Midterm Questions

The nurse stops at an accident scene to provide emergency care to the victims. Ethically, how would these actions best be labelled? a. Respect for persons b. Beneficence c. Maleficence d. Triage

ANS: B Feedback A Respect for persons has to do with equal treatment of people irrespective of their social standing and so on. B Beneficence refers to positive actions to help others, as in providing emergency care at an accident scene. C Maleficence refers to causing harm or hurt to others. D Triage is the screening and classification of casualties to make optimal use of treatment resources and to maximize the survival and welfare of patients.

Which of the following statements is true, regarding standards of care? a. Standards of care are legal documents. b. Standards of care are created by practicing nurses. c. Standards of care apply only to nursing in institutional settings. d. Standards of care are not used in negligence lawsuits to establish prudency.

ANS: A Feedback A Standards of care are legal guidelines for nursing practice. B Standards of care are created by national and provincial or territorial nursing organizations. C Standards of care apply to nursing in all settings, not just institutional settings. D Standards of care are used in negligence lawsuits in order to determine whether the nurse has acted as any reasonably prudent nurse in a similar setting would act.

As nurses move forward in their education, different roles may be assumed with regard to research. What is the expected research role for the baccalaureate-prepared student nurse? a. Assume the role of a clinical expert. b. Collaboratively investigate patient outcomes and nursing care. c. Develop methods of inquiry relevant to nursing. d. Acquire funding for research projects.

ANS: B Feedback A Assuming the role of a clinical expert is not a student nurse role. B Student nurses with a baccalaureate degree are prepared to participate in investigations of patient outcomes and nursing care, commonly called quality assurance or improvement studies. C Developing methods of inquiry relevant to nursing is not a student nurse role. D Acquiring funding for research projects is not a student nurse role.

Feminist ethicists consider their work to be a critique of which of the following areas? a. Social values b. Health care delivery c. Resource allocation d. Modern justice practices

ANS: A Feedback A Feminist ethicists consider their work to be a critique of conventional ethics and social values. B Feminist ethicists do not consider their work to be a critique of health care delivery. C Feminist ethicists do not consider their work to be a critique of resource allocation. D Feminist ethicists do not consider their work to be a critique of modern justice practices.

As the nurse prepares to take Mrs. Jones to the operating room for surgery, Mrs. Jones states, "I wish I knew what was going to happen to me when I am put to sleep." Which initial action by the nurse is most appropriate? a. Notify the physician. b. Explain the procedure to the patient. c. Ask the patient if she would like to postpone surgery. d. Document the comment on the patient's chart.

ANS: A Feedback A The most appropriate initial action for the nurse to take is to notify the physician. It is the physicians' role to ensure that informed consent is obtained. B Explaining the details of the procedure to the patient is not a nursing role. C Suggesting that surgery be postponed is not appropriate. D Although the nurse may document the patient's comment, it is not the most appropriate initial action.

A nurse is ambivalent about performing vigorous suctioning in a terminally ill patient in a comatose state. Which of the following is the appropriate statement by the nurse in regard to processing this ethical dilemma? a. "I need to know the legalities of the living will of this patient." b. "My spiritual beliefs mandate that I continue to provide all the interventions within my scope of practice." c. "I cannot figure out what's right in this situation. I need to collect more data." d. "I just feel that I should not suction this patient."

ANS: C Feedback A The nurse who wants to know the legalities of the living will of a patient is collecting some, but not all, data pertaining to the problem. B The statement "My spiritual beliefs mandate that I continue to provide all the interventions within my scope of practice" describes the nurse's own beliefs. C The first step in processing an ethical dilemma is determining whether the problem is an ethical one. The nurse who cannot figure out what is right is stating a characteristic of an ethical dilemma, which is that the problem is perplexing. The next step is to gather as much relevant information as possible. D The nurse is describing the problem in terms of her feelings.

What is the main difference between the tort of negligence and criminal negligence that causes death? a. The severity of a patient's adverse outcome b. The amount of intentional physical contact without consent c. The degree to which the act deviated from the standard of a reasonable, prudent nurse d. The extent of the violation of protecting a patient's right to be free from unwanted intrusion

ANS: C Feedback A The severity of a patient's adverse outcome is not the main difference between the tort of negligence and criminal negligence that causes death. B Battery is the amount of intentional physical contact without consent. C The degree to which the act deviated from the standard of a reasonable, prudent nurse is the difference between the tort of negligence and criminal negligence causing death. D Invasion of privacy is the extent of the violation of protecting a patient's right to be free from unwanted intrusion.

For which of the following health care tasks is the federal government responsible? a. Provide health care insurance plans. b. Manage and plan insurable health services. c. Deliver health services for targeted groups. d. Provide long-term care services.

ANS: C Feedback A Health care insurance plans are the jurisdiction of the provinces or territories. B Managing and planning insurable health services are the jurisdiction of the provinces or territories. C The federal government is charged with delivering, or co-delivering, health services for targeted groups. D Providing long-term care services is the jurisdiction of the provinces or territories.

A physician asks a family nurse practitioner to prescribe a medication that the nurse practitioner knows is incompatible with the patient's current medication regimen. Which of the following would occur if the nurse practitioner implements the physician's request? a. The nurse practitioner would be liable for the action. b. Good Samaritan laws would protect the nurse. c. If the nurse practitioner has developed a good relationship with the patient, a problem will probably not arise. d. This situation illustrates one of the reasons for nurse practitioners to have malpractice insurance.

ANS: A Feedback A A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the patient and may be found negligent, disciplined, or dismissed by the employer, or investigated by the professional regulatory body. B Good Samaritan laws will not protect the nurse in this situation. Good Samaritan laws are for providing care at the scene of an accident. The nurse should refuse to administer the medication when he or she knows it is wrong. C Developing a good relationship with the patient is important, but this will not protect the nurse from legal liability for providing incompetent care. D As having malpractice insurance does not help protect the patient from harm, the nurse practitioner should refuse to administer the medication.

A patient has an order for intramuscular morphine sulphate, as needed, for pain, and the nurse accidentally administers an incorrect dosage. Which law best addresses this situation? a. Civil law b. Criminal law c. Human rights law d. Statute law

ANS: A Feedback A Civil laws protect the rights of individual persons. Administration of an incorrect dosage of morphine sulphate would fall under civil law because it could cause harm to an individual. B Criminal law aims to protect society from harm and provide punishment for crimes (often imprisonment). C Public law relates to human rights. D Statute law is created by parliamentary, provincial, and territorial legislatures.

A patient who recently immigrated to Canada believes that she has been made to wait in the emergency department longer than the other individuals because she has not yet qualified for provincial health coverage. Which one of the following ethical principles is involved in this particular situation? a. Justice b. Autonomy c. Beneficence d. Nonmaleficence

ANS: A Feedback A Justice refers to fairness. Allocation of resources and access to health care involve the ethical principle of justice. The patient without provincial health insurance should not have to wait longer to receive health care than those with coverage. The duration of the wait should be determined by need alone. B Autonomy refers to a person's independence. Autonomy represents an agreement to respect another's right to determine a course of action. C Beneficence refers to taking positive actions to help others. D Nonmaleficence refers to the avoidance of causing harm or hurt to others.

The nurse must be aware of the types of individuals who can give consent for procedures and treatments. Which one of the following individuals may legally give informed consent? a. A sedated 42-year-old patient b. An 18-year-old mother of a newborn child c. The friend of an 84-year-old married patient d. A 56-year-old who does not understand the proposed treatment plan

ANS: B Feedback A A person who has been sedated is not in a position to give legally acceptable informed consent. Consent should be obtained before a sedative is administered. B Parents are usually the legal guardians of pediatric patients, and therefore they must sign the consent. C If the 84-year-old patient were unable to give consent, then the patient's wife would be the person legally authorized to do so on the patient's behalf. For a friend to give legal consent, he or she should have power of attorney or legal guardianship of the patient. D If a patient does not understand the proposed treatment plan, the nurse must notify the physician or nursing supervisor and must ensure that the patient is fully informed before signing the consent.

Because of an influenza epidemic among the nursing staff, a nurse has been moved from the ophthalmology unit to the general surgery unit. The supervisor recognizes that the nurse is inexperienced in this specialty. What would be the nurse's initial recourse? a. Politely refuse to move, take the day off, and go home. b. Ask to work with an experienced general surgery nurse. c. Submit a report noting his dissatisfaction. d. Notify the Canadian Nurses Association (CNA) of the issue.

ANS: B Feedback A Refusing to accept an assignment may be considered insubordination; and patients will suffer if there is a reduction in the number of available staff. B Nurses who "float" (are temporarily reassigned to another unit) should inform the supervisor of their lack of experience in caring for patients on a particular nursing unit. They also should request, and be given, orientation to the unit. Asking to work with an experienced general surgery nurse would be an appropriate action. C The nurse can make a written protest to nursing administrators, but it should not be the nurse's initial recourse. D Notifying the CNA should not be the nurse's initial recourse. The nurse should first notify the supervisor and request appropriate orientation and training.

A junior nursing student is preparing to give her patient an injection. What standard of care applies to the student nurse's conduct when providing care normally provided by a registered nurse (RN)? a. The standard of care for an unlicensed person b. The same standard of care as for an RN c. A standard similar to, but not the same as, that for the staff nurse with whom she is assigned to work d. No special standard of care because her faculty member is responsible for her conduct

ANS: B Feedback A Student nurses do not operate in the same capacity as an unlicensed person and therefore their standard is not compared with the standard of an unlicensed person. B Student nurses are expected to perform as professional nurses (i.e., as an RN would in providing safe patient care). C The statement "A standard similar to, but not the same as, that for the staff nurse with whom she is assigned to work" is not a true statement. Staff nurses may serve as preceptors, but that does not excuse the student from performing at the level of an RN. D If a patient is harmed as a direct result of a student nurse's actions or lack of action, the liability for the error is generally shared by the student, instructor, hospital or health care facility, and the university or educational institution.

Which of the following is an aspect of medical futility? a. A balance between knowledge and caring b. Patient care directed at symptom management c. Treatment that will not achieve its therapeutic goal d. Care that identifies which life-sustaining treatment a patient desires

ANS: C Feedback A A balance between knowledge and caring is not an aspect of futile care. B Patient care directed at symptom management is an aspect of palliative care. C Futile care is defined as medical treatment that is considered unlikely to achieve its therapeutic goal, or suggests that there is something problematic about the goal. D Care that identifies which life-sustaining treatment a patient desires is care related to an advance directive.

On admission to the hospital, a patient with terminal cancer says that he has a living will. Which of the following does this document state as the patient's desire? a. Receive all means of mechanical assistance to prolong life. b. Have his wife make decisions regarding his care. c. Be allowed to die and not be subject to life-prolonging measures. d. Have a lethal injection administered to free him from his suffering.

ANS: C Feedback A A living will specifies what life-prolonging interventions the patient does not want for himself or herself. B If the patient's wife had been appointed by him as his health care agent, then she could make treatment decisions on his behalf. C A living will is a document in which a person records refusal of life-prolonging measures that may be administered during his or her probable state of mental incompetence in the future. D Assisted suicide, such as a lethal injection, is not a function of a living will. A living will defines a patient's wishes for withholding life-prolonging treatments.

Which of the following themes is a theme of relational ethics? a. Apathy b. Compassion c. Embodiment d. Accountability

ANS: C Feedback A Apathy is not a theme of relational ethics. B Compassion is not a theme of relational ethics. C Embodiment is one of the four themes of relational ethics. The other three themes are environment, mutual respect, and engagement. D Accountability is not a theme of relational ethics.

The nurse is about to obtain consent from a patient who is scheduled to undergo a surgical procedure the next morning. What does the nurse's signature as a witness on the informed consent form indicate? a. The patient fully understands the procedure. b. The patient agrees with the choice of the procedure to be performed. c. The patient has voluntarily signed the form. d. The patient has authorized the physician to continue with the treatment.

ANS: C Feedback A It is the physician's responsibility to make sure that the patient fully understands the procedure. If the nurse suspects lack of understanding in the patient, the nurse should notify the physician. B The nurse's signature does not indicate that the patient agrees with the choice of the procedure to be performed but that the patient has voluntarily given consent and is mentally competent to do so. Patients have the right to refuse treatment, which also is signed and witnessed. C A nurse's signature witnessing the consent means that the patient voluntarily gave consent, that the patient's signature is authentic, and that the patient appears to be mentally competent to give consent. D The nurse's signature does not verify that the patient has authorized the physician to continue with treatment. It verifies only that the consent was given voluntarily, that the patient is mentally competent to give consent, and that the signature is authentic.

Which of the following statements about caring for patients with communicable diseases, such as severe acute respiratory syndrome (SARS) and acquired immunodeficiency syndrome (AIDS), is true? a. Every health care worker who comes into contact with a patient has the right to know the patient's HIV infection status. b. A nurse can refuse to care for a patient with SARS or AIDS if he or she fears for his or her own personal health. c. Strict compliance with standard precautions should be the nurse's strategy when caring for all patients. d. In known cases of AIDS or SARS, information can be disclosed without the patient's consent.

ANS: C Feedback A Not every health care worker who comes in contact with a patient needs to know the patient's HIV status. Confidential information must be protected. B Nurses who refuse to care for an HIV-infected patient or a patient with SARS may be reprimanded or fired for insubordination. C Strict compliance with standard precautions or routine practices and the use of transmission-based (e.g., airborne or droplet) precautions for patients known or suspected of having serious communicable illnesses is the nurse's wisest strategy. D Whenever information about a patient is requested by any third parties, including insurance companies or employers, nurses must obtain a signed release from the patient before releasing confidential information.

In the course of nursing practice, a nurse may be liable for actions that constitute an unintentional tort. Which one of the following is an example of an unintentional tort? a. Physical restraint of a patient who refuses care b. Taking photos of a patient's surgical wounds without the patient's permission c. The patient falling and being injured as a result of side rails being left down d. Talking about a patient's history of sexually transmitted infections

ANS: C Feedback A Physically restraining a patient who refuses care would be an example of assault and battery B Taking photos of a patient's surgical wounds without the patient's permission is an example of invasion of privacy C An unintentional tort is an unintended wrongful act against another person that produces injury or harm. An example of an unintentional tort would be leaving the side rails down, which causes the patient's fall and injury. D Talking about a patient's history of sexually transmitted infections would fall under the category of invasion of privacy. Personal information about the patient should be kept confidential.

The nurse observes her colleague administering the wrong medication to a patient. The colleague states, "I am glad it was only Tylenol, so there won't be any adverse effects and I won't have to report it." What is the most appropriate action for the nurse who hears this comment to take? a. Report the incident to the physician. b. No action should be taken, as it is the colleague's decision to report the incident. c. Tell the colleague that an incident form must be completed. d. Report the incident to the provincial or territorial registering body.

ANS: C Feedback A Reporting the incident to the patient's physician is not an appropriate action. B Taking no action is not an appropriate response. C Whistleblowing (i.e., reporting a colleague's errors, incompetence, unsafe or negligent practice, or patient abuse) is one of the most difficult things a nurse has to do to ensure safe, compassionate, competent, and ethical care. If the other nurse has not filled out the incident report, then the nurse who hears this comment should do so. D Reporting the incident to the provincial or territorial registering body is not an appropriate action.

The nurse has just obtained the licence to practice and is determining whether individual malpractice insurance is necessary. Which of the following is the most important factor in the nurse's decision to carry malpractice insurance? a. The amount of the malpractice insurance provided by the employer b. Working in a critical area of nursing where patients have higher morbidity and mortality rates c. Employment status and professional liability coverage d. The nurse's knowledge level of Good Samaritan laws

ANS: C Feedback A The amount of the malpractice insurance provided by the employer is not the most important factor in deciding about private insurance. Generally, the employer's malpractice insurance coverage is much greater than private insurance coverage. B The area of nursing is not the most important factor in deciding whether to carry malpractice insurance. Lawsuits can occur anywhere. C All nurses should have clear knowledge of their employment status and professional liability coverage. Publicly funded health care facilities carry malpractice insurance. The facility is considered the employer and is liable for the negligent acts of its employees as long as their actions were within their scope of practice. D The nurse should be aware of Good Samaritan laws, but this would not ensure sufficient coverage for most nursing practice. Therefore, it is not the most important factor in determining whether to purchase private malpractice insurance.

The nurse always tries to apply ethical principles in her clinical practice. Which following statement reflects the application of the ethical principle of confidentiality? a. "I'm concerned that decreased funding may affect the outpatient program." b. "I'm going to make sure that the patient understands the instructions." c. "I cannot share that information about the patient with you." d. "I need to get more information about the patient's health history."

ANS: C Feedback A The statement "I'm concerned that decreased funding may affect the outpatient program" reflects a concern regarding allocation of resources. It is not a confidentiality issue. B The nurse who makes sure that a patient fully understands instructions is being ethically responsible. C The statement "I cannot share that information about the patient with you" reflects the application of the ethical principle of confidentiality. Patient information is not to be shared with others without patient consent. D The statement "I need to get more information about the patient's health history" reflects data gathering. The information that is gathered is to be used for the purpose of providing competent health care and should not be shared with others without the specific consent of the patient.

Which of the following statements best illustrates deontological ethical theory? a. "I believe this disease was allowed to occur by a supreme being." b. "He has become a stronger individual through experiencing the loss of his father." c. "It would never be right for a person to stop cardiopulmonary resuscitation efforts." d. "The chemotherapy did not cure this person, but it provided a better life for him."

ANS: C Feedback A The statement, "I believe this disease was allowed to occur by a supreme being" does not reflect deontological ethical theory. It is based on feminist ethical theory, because it reflects a relationship between disease and a supreme being. B The statement, "He has become a stronger individual through experiencing the loss of his father" does not best illustrate deontological ethical theory, because it is citing a consequence. It is based on utilitarian ethical theory. C Deontology defines actions as right or wrong based on their "right-making characteristics, such as fidelity to promises, truthfulness, and justice" (Beauchamp & Childress, 2001). Deontology does not look to the consequences of actions to determine the rightness or wrongness of the actions. Determining the wrongness of this statement may be based on fidelity to promises and beneficence. D The statement, "The chemotherapy did not cure this person, but it provided a better life for him" does not best illustrate deontological ethical theory because it is citing a consequence. It based on utilitarian ethical theory.

Which of the following is an example of a nurse's use of the ethical principle of autonomy in a situation with a patient? a. Learning how to do a procedure safely and effectively b. Returning to speak to the patient at a mutually agreed time c. Preparing the patient's room for comfort and privacy d. Supporting the patient's decision to refuse therapy

ANS: D Feedback A Learning how to do a procedure safely and effectively demonstrates the nurse's application of the ethical principle of responsibility. B Returning to speak to the patient at a mutually agreed time demonstrates the ethical principle of fidelity. C Preparing the patient's room for comfort and privacy demonstrates the nurse's application of the ethical principle of responsibility. D Following the ethical principle of autonomy, the nurse allows the patient to make decisions regarding care and then supports that decision.

What is the purpose of a pretrial conference? a. To outline what the defendant did wrong b. To allow the defendant to deliver the statement of defence c. To explain and interpret all of the evidence as it emerges d. To identify points of contention and narrow down the issues

ANS: D Feedback A Outlining what the defendant did wrong is done in the pleadings. B The delivery of the defendant's statement of defence occurs in the pleadings. C Explaining and interpreting the evidence as it emerges occurs through expert witnesses.Explaining and interpreting the evidence as it emerges occurs through expert witnesses. D The purpose of a pretrial conference is to identify points of contention, narrow down issues, and encourage out-of-court settlements.

The nurse recognizes that issues concerning death and dying may influence nursing practice. Which of the following statements is true, concerning the legalities related to death and dying? a. Passive euthanasia is illegal in all provinces, except Manitoba. b. Assisted suicide is a constitutional right. c. Organ donation must be sought if it will save the recipient's life. d. Feedings may be refused by mentally competent individuals who are unable to feed themselves.

ANS: D Feedback A Passive euthanasia is illegal in all provinces. (Manitoba is the only province that has a statutory definition of death.) B In Canada, euthanasia is illegal. According to Section 241 of the Criminal Code (1985), it is an offence to "aid a person to commit suicide, whether suicide ensues or not." C It is not mandatory to seek organ donation even if it will save a recipient's life. D Mentally competent patients have the right to refuse treatment. This includes life-saving hydration and nutrition.

Mr. Smith, 62 years old, is leaving the hospital against medical advice the day after his surgery. The nurse informs him that he is not allowed to leave and proceeds to call a "code purple" to lock down the unit. What type of intentional tort does the nurse's action demonstrate? a. Assault b. Battery c. Invasion of privacy d. False imprisonment

ANS: D Feedback A Preventing a patient from leaving a health care facility by locking the unit doors is not an example of assault. B Preventing a patient from leaving a health care facility by locking the unit doors is not an example of battery. C Preventing a patient from leaving a health care facility by locking the unit doors is not an example of invasion of privacy. D Preventing a patient from leaving a health care facility by locking the unit doors is an example of the tort of false imprisonment. The tort of false imprisonment serves to protect a person's individual liberty and basic rights.

According to the standards of care mandated by the Canadian Council on Health Services Accreditation (CCHSA), which of the following is an institution required to establish? a. Limits of professional liability b. Educational standards for nurses c. A delineated scope of practice for health care providers d. Written nursing policies and procedures for care

ANS: D Feedback A Standards of care help define the limits of professional liability. The CCHSA does not require an institution to establish the limits of professional liability. B Educational requirements for nurses are established by nursing practice acts that describe and define nursing practice within each province and territory. C Nursing practice acts establish the scope of nursing practice. The rules and regulations enacted by the provincial board of nursing define the practice of nursing more specifically. The CNA has developed standards for nursing practice that delineate the scope, function, and role of the nurse and establish clinical practice standards. D The CCHSA requires that accredited health care institutions establish written nursing policies and procedures.

An RN interprets a scribbled medication order by the attending physician as 25 mg, administers the dose to the patient, and then discovers that the dose was, in fact, 15 mg. Who would ultimately be held responsible for the error? a. The attending physician b. The assisting resident c. The pharmacist d. The nurse

ANS: D Feedback A The attending physician could be included in the lawsuit, but the nurse would be ultimately held responsible for the error. B The assisting resident would not be ultimately held responsible for the error, as the resident did not administer the inaccurate dose. C The pharmacist could be included in the lawsuit, but the nurse would ultimately be held responsible for the error because it was the nurse who administered the inaccurate dose. D A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the patient. The nurse should have the physician clarify the order when the writing is hard to read.

The nurse is providing care to a female patient who has been diagnosed with terminal cancer and who has a poor prognosis. When the patient's husband comes in to visit, the nurse expresses her sympathy to the man for his wife's terminal illness. The patient's husband bursts into tears and says that he did not know about his wife's diagnosis. This nurse's action exemplifies which of the following violations? a. Assault b. Slander c. Negligence d. Invasion of privacy

ANS: D Feedback A This action is not an example of assault. B The nurse can be held liable for slander if the nurse discusses private information about a patient that is overheard by others. C This action is not an example of negligence. D This action is an example of invasion of privacy and occurs if a patient's medical information is discussed without the consent of the patient.

An unconscious patient with a head injury needs immediate life-saving surgery. His wife speaks only French, and the health care providers who are not fluent in French are having a difficult time explaining his condition to her. Which of the following is the most correct answer regarding this situation? a. Two licensed health care workers should witness and sign the preoperative consent form indicating that they heard an explanation of the procedure given in English. b. An institutional review board must be contacted to give its emergency advice on the situation. c. A friend of the family may act as an interpreter, but the explanation cannot contain details of the patient's accident because of confidentiality laws. d. The health care team should continue with the surgery after providing information in the best manner possible

ANS: D Feedback A Two witnesses are required usually when telephone consents are involved. This is not the case in this situation. B In an emergency, it is not necessary to contact the institutional review board. Doing so would take up valuable time. C A family member or acquaintance who is able to speak the patient's language should not be used to interpret health care information. An official interpreter must be available to explain the terms of consent (except in an emergency situation). D In emergency situations, if it is impossible to obtain consent from the patient or an authorized person, the beneficial or life-saving procedure may be undertaken without liability for failure to obtain consent. In such cases, the law assumes that the patient would wish to be given the treatment. This is referred to as the emergency doctrine.

Which province was the first in Canada to gain legislation related to nursing registration? a. Ontario b. Nova Scotia c. New Brunswick d. British Columbia

ANS: B Feedback A Ontario was not the first province in Canada to gain legislation related to nursing registration. B Nova Scotia was the first province in Canada to gain legislation related to nursing registration, with the passing of a voluntary registration act in 1910. C New Brunswick was not the first province in Canada to gain legislation related to nursing registration. D British Columbia was not the first province in Canada to gain legislation related to nursing registration.

The nurse is planning interventions for the clients of a homeless shelter. Which of the following activities represents a primary level intervention regarding sexually transmitted infections? a. HIV screening for all residents b. Sex education for teenage residents c. Treatment for residents diagnosed with AIDS d. Gynecological referrals for female residents

ANS: B Feedback A Screening a disease is a secondary level intervention. B Primary health care focuses on education, rehabilitation, support services, health promotion, and disease prevention. C Treatment of disease is a tertiary level intervention. D Referrals are secondary level interventions.

Aboriginal health care is directed by a number of treaties. Which of the following refers to Treaty 6, which includes a provision for health care services? a. The Indian Act b. The "medicine chest" clause c. The Indian band agreements d. The land and relationship understanding

ANS: B Feedback A The Indian Act does not refer to Treaty 6. B Treaty 6 was often referred to as the "medicine chest" clause, as it included a provision for health care services to be provided to First Nations communities. C The Indian band agreements were signed with the British government before Confederation and do not refer to Treaty 6. D Land and relationship agreements do not refer to Treaty 6.

A client is being discharged home from an acute care facility following a total hip replacement. She will require follow-up for health care and also exercise. In addition to a home health nurse, what other service will this client require? a. Dietitian b. Social worker c. Physiotherapist d. Respiratory therapist

ANS: C Feedback A A dietitian may not be required. B A social worker may not be required. C Community health nurses bring together resources to improve continuity of care for clients. In collaboration with clients, health care and social service providers, and other community members, they coordinate health care services, locate appropriate services, and develop innovative approaches to address clients' health care issues. A physiotherapist would be an appropriate service to facilitate an exercise program for a client after a hip replacement. D A respiratory therapist may not be required.

Which of the following must the nurse do in order to be culturally competent? a. Be sensitive to a client's cultural uniqueness. b. Evaluate a client's beliefs and values about health in terms of the nurse's own experience. c. Be able to appraise and understand a client's cultural beliefs, values, and practices. d. Be ready to discuss a client's beliefs and values with him or her.

ANS: C Feedback A Being culturally competent involves more than being sensitive to a client's cultural uniqueness. B The nurse cannot judge a client's beliefs and values about health in terms of that nurse's own culture. C The nurse must be able to appraise and understand a client's cultural beliefs, values, and practices in order to work with him or her to determine the needs and interventions most likely to improve health. D Being ready to discuss a client's beliefs and values with him or her could be interpreted as judging the client's beliefs and values.

Which of the following statements reflects a current concern with the use of the nursing diagnoses approved by the North American Nursing Diagnoses Association (NANDA)? a. NANDA's list of nursing diagnoses stifles critical thinking. b. NANDA's list of nursing diagnoses should replace conceptual nursing models. c. NANDA's list of nursing diagnoses is an inherent barrier to individualized care. d. NANDA's list of nursing diagnoses does not reflect practical diagnoses.

ANS: C Feedback A NANDA's list of nursing diagnoses may stifle critical thinking, but this has not been recognized as a concern. B NANDA's list of nursing diagnoses is often considered to be less thorough than conceptual models of nursing, as it involves only one aspect of caring for patients. C NANDA's list of nursing diagnoses is recognized by many nurses as a system that relies entirely upon an agreement about what constitutes average wellness and illness experiences. It can therefore create worrisome barriers to the individualized care of patients. D NANDA's list of nursing diagnoses does reflect practical diagnoses.

When assessing members of a vulnerable population, which of the following should the community health nurse realize is their primary need? a. Obtaining a culturally competent assessment b. Receiving food security c. Providing a comfortable, nonthreatening environment d. Assessing for indications of mental or physical abuse

ANS: C Feedback A Obtaining a culturally competent assessment is not the primary need. B Receiving food security is not the primary need. C When assessing members of a vulnerable population, it is important to create a comfortable, nonthreatening environment. The nurse may only have one opportunity to work with the vulnerable person or family. Creating a comfortable and nonthreatening environment will encourage the client to participate in the assessment. D Assessing for indications of mental or physical abuse is important but is not the primary need.

Which one of the following individuals' theories should be selected if the nurse wants to focus on stress reduction for a client? a. Peplau b. Henderson c. Neuman d. Parse

ANS: C Feedback A Peplau's theory focuses on interpersonal relationships between nurses and clients and the interactive, therapeutic nature of the nursing process. B Henderson's theory focuses on the 14 basic human needs. C Neuman's theory focuses on stress reduction as the goal of the systems model of nursing practice. D Parse's theory focuses on the notion of nurses' engagement with, and care of, people in a continuous process of making choices and changing health priorities.

Which of the following statements describes a population? a. A group of people who live in a given community b. Geographic groupings, such as individuals, who live in neighbourhoods c. A collection of individuals who have personal and environmental characteristics in common d. A group of individuals who are engaged in collective relationships that create a supportive living environment

ANS: C Feedback A Population is different from community. A community is a group of people who share a geographic (locational) dimension and a social (relational) dimension. B Individuals who live in neighbourhoods are part of a community. C A population is defined as a collection of individuals who have one or more personal or environmental characteristics in common. Examples of populations include Canadians inclusively, or, more specifically, high-risk infants, older adults, or cultural groups such as Aboriginals. D A healthy community is a group of individuals who are engaged in collective relationships that create a supportive living environment.

Which of the following is the fastest growing component of the health care system? a. Primary care b. Respite care c. Home care d. Palliative care

ANS: C Feedback A Primary care is not the fastest growing component of the health care system. B Respite care is not the fastest growing component of the health care system. C Canadian health care is shifting from an institution-based system to one in which community care is playing a greater role. Home care is one of the fastest growing components of the health care system, partly because clients are sent home from hospital sooner than they used to be. D Palliative care is not the fastest growing component of the health care system.

Which of the following patterns of knowledge in nursing allows change to occur? a. Esthetics b. Empirics c. Personal knowledge d. Emancipatory knowing

ANS: D Feedback A Esthetics is the art of nursing—creativity, with an artistic or expressive component. B Empirics is the science of knowledge development in nursing—knowledge developed through systematic research to describe and explain phenomena. C Personal knowledge is derived from the depth and power of the interpersonal relationship with the patient. D Emancipatory knowing is the social, economic, and political component of nursing—knowledge that allows change to occur.

Which of the following is referred to as a body of knowledge that encompasses definitions of person, environment, health, and nursing? a. Family nursing practice b. Prescriptive nursing theory c. Advanced nursing practice d. Metaparadigm of nursing

ANS: D Feedback A Family nursing practice, although perhaps focusing on all of these concepts, is not a body of knowledge. B Prescriptive nursing theory addresses nursing interventions and helps predict consequences of a specific intervention. C Advanced nursing practice may focus on these concepts but is not a body of knowledge specific to these concepts. D The major components of nursing theory, sometimes called the metaparadigm concepts, are person, environment, health, and nursing.

Which province established the first undergraduate nursing degree program? a. Ontario b. Nova Scotia c. New Brunswick d. British Columbia

ANS: D Feedback A Ontario was not the first province to establish an undergraduate nursing degree program. B Nova Scotia was not the first province to establish an undergraduate nursing degree program. C New Brunswick was not the first province to establish an undergraduate nursing degree program. D British Columbia was the first province to establish an undergraduate nursing degree program, at the University of British Columbia in 1919.

Which of the following correctly defines the theorizing term proposition? a. A purposeful set of assumptions b. A declarative assertion c. The process of formulating concepts d. The structure that links concepts together

ANS: B Feedback A A purposeful set of assumptions is a theory. B A proposition is a declarative assertion. C The process of formulating concepts is conceptualization. D The structure that links concepts together is a conceptual framework.

Creativity, with its artistic or expressive component, is an example of which of the following fundamental patterns of knowing in nursing? a. Ethics b. Esthetics c. Personal knowledge d. Emancipatory knowledge

ANS: B Feedback A Ethics includes resolving dilemmas in practice based on what ought to be done in particular situations. B Esthetics incorporates an artistic, expressive component, which involves knowledge and understanding. C Personal knowledge is derived from the depth and power of the interpersonal relationship with the client. D Emancipatory knowledge—the social, economic, and political component—allows change to occur.

Which of the following was considered to be the main driving force for the modernization of nursing? a. Globalization b. The Crimean War c. Missionary nursing d. The women's suffrage movement

ANS: A Feedback A The history of modern nursing, at its heart, is a story of globalization. Nurses often travelled across geographic and national boundaries to bring nursing service and training to communities in need. B Although Florence Nightingale reduced morbidity and mortality rates by applying modern principles of cleanliness and comfort during the Crimean War, this war was not the main driving force for the modernization of nursing. C Missionary nursing was the result of a series of sociopolitical factors converging at the same time but was not the main driving force for the modernization of nursing. D The women's suffrage movement was not the main driving force for the modernization of nursing, although nursing did become an instrument of women's emancipation against middle-class female restrictions.

Which of the following is one of the five health promotion strategies identified by the Ottawa Charter for Health Promotion? a. Create supportive environments b. Strengthen educational opportunities c. Develop a medical approach d. Minimize stressful situations

ANS: A Feedback A "Create supportive environments" is one of the five broad health promotion strategies identified by the Ottawa Charter for Health Promotion. These strategies are: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services. B "Strengthen educational opportunities" is not one of the five strategies. C "Develop a medical approach" is not one of the five strategies. D "Minimize stressful situations" is not one of the five strategies.

A community health nurse is working with a variety of clients and decides to use a systems theory approach to help them to meet their health care needs. When using systems theory, on which of the following should the nurse focus? a. The client's interaction with his or her environment b. The hierarchy of the client's human needs c. The client's attitudes toward health behaviours d. The response of the client to the process of growth and development

ANS: A Feedback A According to systems theory, a system is made up of parts that depend on one another, are interrelated, share a common purpose, and together form a whole. A client's interaction with the environment is an example of an open system. The nurse understands that factors that change the environment also can have an impact on the system. B Maslow's hierarchy of human needs is an interdisciplinary theory useful in planning individualized care. C Determining a client's attitudes toward health behaviours follows a health and wellness theoretical model. D Focusing on the response of a client to the process of growth and development is consistent with developmental theories.

Among the following nursing skills, which one must be demonstrated to successfully fulfill the role of facilitator? a. Advocacy b. Paternalism c. Autonomy d. Negotiation

ANS: A Feedback A Community health nurses work within a participatory process; leadership and advocacy are critical skills needed for the role of facilitator. B Paternalism is not a skill critically needed for the role of facilitator. C Autonomy is not a skill critically needed for the role of facilitator. D Negotiation is a characteristic of appropriate communication skills in community health nursing practice, rather than a reflection of the nurse in the role of facilitator.

Which of the following groups of health concerns affect youth, young men, and those in Aboriginal communities in particular? a. Depression, suicide, unemployment, and unintentional injuries b. Chronic illness, mental illness, impaired function, and nutrition c. Physical abuse, emotional abuse, sexual abuse, and neglect d. Substance abuse, alcoholism, sexually transmitted diseases, and AIDS

ANS: A Feedback A Depression, suicide, unemployment, and unintentional injuries are concerns that affect youth, young men, and those in Aboriginal communities. B Chronic illness, mental illness, impaired function, and nutrition are not specific to youth, young men, or those in Aboriginal communities. C Physical abuse, emotional abuse, sexual abuse, and neglect are major public health problems affecting older adults, women, and children. Abuse occurs in many settings, including the home, workplaces, schools, health care facilities, and public areas, and is most often committed by an acquaintance of the victim. D Substance abuse, alcoholism, sexually transmitted diseases, and AIDS are health problems that are related to vulnerable populations.

The Ottawa Charter for Health Promotion identified which of the following as a prerequisite for health? a. Education b. Social support c. Self-esteem d. Physical environment

ANS: A Feedback A Education is one of the nine prerequisites for health that were identified in the Ottawa Charter for Health Promotion. B Lack of social support was identified as a psychosocial risk factor by Labonte (1993). C Low self-esteem was identified as a psychosocial risk factor by Labonte (1993). D Dangerous physical environments were identified as socioenvironmental risk conditions by Labonte (1993).

Which of the following is a key characteristic of a healthy community? a. A collective capacity to solve problems b. Proximity to lakes and forests c. Access to recreational facilities d. Government interventions to solve community problems

ANS: A Feedback A Key characteristics of healthy communities include a collective capacity to solve problems, adequate living conditions, a safe environment, and sustainable resources such as employment, health care, and educational facilities. B Proximity to lakes and forests is not a key characteristic of a healthy community. C Access to recreational facilities is important when defining a healthy community, but is not a key characteristic. D Government should attempt to solve community problems in conjunction with the community.

What is the primary purpose of licensure laws for the nursing profession? a. To protect the public against unqualified and incompetent practitioners b. To enhance the quality of nursing care and improve Canadians' health outcomes c. To ensure that nurses demonstrate knowledge and skills in a variety of professional roles d. To provide an opportunity for practitioners to validate their expertise in a specialty

ANS: A Feedback A Licensure laws are designed to protect the public against unqualified and incompetent practitioners. Because constitutional responsibility for education and health falls under the purview of the provinces and territories, each has a nursing practice act to regulate the licensure and practice of nursing. B The statement "To enhance the quality of nursing care and improve Canadians' health outcomes" does not reflect the primary purpose of licensure laws. C The statement "To ensure that nurses demonstrate knowledge and skills in a variety of professional roles" does not reflect the primary purpose of licensure laws. D The statement "To provide an opportunity for practitioners to validate their expertise in a specialty" does not reflect the primary purpose of licensure laws.

A client comes to the ambulatory care clinic for management of a chronic condition. What does the nurse tell him when he asks for an explanation of the Medicare system? a. It is Canada's national health insurance system. b. It is a fee-for-service insurance plan. c. It is a plan in which monies from provincial taxes are used for nursing homes. d. It is a social insurance program for low-income earners.

ANS: A Feedback A Medicare is a key element of Canada's social safety net. It is Canada's national health insurance system, which uses taxes to finance medically necessary services for all citizens, thus providing "free" health care to all. B Medicare is not a fee-for-service insurance plan. C Medicare is not a plan in which monies from provincial taxes are used for nursing homes. D Medicare is not a social insurance program for low-income earners.

The nurse is working within a health care system that uses Neuman's theory. A patient is having difficulty breathing and requires oxygen and medication. Which of the following approaches is the nurse's goal? a. Strengthen the line of defences, and focus on prevention. b. Promote attainment of biological self-care requisites. c. Assist in physiological adaptation to internal changes. d. Achieve the 14 basic needs.

ANS: A Feedback A Neuman's framework for practice includes nursing actions that focus on actual or potential stressors, and thus on prevention. B Orem's theory focuses on the attainment of self-care. C Roy's theory focuses on adaptation. D Henderson's theory focuses on helping the client to achieve 14 basic needs.

According to research about nutrition in Canada, which one of the following statements is true? a. Canadians have increased their total fat and salt consumption. b. Canadians report that their children eat the recommended daily number of fruits and vegetables. c. Fifty percent of children aged 2 to 17 years were overweight or obese. d. The 2004 Canadian Community Health Survey (CCHS) revealed that 40% of adult Canadians were obese (body mass index of 30 or more) and 50% were overweight.

ANS: A Feedback A One-quarter of Canadians overall, and one-third of teens aged 14 to 18 years, had eaten at a fast-food outlet the previous day, exposing them to foods high in fats and salts. B Seventy percent of children aged 4 to 8 ate fewer than the minimum servings of fruits and vegetables daily. C It is 26 % of children aged 2 to 17 years were overweight or obese, not 50%. D The 2004 Canadian Community Health Survey (CCHS) revealed that 23% of adult Canadians were obese (body mass index of 30 or more), not 40% and 36% were overweight, not 50 %.

Which of the following best describes primary care? a. Early detection and routine care, as well as prevention b. Provision of a specialized medical service c. Treatment of all clients with a minimum level of health insurance d. Provision of medical services in a client's home

ANS: A Feedback A Primary care is the first contact of a client with the health care system that leads to a decision regarding a course of action to resolve any actual or potential health problem. The focus is on early detection and routine care, with emphasis on education to prevent recurrences. B Provision of a specialized medical service by a specialist or through referral is an example of secondary care. C No client is refused treatment based on level of insurance. D Medical services provided in the client's home, although not very common, could fall under primary care, but would not best describe primary care.

Which one of the following is an example of ethical responsibility? a. Delivery of competent care b. Formation of interpersonal relationships c. Application of the nursing process d. Evaluation of new computerized technologies

ANS: A Feedback A Providing competent care is one of the values in the CNA Code of Ethics that nurses have to uphold. B Formation of interpersonal relationships is not an ethical responsibility. C Application of the nursing process is not an ethical responsibility. D Evaluation of new computerized technologies is not an ethical responsibility.

Which of the following is one of the four pillars of primary health care, as described by the National Primary Health Care Awareness Strategy (2006)? a. Teams b. Universality c. Health promotion d. Immediate access to primary care

ANS: A Feedback A Teams are one of the four pillars, along with access, information, and healthy living. B Universality is not one of the four pillars. C Health promotion is not one of the four pillars. D Immediate access to primary health care is not one of the four pillars.

The population health promotion model aims to develop actions for improving health. In addition to asking "On what should we take action?" "How should we take action?" and "Why should we take action?", what is the fourth major question explored by the model? a. "With whom should we act?" b. "When should we take action?" c. "Which government should take action?" d. "Where should we first act?"

ANS: A Feedback A The fourth question is "With whom should we act?" B "When should we take action?" is not one of the four questions. C "Which government should take action?" is not one of the four questions. D "Where should we first act?" is not one of the four questions.

A patient has just been informed by her physician that she has cancer. The patient says that she is not ready to discuss this with her family. The nurse encourages the patient to consider sharing the information with her family so that the family can support her through the decisions she will need to make regarding her care. Which following principle must the nurse be careful not to breach? a. Confidentiality b. Fidelity c. Veracity d. Justice

ANS: A Feedback A The nurse should recognize the importance of privacy and confidentiality, and safeguard the patient's personal, family, and community information obtained in the context of a professional relationship. B Fidelity refers to an agreement to keep promises. C Veracity, in general, means accuracy or conformity to truth. In this situation, the nurse encourages the patient to be truthful with her family. D Justice refers to fairness.

Which of the following statements would help the nurse to best discuss the impact of a known risk factor on a client's health? a. "It doesn't mean that you'll get the disease, just that the odds are greater for you." b. "Now that you know the possibility is there, you can take steps to prevent it." c. "This risk factor can be managed by making a change to your lifestyle." d. "You're lucky because you have the benefit of being able to do something about it."

ANS: A Feedback A The presence of risk factors does not mean that a disease will develop, but risk factors increase the chances that the individual will experience a particular disease or dysfunction. B While the statement, "Now that you know the possibility is there, you can take steps to prevent it" is not incorrect, it does not address the impact of the risk factor on the client's health. C It is not always true that a risk factor can be managed by making lifestyle changes, and therefore this is not the best available option. D The strategy of telling the client that he or she is lucky and has the benefit of being able to do something about a risk factor minimizes the client's concern, and does not address the impact of the risk factor on the client's health.

A secondary schoolteacher with advanced multiple sclerosis teaches from her wheelchair but insists on being treated the same as other colleagues. Which of the following is the teacher demonstrating? a. Preserving dignity b. Choosing from alternatives c. Considering all consequences d. Acting with a pattern of consistency

ANS: A Feedback A The teacher's choice is preserving dignity, which is a value included in the Canadian Nurses Association (CNA) Code of Ethics. She cherishes her choice of being treated like everyone else despite her medical condition and publicly affirms the choice by teaching from her wheelchair and insisting that she be treated the same as her colleagues. B At this point, the teacher is not choosing from alternatives. She could have chosen to quit teaching, but she did not. She has already made her choice. C The teacher is not demonstrating that she is considering all consequences. She has already made her choice. D At this point, the teacher is not demonstrating that she is acting with a pattern of consistency. She is not repeating a behaviour.

"Residents temporarily absent from their home province are to have their incurred services paid for by the home province, in the same amount that would have been paid by the home province." This statement describes which principle of the Canada Health Act (1984)? a. Portability b. Universality c. Public administration d. Accessibility

ANS: A Feedback A This statement describes the principle of portability. B The principle of universality means that 100% of the insured persons of a province are covered by the health care plan. C The principle of public administration means that the health care plan must be administered and operated on a nonprofit basis by a public authority, responsible to the provincial government and subject to audits of its accounts and financing transactions. D The principle of accessibility means that the health care plan of a province must provide for (a) insured health services and reasonable access by insured persons; (b) reasonable compensation to physicians and dentists for all insured services rendered; and (c) payments to hospitals in respect to the cost of insured health services.

The nurse is working in a free clinic and caring for a homeless client diagnosed with paranoid schizophrenia. The client reports, "I hurt my foot running away from them. It hurts so bad I can hardly walk now." On assessment, the nurse notices bruising on the client's back, arms, and thighs, a red rash on her neck and face, and poor personal hygiene, in addition to edema of the left ankle. Which of the following pose a risk to this client? a. Physical abuse and assault b. Drug addiction relating to pain c. Communicable immune disorders d. Hospitalization due to a mental disorder

ANS: A Feedback A When a client has a severe mental illness, multiple health and socioeconomic challenges must be explored. Many such clients are homeless or marginally housed. The client's report of needing to run away from others requires further assessment in order to rule out physical abuse or assault. B Drug addiction may be a consideration, even though the client is not seeking drugs. C Communicable disease is a risk factor. However, this is not the best available option, since several factors relate to abuse or assault. D Hospitalization may be required for medical treatment, but there is no indication that this client requires hospitalization for psychiatric crisis.

The patient states that she needs to exercise regularly, watch her weight, and reduce her fat intake. What does this demonstrate about the patient? a. She believes she will have a heart attack. b. She values health promotion activities. c. She believes she will not become sick. d. She has unrealistic expectations for herself.

ANS: B Feedback A A belief is a conviction of the truth of something. The patient's statement does not indicate that she has beliefs or fears about having a heart attack. B A value is a strong personal belief. It is an ideal that a person or group (such as nurses) strives to uphold. An individual's values reflect cultural, social influences, and personal needs. C A belief is a conviction of the truth or reality of something. The patient does not state that she believes these health promotion activities will keep her from becoming sick. D These are not unrealistic expectations.

Which of the following assists in protecting the patient's right to autonomy? a. Answerability b. Informed consent c. Constrained moral agency d. Maleficence

ANS: B Feedback A Answerability offers reasons and explanations for certain aspects of nursing practice. B The goal of informed consent is to protect the patient's right to autonomy. C If the nurse feels powerless to act for what he or she thinks is right, or believe the actions will not bring about change, the nurse will have difficulty being an effective advocate. D Maleficence refers to hurt or harm.

In the early twentieth century, which of the following was seen as critical to the nation's overall health? a. Contraception education b. The health of mothers and children c. National immunization clinics d. Rehabilitation of the casualties from World War I

ANS: B Feedback A Contraception education was not seen as critical to the nation's overall health in the early twentieth century. B The health of mothers and children was seen as particularly critical to the nation in the early twentieth century, as nurturing the health of the young was believed to raise the likelihood that the future adult population would be healthier than past generations. C National immunization clinics were not seen as critical to the nation's overall health in the early twentieth century. D Rehabilitation of war casualties was not seen as critical to the nation's overall health in the early twentieth century.

In which type of research design are relationships between two or more variables studied? a. Experimental b. Descriptive survey c. Scientific nursing d. Exploratory descriptive

ANS: B Feedback A Experimental research asks why one variable causes a predictable change in another variable. In this type of research, variables are tightly controlled and the aim is to prove a cause-and-effect relationship. B Descriptive survey designs aim to answer questions pertaining to relationships among variables. C Scientific nursing research investigates nursing phenomena that can be precisely measured and quantified, such as body temperature changes, pain severity, and rates of wound healing. D Exploratory descriptive designs provide in-depth descriptions of populations or variables not previously studied. No relationships among variables are established, although the results might indicate that relationships ought to be studied in subsequent research.

The nurse is conducting a research project on optimal time frames for postoperative ambulation of patients. After identifying the problem, what is the next step in the research process? a. Selecting the population b. Reviewing the literature c. Identifying the instrument to use for data analysis d. Obtaining approval to conduct the study

ANS: B Feedback A Following identification of the problem and review of the literature, the researcher will design the study protocol. Selecting the population is a component of this phase of the research process. B After identifying the problem, the next step in the research process is reviewing the literature in order to determine what is known about the problem. C Identifying the instrument to use for data analysis occurs during the process of designing the study protocol. This step would occur during the study design phase of the research process after problem identification and literature review have taken place. D Obtaining necessary approvals is part of conducting the study, which follows the design phase in the research process.

Child immunizations, support groups for adolescent parents, and chlorinated water are examples of which level of health care? a. Health promotion b. Disease and injury prevention c. Supportive care d. Rehabilitation

ANS: B Feedback A Health promotion services include antismoking services, advocacy for healthy public policy, and provision of wellness services. B Disease and injury prevention includes illness prevention (chlorinated water, immunizations) and support groups. C Supportive care describes services provided over a prolonged period to people who are disabled, who have never been able to function independently, or who have a terminal disease. D Rehabilitation, such as physiotherapy, involves restoring a person to optimal health.

Whose definition of nursing, which was adopted by the International Council of Nurses (ICN), is the current primary description of the role of the nurse? a. Jeanne Mance b. Virginia Henderson c. Florence Nightingale d. Mary Agnes Snively

ANS: B Feedback A Jeanne Mance was not responsible for the current primary description of the role of the nurse. B Virginia Henderson's definition of nursing (1966) was adopted by the ICN in 1973 and continues to be the primary description of the role of the nurse. C Florence Nightingale was not responsible for the current primary description of the role of the nurse. D Mary Agnes Snively was not responsible for the current primary description of the role of the nurse.

One well-designed randomized clinical trial (RCT) reflects which of the following levels of research evidence? a. Level I b. Level II c. Level III d. Level IV

ANS: B Feedback A Level I research evidence includes systematic reviews, meta-analysis, and three or more RCTs. B One or two well-designed RCTs reflect level II research evidence. C Level III research evidence shows one or more well-designed controlled trials without randomization. D Level IV research evidence shows one or more well-designed case control or cohort studies.

Which province opened the first hospital diploma school in Canada? a. Manitoba b. Ontario c. Quebec d. Newfoundland

ANS: B Feedback A Manitoba did not open the first hospital diploma school. B Ontario opened the first hospital diploma school in Canada, the St. Catharines Training School, in 1874, at St. Catharines General and Marine Hospital. C Quebec did not open the first hospital diploma school. D Newfoundland did not open the first hospital diploma school.

Which of the following is the primary motivator of nursing? a. Money b. Altruism c. Self-efficacy d. A curative model of care

ANS: B Feedback A Money is not the primary motivator of nursing. B Nursing is practical and theoretical, is motivated by altruism, and is based on professional and ethical standards. C Self-efficacy is not the primary motivator of nursing. D The curative model of care is not the primary motivator of nursing.

A nurse researcher desires to conduct an experimental research study. Which of the following subjects best lends itself to this process? a. The effects of therapeutic touch on a geriatric client with Alzheimer's disease b. Using humour as an intervention with patients in a sample group who are recovering from orthopedic surgery c. Determining the blood pressure patterns of a patient who recently had a cerebrovascular accident (i.e., stroke) d. Ranking three nursing diagnoses for a newly admitted patient with diabetes mellitus

ANS: B Feedback A Observation of the effects of therapeutic touch on a geriatric client with Alzheimer's disease lends itself to the nursing process as a nursing intervention, perhaps to assist a client in meeting a goal of preventing social isolation. To use the experimental research process, other clients would need to be involved (i.e., two groups of clients with Alzheimer's disease, with one group receiving therapeutic touch and one group not receiving therapeutic touch) in order to determine whether therapeutic touch had any effect. B In experimental research, the investigator controls the study variable (use of humour) and randomly assigns subjects to different conditions (those who receive humour as an intervention, and those who do not). C Determining the blood pressure patterns of a patient who recently had a cerebrovascular accident is part of the assessment phase of the nursing process. No variable is being controlled by the nurse, as would be the case in an experimental research study. D Setting priorities in nursing diagnoses for patient care is an example of using the nursing process.

Which province was the first to implement the basic entry to nursing practice as the baccalaureate degree? a. Ontario b. Alberta c. British Columbia d. Prince Edward Island

ANS: B Feedback A Ontario was not the first to implement the baccalaureate degree as the requirement for entry to nursing practice. B In 1975, the Alberta Task Force on Nursing Education proposed their entry-to-practice position, which was that all new nursing graduates be qualified at the baccalaureate level; however, Alberta was not the first to implement this requirement. C British Columbia was not the first to implement the baccalaureate degree as the requirement for entry to nursing practice. D Prince Edward Island was the first province to implement the baccalaureate degree as the requirement for entry to nursing practice, in 1992.

Different types of theories may be used by nurses seeking to study the basis of nursing practice. Which one of the following types of theories speculates on why phenomena occur? a. Prescriptive b. Descriptive c. Grand d. Middle-range

ANS: B Feedback A Prescriptive theories address nursing interventions and predict the consequences of a specific nursing intervention. B Descriptive theories describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena. C Grand theories provide the structural framework for broad, abstract ideas about nursing. D Middle-range theories address specific phenomena or concepts and reflect practice.

Since the early 1990s, which group has had the highest amount of absenteeism of all workers in Canada? a. "White collar sector" workers b. Nurses c. Workers in the trades d. Transport and equipment operators

ANS: B Feedback A Rates of absenteeism for the "white collar sector" were not given. B There is considerable concern regarding negative workplace conditions in the health care sector. Nurses have had the highest or second-highest rate of absenteeism of all workers in Canada since the early 1990s. C Rates of absenteeism for workers in the trades were not given. D Rates of absenteeism for transport and equipment operators were not given.

A mother brings her child to be seen in a nurse-managed setting. She is concerned that her child's rash could be measles. What type of care does this represent? a. Respite care b. Primary care c. Supportive care d. Secondary care

ANS: B Feedback A Respite care is a component of supportive care. B Primary care focuses on early detection and routine care, and can be offered in nurse-managed clinics. C Supportive care describes services provided to disabled and terminally ill patients over a prolonged time period. D Secondary care is the provision of specialized medical services by a physician specialist or through referral from a primary care provider.

Which of the following is true regarding the Romanow Commission? a. Roy Romanow recommended making long-term care an essential service. b. Roy Romanow concluded that Canada's Medicare system is sustainable and must be preserved. c. The Romanow Commission's top priority was to abolish the National Health Council in order to replace it with provincial regulating bodies. d. The Romanow Commission saw increased use of telehealth as a key area for change and reduced costs.

ANS: B Feedback A Roy Romanow recommended making home care an essential service for post-acute, palliative care, and mentally ill clients. B The Romanow Commission concluded that Canada's Medicare system is sustainable and must be preserved. C The Romanow Commission promoted the concept of a National Health Council. D The Romanow Commission recommended change in key areas but did not identify telehealth as a key area.

What is the name of the nursing portal database that the Canadian Nurses Association (CNA) has made available to all nurses across Canada? a. The Nurse b. NurseOne c. Nursing Initiatives d. Evidence-informed Nursing

ANS: B Feedback A The Nurse is not the name of the CNA's nursing portal database. B NurseOne is the CNA's nursing portal database and is available to all nurses across Canada. C Nursing Initiatives is not the name of the CNA's nursing portal database. D Evidence-based Nursing is not the name of the CNA's nursing portal database.

The Canadian Patient Safety Institute (CPSI) provides leadership in building and advancing a safer health care system. According to the CPSI, how many clients contract an infection while in hospital? a. 1 in 20 clients b. 1 in 9 clients c. 1 in 4 clients d. 1 in 50 clients

ANS: B Feedback A The documented number of clients is not 1 in 20. B According to the CPSI, 1 in 9 clients will contract an infection while in hospital. The same number of clients will experience a medication-related error. C The documented number of clients is not 1 in 4 D The documented number of clients is not 1 in 50.

A paraplegic patient is in the hospital for an electrolyte imbalance. At which level of prevention is the patient receiving care? a. Primary prevention level b. Secondary prevention level c. Tertiary prevention level d. Health promotion level

ANS: B Feedback A The primary prevention level focuses on health promotion and specific protection measures such as immunizations, and the reduction of risk factors such as smoking. B The secondary prevention level focuses on early detection of disease once pathogenesis has occurred, so that prompt treatment can be initiated to halt disease and limit disability. C The tertiary prevention level focuses on minimizing residual disability. D Health promotion is a focus of the primary prevention level.

The nurse identified a level II question for a research study. Which of the following questions exemplifies this level? a. What are the health-promoting behaviours of older adults living in subsidized housing? b. What is the relationship between ethnicity and suicide among university students? c. Why does postoperative anxiety decrease when structured preoperative teaching is done? d. What is the experience of people who assume the role of surrogate decision makers?

ANS: B Feedback A The question "What are the health-promoting behaviours of older adults living in subsidized housing?" is a level I question, which is used when little is known about the topic. These basic questions typically begin with the word "what." B A level II question such as "What is the relationship between ethnicity and suicide among university students?" explores the relationship between two variables. C When the researcher uses a level III question such as "Why does postoperative anxiety decrease when structured preoperative teaching is done?", he or she must explain why a specific variable causes a specific change in another variable. D The questions "What is the experience of people who assume the role of surrogate decision makers?" is a level I question.

In which of the following instances does the nurse recognize that interventions for values clarification are beneficial for the patient? a. The patient and nurse have different beliefs. b. The patient is experiencing a values conflict. c. The nurse is unsure of the patient's values. d. The patient has rejected normal values.

ANS: B Feedback A Values clarification can help nurses strengthen their ability to advocate for patients, as nurses are better able to accurately identify the personal values of patients. Values clarification is not necessarily beneficial to the patient when the patient and nurse have differing beliefs. B Values clarification is the process of appraising one's own personal values. It is not a set of rules; nor does it suggest that certain values should be accepted by all people. C Values clarification will not necessarily help the nurse who is unsure of the patient's values. Values clarification interventions are for the benefit of the patient and not for the nurse to gain awareness. D The values that an individual holds reflect cultural and social influences, relationships, and personal needs. Values vary among people, and they develop and change over time. Therefore, it may be inappropriate to state that a patient has rejected "normal" values when different value systems exist among people. What is considered normal for one person may not be so for another.

A nurse is working with a patient to try to clarify the patient's values in relation to his care. Which of the following is an example of the type of response that the nurse should use in such a situation? a. "Your questions were pretty blunt." b. "Tell me what you are thinking about." c. "I've felt that way before; I'd be upset, too." d. "You seem concerned about your tests. Let me explain them."

ANS: B Feedback A Values clarification is a process of self-discovery, and the nurse can assist the patient through it. The character of the nurse's response to a patient can motivate the patient to examine personal thoughts and actions. When the nurse makes a clarifying response, it should be brief and nonjudgemental. This response is a judgemental one. B Values clarification is the process of appraising one's own personal values. It involves self-reflection that leads to greater self-awareness and personal insight. C The nurse should not influence the patient with his or her own values, even if these values are similar to the patient's. D The statement "You seem concerned about your tests. Let me explain them" is therapeutic in that it reflects the patient's feelings and offers information. However, it does not encourage the patient to examine his or her values.

The nurse takes on ethical responsibilities when conducting research with human subjects. Which of the following violates an ethical responsibility associated with informed consent? a. Providing alternatives, including the right of refusal and standard practices b. Using data obtained before the initiation of the study c. Explaining the possibility of unknown risks d. Adhering to verbal and written agreements

ANS: B Feedback A Within the consent document, the researcher must outline alternative methods of treatment and alternatives to participation, including the right to withdraw from the study at any given time. B Using data obtained before the initiation of the study would be a breach of privacy because the participant has not yet given informed consent for use of those data. C One component of informed consent consists of informing the research subject of the potential harm and benefits. This would include the risks to the subject (including financial risks) and the potential for no benefit. D Adhering to verbal and written agreements is central to informed consent and the implementation of ethical research.

Which of the following health care issues prompted the formation of the Victorian Order of Nurses (VON) in 1898? a. Flu epidemic b. Measles outbreak c. Labour and birth difficulties d. War casualties

ANS: C Feedback A A flu epidemic was not the health care issue responsible for the creation of the VON. B A measles outbreak was not the health care issue responsible for the creation of the VON. C Lady Ishbel Aberdeen, wife of the governor general of Canada, conceived of the idea of establishing the VON after learning the plight of women in western Canada who had to give birth in remote locations with no assistance. D War casualties were not the health care issue responsible for the creation of the VON.

Which of the following is an example of a harm reduction program? a. A nutrition clinic b. A prenatal clinic c. A needle exchange program d. An exercise program

ANS: C Feedback A A nutrition clinic is not a harm reduction program. B A prenatal clinic is not a harm reduction program. C Harm reduction initiatives such as needle exchange programs, which are now available in most Canadian provinces, exemplify community nursing practice guided by primary health care, health promotion, empowerment, and ethical principles. D An exercise program is not a harm reduction program.

Nurses use levels of prevention to provide a framework or guide for nursing interventions. Focus is based on the client's needs and the care or service provided. Which of the following is an example of a true health promotion service? a. An immunization clinic b. A diabetic support group c. A prenatal nutrition class d. A smoking cessation clinic

ANS: C Feedback A An immunization clinic is an example of disease and injury prevention. B A diabetic support group may be an example of a rehabilitation service, to help clients adapt to a change in lifestyle. C Community clinics offer prenatal nutrition classes that promote the health of the woman, fetus, and infant. Building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, reorienting health services are part of health promotion service. D A smoking cessation clinic may be offered as part of a rehabilitation service or as a disease and injury prevention intervention.

What priority strategy for health promotion in Canada is seen as important to incorporate in nursing education curricula? a. Knowledge of disease prevention b. Strategies for health promotion c. Policy advocacy d. Concepts of determinants of health

ANS: C Feedback A Disease prevention is an integral part of nursing curricula. B Health promotion is a fundamental part of nursing curricula. C Increasingly, policy advocacy is incorporated into nursing role statements and nursing education curricula. Nurses should think about policies that have contributed to health problems, policies that would help to alleviate health problems, and how nursing champions public policies. D Nursing curricula integrate determinants of health.

The nurse is investigating the process for resolving an ethical problem. Which of the following is the correct sequence for resolving ethical problems? a. Examining one's own values; evaluating; identifying the problem b. Evaluating the outcomes; gathering data; considering actions c. Gathering facts; verbalizing the problem; considering actions d. Recognizing the dilemma; evaluating; gathering information

ANS: C Feedback A Examining one's own values; evaluating; identifying the problem is not the correct sequence for resolving ethical problems. B Evaluating the outcomes; gathering data; considering actions is not the correct sequence for resolving ethical problems. C The correct sequence for resolving ethical problems is recognizing the dilemma, gathering facts, examining one's own values, verbalizing the problem, considering actions, negotiating the outcome, and evaluating the action. D Recognizing the dilemma; evaluating; gathering information is not the correct sequence for resolving ethical problems.

Older adults, who constitute less than 14% of the Canadian population, account for what percentage of health care spending? a. 24% b. 34% c. 44% d. 54%

ANS: C Feedback A Health care spending on older adults is not 24%. B Health care spending on older adults is not 34%. C Older adults account for 44% of health care spending in Canada. D Health care spending on older adults is not 54%.

What is the most commonly cited definition of health? a. Health is the absence of disease. b. Health is a function of the physiological state. c. Health is a state of well-being involving the whole person. d. Health is the ability to pursue activities of daily living (ADLs).

ANS: C Feedback A Health is considered to be more than merely the absence of disease. B The definition of health has broadened beyond the physiological state to include mental, social, and spiritual well-being. C The most commonly cited definition of health is from the World Health Organization and is "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." The nurse should consider the total person when formulating a definition of "health." Health is a positive concept emphasizing social and personal resources, as well as physical capacities. D An individual who is able to pursue ADLs may not define himself or herself as healthy. Life conditions such as environment, diet, and lifestyle practices may negatively affect one's health long before one is unable to perform ADLs.

Which of the following concepts is discussed in the Kirby Report (The Health of Canadians—The federal role, 2002)? a. The private sector should not be involved in health care delivery. b. The present Medicare system is sustainable and must be preserved. c. Accountability is important for services and funding. d. A National Health Council is required.

ANS: C Feedback A Kirby believed that the private sector should have a stronger role in health care delivery. B Kirby concluded that the present Medicare system is not sustainable. (The Romanow Commission concluded it was sustainable.) C Kirby emphasized the importance of accountability for services and funding. D Instead of a National Health Council, as recommended by Romanow, Kirby suggested an appointed council of fewer members with limited advisory functions.

Which one of the following people decried the exploitation of nurses in schools of nursing in the early 1920s? a. Mary Agnes Snively b. Lady Ishbel Aberdeen c. Jean I. Gunn d. Ethel Gordon Bedford Fenwick

ANS: C Feedback A Mary Agnes Snively achieved acclaim for her organizational work in nursing education. By the end of her tenure in 1910, Toronto General Hospital was the largest school of nursing in Canada and served as a model for others. B Lady Ishbel Aberdeen, who was president of the National Council of Women, approved the formation of the VON in 1898. C Jean I. Gunn advocated for nursing and nurses on many fronts. She castigated hospital boards for reviewing costs of hospital services while ignoring the savings that accrued from educating a nurse. She decried the exploitation of nurses in schools of nursing and envisioned university degree programs in nursing. D Ethel Gordon Bedford Fenwick, editor of the British Journal of Nursing, attended the 1893 Congress of Charities, Corrections, and Philanthropy in Chicago where she spoke of British struggles to achieve registration in nursing. In 1899, she founded the ICN.

Which of the following is a characteristic of complexity science? a. Patterns of knowledge application b. A rigid approach for describing experiences c. Reducing phenomena to smallest properties d. Orientation to studying the nature of people's needs

ANS: C Feedback A Patterns of knowledge application are not characteristic of complexity science. B Complexity science is not a rigid approach for describing experiences. C Complexity science consists of dynamic and interactive phenomena reduced to the smallest properties that can be observed within their natural context so that their interactions can be interpreted with as little interference as possible from prior assumptions. D Complexity science is not characterized by an orientation to studying the nature of people's needs.

Which one of the following is an example of tertiary prevention? a. Reduction of risk factors, such as smoking b. Breast self-examination and testicular self-examination c. Cardiac rehabilitation programs d. Blood pressure screening to detect hypertension

ANS: C Feedback A Reducing risk factors, such as smoking, is an example of primary prevention. B Breast self-examination and testicular self-examination are examples of secondary prevention. C Tertiary prevention activities occur in the convalescence stage of disease and are directed toward minimizing residual disability and helping people to live productively with limitations. An example is a cardiac rehabilitation program following a myocardial infarction. D Blood pressure screening to detect hypertension is an example of secondary prevention.

Which of the following is an appropriate referral for an older client who requires some assistance with daily activities within a partially protective environment? a. Respite care b. Rehabilitative care c. Assisted living d. Extended care

ANS: C Feedback A Respite care is a service that provides short-term relief for family caregivers or persons providing home care to the ill or disabled. B Rehabilitative care provides therapy and training, with the goal of decreasing the client's dependence on care. C The client requires assisted living. Assisted living allows adults to receive a range of support services, including personalized assistance in achieving a level of independence. Personal assistance services are "designed to promote maximum dignity and independence," including meal preparation, personal hygiene practice, mobility, and socialization. D An extended, or long-term, care facility provides intermediate medical, nursing, or custodial care for clients recovering from acute or chronic illness or disabilities.

Which of the following is true in regard to social justice? a. The focus of social justice is on disease prevention. b. Social justice is used only with people in precarious situations. c. Social justice is rooted in societal responsibility and fairness. d. Social justice is a process to exercise the ability to enhance control.

ANS: C Feedback A Social justice does not focus on disease prevention. B Social justice applies to many groups of people and communities, not only those in precarious situations. C Social justice is rooted in notions of societal responsibility and fairness of justice. It encompasses equity, human rights, democracy and civil rights, capacity building, just institutions, enabling environments, poverty reduction, ethical practice, advocacy, and partnerships. D Social justice is not a process to exercise the ability to enhance control.

Which of the following levels of nursing research planning uses analysis of variance as the statistical method to address a research question? a. Level I b. Level II c. Level III d. Level IV

ANS: C Feedback A Statistical analysis with level I research questions uses mainly content analysis and descriptive statistics. B Statistical analysis with level II research questions uses correlation or tests of association. C Statistical analysis with level III research questions uses tests that search for differences between means, such as analysis of variance. D Nursing research planning does not include a fourth level.

Community assessments are important in order for the nurse to understand and respond to the needs of the population. What will the nurse focus on when assessing the structure of the community? a. Collecting demographic data on age distribution b. Visiting neighbourhood schools to review health records c. Interviewing clients to determine the cultural makeup of subgroups d. Observing the physical environment and location of services

ANS: D Feedback A Collecting demographic data on age distribution is an example of assessing the community's population. B Visiting neighbourhood schools to review health records is an example of assessing a social system within the community. C Interviewing clients to determine the cultural makeup of subgroups is an example of assessing the population within the community. D When assessing the structure or locale of a community, the nurse should travel around the neighbourhood and observe the physical environment, the location of services, and the locations where residents congregate. Locale and structure make up one of the three components of community assessment.

Carper (1978) has identified four patterns of "knowing" upon which nursing practice is founded. Which pattern describes the ability of the nurse to assist a patient in reaching health goals through the rapport established with this individual? a. Empirics b. Esthetics c. Personal knowledge d. Ethics

ANS: C Feedback A The empirical pattern of knowing is "knowledge that is systematically organized into general laws and theories for the purpose of describing, explaining, and predicting phenomena of special concern to the discipline of nursing" (Carper, 1978, p. 14). B The esthetic pattern of knowing "involves the active transformation of the patient's behavior into a perception of what is significant in it—that is, what need is being expressed by the behavior" (Carper, 1978, p. 17). C Personal knowledge "is concerned with the knowing, encountering, and actualizing of the concrete, individual self" (Carper, 1978, p. 18). This type of knowing deals with ways a nurse successfully assists a patient to reach health goals through the rapport established with this individual. D The ethical pattern of knowing "requires an understanding of different philosophical positions regarding what is good, what ought to be desired, and what is right; of different ethical frameworks devised for dealing with the complexities of moral judgements; and of various orientations to the notion of obligation" (Carper, 1978, p. 21).

While working on a postoperative unit, the nurse is applying elements of self-care theory, and is assisting a patient to attain and manage self-care in wound management. Which one of the following nursing pioneers developed this theory? a. Florence Nightingale b. Virginia Henderson c. Dorothea Orem d. Hildegard Peplau

ANS: C Feedback A The goal of Nightingale's theory is to shift the focus from the disease process toward an environment conducive to healing. B Henderson defined nursing practice as assisting the individual, sick or well, in the performance of those activities that will contribute to health, recovery, or a peaceful death. C The goal of Orem's theory is to help the patient perform self-care. D Peplau's theory defined the core of nursing as the interpersonal relationship between the nurse and the patient.

What does the principle "Health promotion is multisectoral" mean? a. Relationships between individual, social, and environmental factors must be recognized. b. Physical, mental, social, ecological, cultural, and spiritual aspects of health must be recognized. c. In order to change unhealthy living and working conditions, areas other than health must also be involved. d. Health promotion uses knowledge from disciplines such as social, economic, political, environmental, medical, and nursing sciences, as well as from first-hand experience.

ANS: C Feedback A The principle explained by the necessity to recognize relationships between individual, social, and environmental factors is "Health promotion addresses health issues in context." B The principle explained by the necessity to recognize physical, mental, social, ecological, cultural, and spiritual aspects of health is "Health promotion supports a holistic approach." C The principle explained by the necessity to involve areas other than health in order to change unhealthy living and working conditions is "Health promotion is multisectoral." D The principle explained by the idea that health promotion uses knowledge from disciplines such as social, economic, political, environmental, medical, and nursing sciences, as well as from first-hand experience is "Health promotion draws on knowledge from a variety of sources."

Mr. Jones is 72 years old. He is ambulatory and is to be discharged from hospital following a total hip replacement, with requirements for daily physiotherapy and respiratory therapy. Which of the following would be the most appropriate facility referral for the nurse to make? a. A rehabilitation centre b. An assisted-living facility c. A community health clinic d. A home care agency

ANS: D Feedback A A rehabilitation centre is not required, as Mr. Jones is ambulatory. B Assisted-living facilities are community-based residential facilities where adults live in their own apartments and are provided with a range of support services such as meals, social and recreational programs, laundry, and a variety of others. C A community health clinic offers the first point of contact, offering a range of primary services emphasizing prevention, health promotion, health education, community development, and partnerships to develop a healthy local community. D A home care agency provides health services to individuals and families in their homes. Home care was created to provide individualized care for people following hospital discharge but has increasingly included a range of clients in a range of ages from very young to very old; those with mental, physical, or developmental challenges; and those requiring recovery to end-stage care.

Which of the following is true in regard to public health nursing? a. The main focus of public health nursing is on political processes for healthy public policy. b. Public health nursing is the same as community health nursing. c. Public health nursing focuses on the incidence of disease. d. Public health nursing includes direct care and services to various populations.

ANS: D Feedback A Although public health nursing looks at political processes to influence healthy public policy, this is not its main focus. B Public health nursing is not the same as community health nursing. Public health nursing is one aspect of community health nursing, among many others. C Public health nursing has a much more inclusive focus than just the incidence of disease, including health promotion, health protection, and healthy public policy. D Public health nursing strives to safeguard and improve the health of populations in the community, including providing direct care and services.

What is the final step in the process for the implementation of evidence-informed practice? a. Asking a question that presents the clinical problem b. Compiling all of the best evidence c. Integrating the evidence with the patients' values d. Evaluating the outcome of the practice decision or change

ANS: D Feedback A Asking a question that presents the clinical problem is the first step in the evidence-informed practice process. B Compiling all of the best evidence is the second step in the evidence-informed practice process. C Integrating the evidence with the patients' values is the fourth step in the evidence-informed practice process. D The fifth and final step for successful evidence-informed practice is to evaluate the outcome of the practice decision or change.

The shift in scholarly work regarding nursing theories in the late 1980s challenged nurses to include which of the following types of knowledge when theorizing? a. Clinical b. Intuitive c. Theoretical d. Substantive

ANS: D Feedback A Clinical knowledge was not related to this challenge. B Intuitive knowledge was not related to this challenge. C Theoretical knowledge had been the focus of theorizing for many years before the late 1980s. D Meleis (1987) challenged nurses to direct their theorizing away from the processes by which nurses use knowledge and toward the equally challenging issues associated with the substance of that knowledge—that is, to include substantive knowledge.

Unsafe sexual practices remain high among young people. Which of the following actions should the nurse initially undertake to address unsafe sexual practices with a client? a. Document the unsafe practices. b. Complete a physical assessment. c. Decide what strategies would work best for the client. d. Assess the circumstances that contribute to the unsafe practices.

ANS: D Feedback A Documenting the unsafe practices is not the initial action to undertake. B Completing a physical assessment is not the initial action to undertake, although it may be the appropriate follow-up to an assessment of the circumstances that contribute to the unsafe practices. C Deciding what strategies would work best for the client is not the initial action to undertake and does not reflect the collaborative nature of community health nursing. D The nurse should initially partner with the client to assess the circumstances that contribute to substance use, unsafe sexual practices, or other risk behaviours, and identify strategies to address clients' often multiple and interrelated concerns.

The nurse is studying the impact on emergency nurses who care for failed suicide patients. The goal of the study is to describe the lived experience of nurses' perceptions and behaviours related to caring for patients who have attempted suicide. Which of the following types of research design is the nurse using? a. Ethnography b. Grounded theory c. Descriptive survey d. Phenomenology

ANS: D Feedback A Ethnography involves the observation and description of behaviour in social settings. B Grounded theory is a research method that generates hypotheses and theories about social processes inductively from the data (i.e., examining the situation afresh) rather than reviewing the literature to see what has already been researched. C Descriptive survey designs use statistical techniques to test for significant relationships among the variables. D The focus of phenomenology is on the lived experience of a specific phenomenon from the perspective of the people who are engaged in the situation.

A nurse researcher distributed an explanatory information sheet to subjects solicited for participation in her study. Which ethical principle for guiding research did this researcher use? a. Protection of subjects b. Freedom from harm c. Confidentiality d. Informed consent

ANS: D Feedback A In the case of research, regulations identify how protected health information of research subjects is to be managed. The nurse researcher who follows these guidelines is following the ethical principle of protection of subjects. B Research aspects such as minimizing the risk to participants, allowing reasonable risk to participants in relation to anticipated benefits, and monitoring the research to ensure the safety of participants follow the ethical principle of freedom from harm. C Confidentiality guarantees that any information provided by the participant will not be reported in any manner that identifies the subject and will not be made accessible to people outside the research team. Describing how confidentiality is maintained is a component of informed consent. D As a component of informed consent, full and complete information is provided to research subjects about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment.

A student nurse realizes that she has administered the wrong dose of medication to a patient and immediately informs her clinical instructor of this error. How is this student nurse best described as a professional? a. Confident b. Trustworthy c. Compliant d. Accountable

ANS: D Feedback A It would not be correct to describe the student nurse as confident (i.e., sure of oneself) professionally. B It would not be correct to describe the student as trustworthy. To be trustworthy, one should be worthy of trust or confidence and be reliable. In this case, the student could not be relied on to administer medication correctly. C It would not be correct to describe this student nurse as compliant. The student did not act in accordance with wishes, commands, or requirements. D Accountability refers to the ability to answer for one's own actions. The goal is the prevention of injury to the patient. The student nurse who informs her instructor of her error is holding herself accountable for her action and aims to avoid causing any injury to the patient. Accountability is one of the seven values of the CNA Code of Ethics central to nursing practice.

Which one of the following women was most influential in the advancement of nursing in Canada? a. Marie Rollet Hébert b. Florence Nightingale c. Mary Agnes Snively d. Jeanne Mance

ANS: D Feedback A Marie Rollet Hébert was the first laywoman to provide nursing care in New France in 1617. B Florence Nightingale, who is considered the founder of modern nursing, was a nineteenth-century British nurse. C Mary Agnes Snively (1847-1933) was a teacher before becoming a nurse. Upon graduation from the school of nursing at Bellevue Hospital in New York, she became superintendent of nurses at Toronto General Hospital. Toronto General Hospital subsequently became the largest school of nursing in Canada and a model to others. D Jeanne Mance (1606-1673) came to Ville Marie (New France) in 1642. As well as founding and managing Hôtel-Dieu, Mance assisted Maisonneuve in running the colony as confidant, advisor, and accountant. She is hailed as a founder of the city of Montreal. Today, the CNA awards its highest honour in the name of this courageous pioneer.

Which of the following clients presents the highest risk for health-related concerns? a. Ms. Madison, a 25-year-old woman living in a woman's shelter b. Mr. Saliman, a 62-year-old man taking medication for chronic hypertension and diabetes c. Mr. Joseph, a 17-year-old man attending an outpatient mental health clinic d. Ms. Tray, a 31-year-old woman addicted to cocaine

ANS: D Feedback A Ms. Madison has sought protection in a woman's shelter and should not present the greatest risk for health-related concerns. B Mr. Saliman is taking medication for his chronic disease, engaging in measures to maintain his physical health rather than increasing his risk of health-related concerns. C Mr. Joseph is receiving treatment at an outpatient mental health clinic, engaging in measures to maintain his mental health rather than increasing his risk of health-related concerns. D Ms. Tray, because she is a substance user, presents the greatest risk for health-related concerns. Clients who abuse substances also frequently have additional health and socioeconomic problems.

Which of the following elements is key to the framework for practice in Martha Rogers's theory? a. Human becoming b. Manipulation of the patient's environment c. Seven categories of behaviour and behavioural balance d. Focus upon the life process of a human being along a time-space continuum

ANS: D Feedback A Rosemarie Parse's theory of human becoming (1997) viewed the individual as a unitary being who is "indivisible, unpredictable, and ever-changing" and "a freely choosing being who can be recognized through paradoxical patterns co-created all-at-once in mutual process with the universe." B Nightingale's theory includes manipulation of the patient's environment (i.e., appropriate noise, nutrition, hygiene, light, comfort, socialization, and hope) in the framework for practice. C Johnson's theory includes seven categories of behaviour and behavioural balance in the framework for practice. D The framework for practice, according to Martha Rogers's theory, consisted of presenting the client of nursing not simply as a person but as an energy field in constant interaction with the environment, which itself was also an irreducible energy field, co-extensive with the universe. Nursing's role was to focus upon the life process of a human being along a time-space continuum.

During the eighteenth-century British regime, which of the following was the main health reason for the increased need for health care facilities in the British colonies? a. Scurvy b. Bubonic plague c. Increased birth rate d. Infectious diseases

ANS: D Feedback A Scurvy was not the main health reason for increased health care facilities. B Bubonic plague was not the main health reason for increased health care facilities. C The increasing birth rate had nothing to do with an increased need for health care facilities. D Infectious diseases carried by immigrants and travelers spread rapidly in the British colonies, creating a need for more health care facilities.

Although similarities exist in the different nursing theories, key elements distinguish one from another. Which of the following is the emphasis of Jean Watson's conceptual model? a. Self-care maintains wholeness. b. Subsystems exist in dynamic stability. c. Stimuli disrupt an adaptive system. d. Caring is central to the essence of nursing.

ANS: D Feedback A Self-care is central to Orem's theory. B The key emphasis of Johnson's theory is that subsystems exist in dynamic stability. C The key emphasis of Roy's theory is that stimuli disrupt an adaptive system. D Watson believed that nurses must do far more than deal with physical illness; they must attend to their primary function, which is caring. From Watson's perspective, caring infuses all aspects of a nurse's role and draws attention to nursing acts as embodying an esthetic that facilitates both healing and growth.

Which of the following has been identified as the greatest determinant of health affecting Canadians? a. Education b. Health services c. Social support networks d. Income and social status

ANS: D Feedback A Some investigators suggest that literacy and education are important influences on health status because they affect many other health determinants. B Approximately 25% of a population's health status is attributed to the quality of its health care services. C Social support affects health, health behaviours, and health care utilization, but is not the greatest determinant of health. D Income and social status are the greatest determinants of health.

The nurse incorporates levels of prevention as based on client needs and the type of nursing care provided. Which one of the following nursing activities is an example of tertiary level preventive caregiving? a. Teaching a patient how to irrigate a new temporary colostomy b. Providing a lesson on hygiene for an elementary school class c. Informing a client that immunizations for her infant are available through the health department d. Arranging for a hospice nurse to visit with the family of a client with cancer

ANS: D Feedback A Teaching a patient how to irrigate a new colostomy would be an example of secondary prevention. If the colostomy is to be permanent, care may later move to the tertiary level of prevention. B Providing a lesson on hygiene for an elementary school class would be an example of primary prevention. C Informing a client about available immunizations would be an example of primary prevention. D Tertiary prevention occurs when a defect or disability is permanent and irreversible. At this level, the hospice nurse aims to help the client and his or her family to achieve a high level of function, despite the limitations caused by the client's illness.

Which of the following factors is contributing to the shortage of nurses in Canada? a. Increased birth rate creating a greater demand for nursing services b. New technology replacing nurses at the bedside c. Fewer people wishing to practice as nurses because health trends are focusing on natural and alternative therapies d. A large percentage of nurses retiring

ANS: D Feedback A The aging population is creating the greater demand for nursing services. B The replacement of nurses at the bedside by new technology is not a factor identified as contributing to the shortage of nurses. C The focus of health trends on natural and alternative therapies is not a factor identified as contributing to the shortage of nurses. D The nursing workforce is currently challenged by aging workers, high retirement rates, ethical international recruitment, and lack of full-time positions.The average age of registered nurses in Canada is 45.1 years.

What is the greatest internal client factor for the nurse to consider when educating an adult client concerning health promotion activities? a. Emotional wellness b. Developmental stage c. Professed spirituality d. Levels of education and literacy

ANS: D Feedback A The client's degree of stress, depression, or fear, for example, can influence health beliefs and practices. The manner in which a person handles stress throughout each phase of life will influence the way he or she reacts to illness. However, this is not the best available option. B A person's thought and behaviour patterns change throughout life. The nurse must consider the client's level of growth and development when using his or her health beliefs and practices as a basis for planning care. In this case, the client has been identified as an adult, and therefore the developmental stage has been determined. C Spirituality is reflected in how a person lives his or her life, including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life. However, this is not the best available option. D Levels of education and literacy are important influences to consider when educating an adult client concerning health promotion activities. Literacy can influence health both directly (e.g., medication use, safety practices) as well as indirectly through use of services, lifestyles, income, work environments, and stress levels.

Which of the following definitions best explains the idea of a theory? a. "Mental maps" that make sense of information and decisional processes b. Mental formulations of objects or events c. Aspects of reality that can be consciously sensed d. A purposeful set of assumptions that identify relationships between concepts

ANS: D Feedback A The description "Mental maps that make sense of information and decisional processes" explains the idea of conceptual frameworks, which link ideas together. B The description "Mental formulations of objects or events" explains the idea of concepts. C The description "Aspects of reality that can be consciously sensed" explains the idea of phenomena. D A theory is a purposeful set of assumptions that identify the relationships between concepts. Theories are useful because they provide a systematic view of explaining, predicting, and prescribing phenomena.

Nurses need to become familiar with the elements of a research publication. In which section of a study can a brief explanation of the type of measurement to be used be found? a. Introduction b. Conclusions c. Results d. Methods

ANS: D Feedback A The introduction section presents the purpose, a summary of the literature used to formulate the study, and the hypothesis tested or the research questions posed. B The conclusions section consists of the author's summarization of implications that can be drawn from the study. C The results section contains a description of the results obtained in the study, including the appropriate statistical tests used to analyze the data. D The methods section of a study includes the description of the sample (what or who was studied), the type of data collected, and the device or instrument used to measure empirical information.

Which type of data does the population health approach emphasize to determine health and disease? a. Physical b. Psychological c. Experiential d. Epidemiological

ANS: D Feedback A The population health approach does not emphasize the use of physical data to determine health and disease. B The population health approach does not emphasize the use of psychological data to determine health and disease. C The population health approach does not emphasize the use of experiential data to determine health and disease. D The population health approach emphasizes the use of epidemiological data to determine the etiology of health and disease.

What fundamental and guiding principle of French-Canadian hospitals survived into the twentieth century? a. Universal precautions are fundamental in preventing nosocomial infections. b. Nursing is primarily focused on the tertiary level of care. c. Nurses need to recognize the impact of their health, values, and beliefs on practice. d. Care is accessible to all, regardless of their background, status in life, or ability to pay.

ANS: D Feedback A The statement "Universal precautions are fundamental in preventing nosocomial infections" was not a guiding principle of French-Canadian hospitals. B The statement "Nursing is primarily focused on the tertiary level of care" does not reflect a contribution from the past to present nursing beliefs and practices. C The statement "Nurses need to recognize the impact of their health, values, and beliefs on practice" does not reflect a contribution from the past to present nursing beliefs and practices. D A fundamental and guiding principle of the French-Canadian hospitals that survived largely intact into the twentieth century was that care is available to all people, regardless of background, status in life, or ability to pay. This continues to be a principle for which nurses, through their professional organizations, have argued for determinedly in national debates on the nature and continuing direction of our national health care insurance program

Where did the traditions of good nursing practice that anchor nursing in Canada originate? a. England b. United States c. Germany d. New France

ANS: D Feedback A The traditions of good nursing practice that anchor nursing in Canada did not originate in England. B The traditions of good nursing practice that anchor nursing in Canada did not originate in the United States. C The traditions of good nursing practice that anchor nursing in Canada did not originate in Germany. D Nursing in Canada is rooted in the traditions of good nursing practice that developed in New France.