qualitative research is correct? a. Qualitative research requires less time than quantitative research because complex statistical analysis is not necessary. b. To be statistically significant, qualitative studies must consist of large, randomly selected sample sizes. c. Because qualitative studies deal with human concepts such as suffering and quality of life, results can be generalized. d. Interviews are the primary means of collecting data that enable the researcher to describe unclear phenomena.

ANS: D Correct: Qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena. Incorrect: a. Qualitative research is time consuming and costly. One-on-one interviewing takes time, and the interviews must be recorded, typed, transcribed, and analyzed. b. Qualitative studies use small sample sizes that are not randomly selected. c. The small sample sizes used in qualitative research do not allow results to be generalizable to the whole population.

9. A nurse believes that humans use creativity and critical thinking to balance their connections with their surroundings. The nurse decides to conduct a study on the basis of this belief. Which nursing theory would be best for this study?

ANS: D Correct: Rogers' science of unitary human beings, in which humans are seen as energy fields that interact constantly with the environment, is a theory in which the nurse promotes synchronicity between human beings and their universe/environment. Incorrect: a. Peplau's theory explores the interpersonal relationship between the nurse and the client and identifies the client's feelings as a predictor of positive outcomes related to health and wellness. b. Roy's adaptation model identifies the client's adaptation to conditions by using environmental stimuli to adjust perception. c. In Orem's self-care deficit model, the nurse facilitates client self-care by measuring the client's deficit relative to self-care needs.

3. A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse completes the following interventions: places the client on the examining table, completes a thorough history and physical, covers the client with a sheet, places the call button within reach, and goes out in the hall to speak with the client's physician. The client tries to get up to speak with his family and falls, sustaining a hematoma on the head and a broken hip. The nurse's actions reflect: a. invasion of privacy. b. libel. c. slander. d. negligence.

ANS: D Correct: The nurse is failing to ensure client safety after medication administration; this is defined as negligence. Incorrect: a. Invasion of privacy occurs when a person's private affairs, such as medical history, are made public without consent. b. Libel is defined as a form of defamation inflicted by the written word. c. Slander is defamation of character achieved through the spoken word.