4

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

: A A coalition is formed when individuals or organizations that share a common interest in a single issue work together toward a goal. Legitimate power is the power or the influence that comes with role and position. In some states, nurses have made a choice to gain that voice and assume control of their practice by using a traditional collective bargaining model, commonly known as a labor union. Other states have elected to control practice through interest-based bargaining (IBB) or a nontraditional approach to collective bargaining to accomplish having that voice and control over practice. Seeking compromise or bargaining is when both positions or sides make concessions. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 383 OBJ: List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system. TOP: Coalitions MSC: NCLEX®: Not applicable

2. A nurse is educating a coworker on the intrinsic factors and cost of health care. The nurse knows that the teaching has been effective when the coworker lists the following intrinsic factor as the major cause of increased cost: a. Almost 10% of Americans over 65 years old are considered at or below the poverty level. b. The new medical technology available has increased the cost of health care. c. There are increasing labor costs in the total hospital spending budget. d. The staff nurse does not understand the responsibility of economics and money management.

: A A major intrinsic factor contributing to the high cost of health care is that an increasing number of Americans are over 65 years old, and a significant portion of this age group does not have the funds to obtain medical care. The US Census Bureau's 2011 Supplemental Poverty Measure reports an even higher percentage, 15.1%. The other options listed are extrinsic factors—new medical technology, increasing labor costs, and lack of staff nurse understanding of fiscal responsibilities of the organization. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 356 OBJ:Use basic knowledge of health care economics to analyze trends in the health care delivery system.TOP:Intrinsic factors for health care costs MSC: NCLEX®: Not applicable

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

: A A misdemeanor is a less serious crime resulting in a fine. A felony is a serious crime that often results in prison time. In court cases, the victim is the plaintiff. PTS: 1 DIF: Cognitive Level: Application REF: p. 450 OBJ:Discuss various sources and types of law. TOP:Court actions based on legal principles MSC: NCLEX®: Safe and effective care environment

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

: A A patient's right to self-determination implies the freedom to make choices and decisions about one's own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity is the duty to tell the truth. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Safe and effective care environment—management of care

z11. How would a nurse determine the political views regarding health care issues of individuals who are running for public office? a. Call the state or national political action committee of the American Nurses Association. b. Talk with the administration of the institution to determine who is supporting health care issues. c. Call the party headquarters of the candidates and ask them to share the views of the candidate with you. d. Call the Accreditation Commission for Education in Nursing (ACEN) and obtain the political action reports.

: A A political action committee should have the information regarding the views of specific candidates. It is the purpose of the committee to determine and collectively endorse candidates that support nursing and health care issues. The Accreditation Commission for Education in Nursing (ACEN), formerly the NLNAC, does not participate in political action activities; however, the National League of Nursing (NLN) does. Calling party headquarters may not provide you with a comprehensive list of the views of a candidate's views. Talking to administration will provide you with their personal thoughts as to who is supporting health care issues, which may be biased. PTS: 1 DIF: Cognitive Level: Application REF: p. 381 OBJ: Describe the function of a political action committee. TOP: PACs MSC: NCLEX®: Not applicable

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

: A An example of a criminal action is the nurse who steals narcotics from the hospital. Verbal disagreements, restraining a patient who has the potential to harm themselves, and refusing visitors who appear intoxicated are not examples of a criminal action. PTS: 1 DIF: Cognitive Level: Application REF: p. 477 OBJ:Discuss various sources and types of law. TOP:Court actions based on legal principles MSC: NCLEX®: Safe and effective care environment

15. A nurse is educating a new nurse on grievances. The teaching has been effective when the new nurse states: a. "I can file a grievance" b. "My employer cannot file a grievance" c. "The nursing union cannot file a grievance" d. "My coworkers cannot file a grievance"

: A Any nurse, the employer, or the nursing union can file a grievance. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 408 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Resolution of grievances MSC: NCLEX®: Not applicable

11. A student nurse is studying assault and battery. The student interprets assault and battery to include a. the nurse, without consent, touched the patient in an offensive, insulting, or injurious way. b. the nurse threatened to put the patient in restraints if they did not stay in bed. c. the nurse said the bill has to be paid before the patient can leave. d. the nurse failed to perform an act expected of a reasonable nurse.

: A Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Permission to do this touching is usually implied when the patient seeks medical care. Using restraints or threatening to use them on competent patients to make them do what you want them to do against their wishes is an example of false imprisonment. Failure to perform an act expected of a reasonable, prudent nurse can constitute negligence. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Assault MSC: NCLEX®: Safe and effective care environment—management of care

14. A nurse tells a patient, "If you don't stop getting out of that chair, I'm going to put some restraints on you." What may this nurse be accused of? a. False imprisonment c. Invasion of privacy b. Defamation d. Malpractice

: A Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Use of restraints may also be interpreted as false imprisonment. False imprisonment means making someone wrongfully believe that they cannot leave a place. It is often associated with assault and battery claims. Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Malpractice is the improper performance of professional duties, a failure to meet the standards of care that results in harm to another person. Defamation (libel and slander) refers to causing damage to someone else's reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander. Invasion of privacy applies to several behaviors, such as photographing a procedure and showing it without the patient's consent, going through a patient's belongings without consent, or talking about a patient's private life publicly. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Assault MSC: NCLEX®: Safe and effective care environment—management of care

7. Which statement is true about case management? a. There are two models—traditional and full immersion. b. It is used to reduce resource utilization only. c. To be effective, it requires case managers to provide direct patient care. d. It eliminates the need for other caregivers (LPN, LVNs, nursing assistants).

: A Case management is one of the strategies to reduce costs while ensuring coordination of care. The first is the traditional model, which focuses on discharge planning and determining if the care planned throughout the patient's hospital stay is necessary and appropriate (utilization review) so that the insurer will pay for the services. The full immersion model of case management requires the case manager to review the chart and communicate with physicians and nurses caring for the patients on their case load daily. Case managers do not provide direct patient care, and it does not eliminate the need for other health care workers (LPN, CNA). Resource utilization is the examining of resources to ensure optimal allocation, such as restructuring shifts so that nurses work fewer overtime hours is an example of resource utilization. PTS: 1 DIF: Cognitive Level: Application REF: p. 342 OBJ:Discuss patterns of nursing care delivery systems. TOP:Patterns of nursing care delivery MSC: NCLEX®: Safe and effective care environment—management of care

17. Which of the following statements by the nurse shows understanding of the competence framework? a. "Competence development is the means by which the nurse gains knowledge, skills, and abilities." b. "Competence development is the means by which the nurse's knowledge, skills, and abilities are tested." c. "Competence development refers to health and conduct expectations of the nurse." d. "Competence development refers to the nurse's ability to perform the functions of the nursing role."

: A Competence development is the means by which the nurse gains knowledge, skills, and abilities. Competence assessment is the means by which the nurse's knowledge, skills, and abilities are tested. Competence conduct refers to the health and conduct expectations of the nurse, as well as the nurse's ability to perform the functions of the nursing role. PTS: 1 DIF: Cognitive Level: Application REF: p. 391 OBJ:Discuss selected issues affecting nursing: multistate licensure, nursing and collective bargaining, and equal pay for work of comparable value. TOP: Controversial political issues affecting nursing MSC: NCLEX®: Not applicable

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

: A Failure to monitor can result in a civil action against the nurse. Enforcing strict compliance with contact precautions against the family's wishes, refusing to discuss the patient's medical history with family per the patient's request, and assisting the physician in a bedside procedure after obtaining informed consent are not examples that could lead to civil action. PTS: 1 DIF: Cognitive Level: Application REF: p. 450 OBJ:Discuss various sources and types of law. TOP:Court actions based on legal principles MSC: NCLEX®: Safe and effective care environment

5. A nurse manager is training a new hire. Which statement shows an understanding of functional nursing? a. "Functional nursing is organized around tasks." b. "Functional nursing is patient led." c. "Functional nurses is physician led." d. "Functional nursing is unorganized."

: A Functional nursing is where nursing care is broke into a series of tasks performed by many people, which results in a fragmented, impersonal kind of care. Fragmentation of care caused patient problems to be overlooked because they did not fit into a defined assignment. Aides, vocational nurses, and licensed practical nurses are allowed to perform functions such as administration of medication and treatments. This functional kind of nursing results in a fragmented, impersonal kind of care. In team nursing, groups of patients are assigned to a team headed by a team leader, usually a nurse, who coordinates the care for a designated group of patients. In primary nursing, a nurse plans and directs the care of a patient over a 24-hour period. This approach is designed to reduce or eliminate the fragmentation of care between shifts and nurses because one nurse is accountable for planning the care of the patient around the clock. In a patient-focused care system, the patient comes into contact with fewer people, and the nurse, who is familiar with the patient's plan of care, supervises the delivery of care. This model also moves nurses to a higher level of functioning because they are now accountable for a fuller range of services for the patient. PTS: 1 DIF: Cognitive Level: Application REF: p. 342 OBJ:Discuss patterns of nursing care delivery systems. TOP: Patterns of nursing care delivery MSC: NCLEX®: Not applicable

1. Which statement by the nurse indicates understanding of the major factors influencing the increase in health care costs? a. "Health care expenditures are exceeding the cost of the gross domestic product (GDP) in excess of 14%." b. "Older adult patients consume more of the health care product than they can afford to finance." c. "The cost of prescription drugs is soaring so rapidly that the majority of people cannot afford them." d. "Because of the limited payment of Medicare, institutions are not being reimbursed at the same level of expenditures."

: A Health care expenditures consume more than 16% of the GDP—the amount of money being spent exceeds the amount of money recompensed. The older adult population contributes to this situation because they require more health care as a result of chronic conditions. The cost of prescription drugs and the level of Medicare reimbursements also contribute to this problem. PTS: 1 DIF: Cognitive Level: Application REF: p. 356 OBJ: Compare the market of health care with the normal market for goods and services. TOP: Cost of health care MSC: NCLEX®: Not applicable

15. A new nurse is determining which hospital to apply for. The nurse has heard a lot about magnet hospitals from friends that are nurses and knows that working for a magnet hospital would mean a. the nurse would likely experience high job satisfaction. b. the nurse would likely experience poor job satisfaction. c. the nurse would have to have a BSN before being able to apply. d. the nurse would be hired after having a year of nursing experience.

: A Magnet hospitals are known for attracting and retaining nurses because of their high satisfaction rates among nurses. These hospitals have low job turnover and low nurse vacancy even when the hospital is in an area experiencing a nursing shortage. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 335 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including shortage of health care professionals.TOP:Magnet hospitals MSC: NCLEX®: Not applicable

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

: A PACs are a method by which a special-interest group can collectively endorse and support a candidate without the donation of large sums of money. ANA-PACs, as well as state PACs, enable nurses to organize and support candidates that have the ability to influence legislation on health care issues. A PAC can be active in any area of interest, not just health care or other special need areas. It is not an organizational structure for making changes in the health care system. PTS: 1 DIF: Cognitive Level: Application REF: p. 378 OBJ: Define politics and political involvement. TOP: PACs MSC: NCLEX®: Not applicable

6. Which statement by the nurse shows understanding of the Rand Health Insurance Experiment? a. "When consumers were required to pay 25% co-payment, there was a considerable decline in the use of health care services." b. "There was an increase in the use of health care services when consumers were required to make a co-payment." c. "If the health care cost is being paid by insurance companies, the consumer is not concerned about the cost." d. "The implementation of the Oregon Health Policy for reimbursement of the cost of health care services led to the Rand Health Insurance Experiment."

: A Participants in the Rand study either received free care or paid co-payments of 25%, 50%, or 95%. Economic theory would predict that as price increases, the purchase of goods or services would decline. That is exactly what happened. With a co-payment of 25%, there was a decline in utilization of health care of 19% compared with a free plan. There were even greater declines in utilization of health care services at the higher rates of co-payments. PTS: 1 DIF: Cognitive Level: Application REF: p. 362 OBJ: Use basic knowledge of health care economics to analyze trends in the health care delivery system. TOP: Budgeting MSC: NCLEX®: Not applicable

3. Which statement shows the nurses understanding of patient-focused care? a. "Patient-focused care is a nursing care delivery system." b. "Patient-focused care is a model for a health care organization." c. "Patient-focused care is a clinical pathway within an institution." d. "Patient-focused care is an institutional value and philosophy."

: A Patient-focused care is another type of delivery system. The level of productivity is increased through centralization of functions (e.g., phlebotomy, diet instruction, respiratory therapy) on the unit under the direction of the nurse and cross-training ancillary workers to do more than one function. The patient comes into contact with fewer people under this organizational framework. PTS: 1 DIF: Cognitive Level: Application REF: p. 344 OBJ: Identify trends affecting the health care delivery system. TOP: Trends in health care MSC: NCLEX®: Safe and effective care environment—management of care

8. Which statement by the nurse educator is accurate regarding politics? a. "Politics involves influencing the allocation of scarce resources." b. "Politics involves identifying those in a public office that can be influenced." c. "Politics involves attempting to get people in government positions to think the way you want them to." d. "Politics involves lobbying for state and federal legislation to improve the quality of nursing care."

: A Politics is the process of influencing the allocation (who will receive) of scarce resources (nursing care and health care). It is a vital tool that enables the nurse to be more effective in the involvement in the political process and gives an individual nurse a tool that augments his or her power—or clout—to improve the care provided to patients. Whether on the community, hospital, or nursing unit level, political skills and understanding how laws are enacted enable the nurse to identify needed resources, gain access to those resources, work with legislative bodies to lobby for changes in the health care system, and overcome obstacles, thus facilitating the movement of the patient to higher levels of health or function. Lobbying is a part of the political process but is not a definition of politics. It is important to know who is in public office so that contact can be made to inform them of your position on certain issues. PTS: 1 DIF: Cognitive Level: Application REF: p. 382 OBJ: Define politics and political involvement. TOP: Politics—definition MSC: NCLEX®: Not applicable

8. What is the most important way that a nurse can be fiscally responsible to the employing institution? a. By providing quality, safe nursing care b. By considering patient needs and prioritizing appropriately c. By accurately documenting the patient's condition d. By maintaining accurate charges for supplies used in patient care

: A Quality nursing care includes using fiscal resources wisely, but most important is the provision of quality nursing care—preventing falls, controlling the spread of infection, providing care to prevent complications, for example. All of these situations increase the length of stay for a patient and ultimately the costs of the institution. The other options are ways to be fiscally responsible but not the most important. PTS: 1 DIF: Cognitive Level: Application REF: p. 370 OBJ: Describe what is meant by the term fiscal responsibility in clinical practice. TOP: Fiscal responsibility in clinical practice MSC: NCLEX®: Not applicable

13. A nurse is discussing personal seniority with the department manager. The nurse has an adequate understanding of seniority when stating which of the following? a. "Seniority provides certain rights to those with the highest number of years of service" b. "Seniority provides the same amount of vacation time as new hires" c. "Seniority no longer provides protection in today's economy" d. "Seniority means that those with the highest number of years of service can be forced to retire"

: A Seniority provides specific rights, which are spelled out in the bargaining agreement, to those who have the highest number of years of service. These rights will differ with each organization. PTS: 1 DIF: Cognitive Level: Application REF: p. 408 OBJ:Identify the positive and negative aspects of traditional and nontraditional collective bargaining.TOP:The debate over collective bargaining MSC: NCLEX®: Not applicable

10. A charge nurse is providing education to coworkers on state nursing associations. The charge nurse judges that the teaching has been effective when a coworker states: a. "These professional associations address nursing practice." b. "These professional associations do nothing to support nursing." c. "These professional associations protect the rights of physicians." d. "These professional associations are managed by hospital administrators."

: A State nursing associations have represented nurses since 1946. They are multipurpose and are involved in many activities such as addressing nursing practice. These organizations do not protect the rights of physicians and are not managed by hospital administrators. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 400 OBJ: Compare traditional and nontraditional collective bargaining models. TOP: Who represents nurses for collective bargaining? MSC: NCLEX®: Not applicable

3. The nurse enters a patient's room to complete the discharge paperwork and finds the patient in tears. The patient reports that someone from the business office stated they could not leave the hospital until the bill was paid. What is the best nursing action? a. Comfort the patient and continue the preparations for discharge. b. Call the social worker for a financial evaluation. c. Call the family to arrange for the payment. d. Cancel the discharge plans and notify the physician of the situation.

: A The best action is to comfort the patient and continue the discharge preparations. If the patient's claim is accurate, this could be false imprisonment (wrongfully making someone believe that they cannot leave a place). The nurse's best action is to comfort the patient and continue the discharge preparations. However, this should also be reported to the supervisor. Calling the social worker or the contacting the family is not appropriate. PTS: 1 DIF: Cognitive Level: Application REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:False imprisonment MSC: NCLEX®: Safe and effective care environment—management of care

6. A graduate nurse is preparing to start a first nursing job. What action would be the best legal safeguard for the graduate nurse to take? a. Competent practice c. A valid license b. A legal contract d. Following management policies

: A The best legal safeguard is competent practice. Practicing within the parameters of the state's Nurse Practice Act, performing care based on established policies and procedures, and performing as a reasonable nurse are the best ways for a nurse to safeguard against legal action. It is important to maintain a current license and follow management policies; however, the best safeguard is being competent. A legal contract is not necessary for all situations and is not necessarily the best legal safeguard. PTS: 1 DIF: Cognitive Level: Application REF: pp. 467-471 OBJ: Relate the Nurse Practice Act to the governance of your profession. TOP:Nursing practice MSC: NCLEX®: Safe and effective care environment—management of care

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

: A The deontological model of ethical reasoning states that all life is worthy of respect. Abortions and euthanasia are never acceptable because they violate the duty to respect the sanctity of all life. Lying is never acceptable because it violates the duty to tell the truth. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 424 OBJ: Define terminology commonly used in discussions about ethical issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

18. A nurse has an adequate understanding of traditional collective bargaining when making which of the following statements? a. "The goal of traditional collective bargaining is to win something that is controlled by another." b. "The goal of traditional collective bargaining is to win something that another person has worked for." c. "The goal of traditional collective bargaining is to give all power to the nurse." d. "The goal of traditional collective bargaining is to give all power to the organization."

: A The goal of traditional collective bargaining is to win something that is controlled by another. The other statements are not accurate. PTS: 1 DIF: Cognitive Level: Application REF: p. 400 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Traditional collective bargaining MSC: NCLEX®: Not applicable MULTIPLE RESPONSE

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

: A The most common way to establish the duty owed by a nurse is by the testimony of a registered nurse—usually, but not always, with training and background similar to the nurse being sued. This expert witness will then testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. The Joint Commission standards may reflect on hospital policies and procedures, not the nurse's practice. A lawyer provides legal advice but cannot attest to the standards of nursing practice that a nurse can. Faculty can be knowledgeable about standards of care, but the testimony of a nurse with similar training and background can determine what the wise and prudent nurse would have done. PTS: 1 DIF: Cognitive Level: Application REF: p. 481 OBJ:Participate as a professional when dealing with nurses who are impaired or functioning dangerously in a work setting.TOP:Expert testimony MSC: NCLEX®: Not applicable

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

: A The nurse can uphold the ethical principle of fidelity by reporting unscrupulous billing practices. Disclosing the results of an HIV test to a patient's family would violate fidelity. Making health care decisions would violate autonomy. Accepting an assignment that is unsafe violates nonmaleficence. PTS: 1 DIF: Cognitive Level: Application REF: p. 422 OBJ: Define terminology commonly used in discussions about ethical issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

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

: A The nurse had a duty, that duty was breached, the injury was foreseeable, and the patient suffered harm (partial-thickness burn). All four elements for a malpractice suit are present. The other options do not show that all elements are present and are therefore incorrect. PTS: 1 DIF: Cognitive Level: Application REF: p. 470 OBJ: Incorporate an understanding of legal risks into your nursing practice and how to minimize risks. TOP: Malpractice MSC: NCLEX®: Not applicable

17. Which of the following statements indicates the nurse's understanding of fiscal responsibility? a. "Fiscal responsibility should be a concern for all nurses." b. "Fiscal responsibility is only a concern for the department manager." c. "Fiscal responsibility is only a concern for the hospital administrators." d. "Fiscal responsibility is not a concern for the nursing staff."

: A The nurse has an adequate understanding of fiscal responsibility when stating: "Fiscal responsibility should be a concern for all nurses." Fiscal responsibility affects everyone in the health care system. The nurse, as well as the entire hospital staff and administration, needs to have an understanding of the costs of care. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 368-372 OBJ: Describe what is meant by operating budget, personnel budget, and capital budget. TOP: Types of budgets MSC: NCLEX®: Not applicable

16. The nurse has an adequate understanding of productive time when stating: a. "Productive time is the amount of time the nurse is available to give care to patients." b. "Productive time is the amount of time the nurse is attending a continuing education activity." c. "Productive time is counted when the nurse is not directly giving bedside care, such as going to lunch and taking a break." d. "Productive time is counted when the physician is at the patient's bedside."

: A The nurse has an adequate understanding of productive time when stating that "productive time is the amount of time the nurse is available to give care to patients." One work day (8 hours) is usually considered to be 7.5 productive hours. Nonproductive time reflects the amount of time that is not available for direct care, such as vacations, days off, holidays, continuing education, committee work, breaks, and lunch. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 367 OBJ: Describe what is meant by operating budget, personnel budget, and capital budget. TOP: Productive time MSC: NCLEX®: Not applicable

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

: A The nurse should call the physician and report the error after assessing the patient's condition. The nurse should never falsify a document in the medical record or keep the error to themself. PTS: 1 DIF: Cognitive Level: Application REF: p. 467 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Preventing malpractice claims MSC: NCLEX®: Safe and effective care environment

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

: A The nurse shows understanding of the ethical principle of autonomy by allowing patients the right to make their own health care decisions even if the nurse does not agree with their decisions. It is not up to the nurse or the attending physician to make health care decisions for patients. PTS: 1 DIF: Cognitive Level: Application REF: p. 421 OBJ: Define terminology commonly used in discussions about ethical issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

11. A nurse is educating a group of students about health care economics. Which statement would the students make if the teaching were effective? a. "Extrinsic factors include the cost of prescription drugs." b. "Extrinsic factors include the age of the population." c. "Extrinsic factors include the demand for health care." d. Extrinsic factors include employer-paid health insurance."

: A The nurse would know that the teaching was effective when the students states: "Extrinsic factors include the cost of prescription drugs." The other statements about health care economics are false. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 357 OBJ: Define economics and health care economics. TOP: Intrinsic factors MSC: NCLEX®: Not applicable

5. The nurse manager receives the budget variance report for the assigned nursing unit. What other critical information must the nurse manager consider to evaluate this report? a. Projection of costs in the operating budget b. The amount of money allocated to meet expected costs c. Figures on which a zero-based budget were determined d. Planning needs for unit staffing based on patient acuity

: A The operating or budget costs are guidelines by which the nurse manager determines whether the unit has operated within allowable expenses. This is often called an expense or operating budget. The other options are not considered critical information that the nurse manager would need to consider when evaluating the report. The operating budget also includes all of the items necessary for care on the unit. These are called line items in a budget and include such things as supplies, telephones, small equipment (e.g., wheelchairs, nurse pagers, fax machines), postage, and copying costs. Some of these are variable costs—that is, costs that change with the volume of patients cared for in a year. Zero-based budgeting is the efficient allocation of resources because it is based on needs and benefits where all expenditures have to be approved. PTS: 1 DIF: Cognitive Level: Application REF: p. 365 OBJ: Describe what is meant by an operating budget. TOP: Budgeting MSC: NCLEX®: Not applicable

2. A nurse plans to lobby a state senator regarding a particular health care bill. Which action would be appropriate? a. The nurse should be specific about what action the senator should take early in the contact or letter. b. The nurse should tell the senator that if their advice is followed, the nurse will vote for the senator. c. The nurse should use a form letter to express personal opinion and encourage as many as possible to mail in the form letter. d. The nurse should avoid making contact by phone and only submit personal views in writing.

: A The structure and content of a visit or a written contact are very similar. That is, know your issue, keep it short, identify the issue by its bill number and title, and communicate exactly what action you want the lawmaker to take. Using a form letter is not as powerful as one that is specifically written by the person to the senator. It is not appropriate to tell the senator your persuasion on voting for them based on whether they follow your advice on the health care bill. Lobbying is about giving opinions. PTS: 1 DIF: Cognitive Level: Application REF: p. 387 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Health care bills MSC: NCLEX®: Not applicable

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

: A The teleological model of ethical reasoning is interpreted as meaning "the end justifies the means." The rights of some individuals may be sacrificed for the majority. Therefore, abortion may be acceptable because it results in fewer unwanted babies. Euthanasia may be acceptable because it results in decreased suffering. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 425 OBJ: Define terminology commonly used in discussions about ethical issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

7. A nurse is preparing a presentation. How can the nurse explain one of the primary concerns of the proponents for a nontraditional collective bargaining unit versus the traditional, union-based nursing model? a. "The traditional-based union model frequently puts nurses and employers in adversarial positions." b. "The union dictates to members what they can and cannot do within the health care institution." c. "The union-based model can initiate strikes that can be detrimental to the provision of health care in an institution." d. "The union-based model is too expensive and nurses are not fairly compensated by the organization."

: A The traditional-based union model is adversarial and frequently puts nursing and administration in antagonistic positions. Strikes are most often the last resort and are planned well in advance so that the institution can be prepared. Nontraditional process is referred to as interest-based bargaining (IBB) or shared governance. This is a nontraditional style of bargaining that attempts to problem solve differences between labor and management. Although this style of bargaining and mediation will not always eliminate the need for the more traditional and adversarial collective bargaining, many believe this nonadversarial approach of negotiation may be closer to the basic fabric of the discipline of nursing and its ethical code. In both models, nurses pay dues. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 400 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Nontraditional versus traditional collective bargaining units MSC: NCLEX®: Not applicable

16. A nurse is teaching nursing students about issues that keep nursing from becoming a profession of choice. The nurse knows that the teaching has been effective when one of the nursing students states: a. "Nurses downplay their role in health care" b. "Nurse's take credit for their role in health care" c. "Nurses are often seen on the news discussing their role in health care" d. "Nurses are willing to take to media"

: A There are many factors that prevent nursing from becoming a profession of choice. These include nurses downplaying their role in health care, not taking credit for their role, and nurses not being seen in the media. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 415 OBJ:Discuss the impact of the silence of nurses in public communications and the perception of nurses by the public.TOP:Future trends MSC: NCLEX®: Not applicable

1. A nurse is giving a presentation on malpractice. Which statement indicates the nurse understands malpractice? a. "The elements of duty, breach of duty, and patient injury must be present for a malpractice claim." b. "Negligent nursing care and failure to follow standards must be present for a malpractice claim." c. "Failure to report, defamation, and discrimination must be present for a malpractice claim." d. "Error in judgment and invasion of privacy must be present for a malpractice claim."

: A There are three elements that must be present for a malpractice claim: (1) You must have a duty—there must be a professional nurse-patient relationship. (2) You must have breached a duty that was foreseeable—you must have fallen below the standard of care. (3) Your breach of duty caused patient injury or damages. The other options do not indicate the nurse's understanding of malpractice. PTS: 1 DIF: Cognitive Level: Application REF: p. 454 OBJ: Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim. TOP: Malpractice MSC: NCLEX®: Not applicable

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

: A Variables of the justice principle involve the allocation of scarce or expensive health care resources. The following questions are a few examples illustrating this principle: What kind of access to health care should illegal immigrants receive—preventive care or only more costly emergency care? How should the health care of children be allocated? Should all children receive the same health care regardless of ability to pay? PTS: 1 DIF: Cognitive Level: Analysis REF: p. 442 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Not applicable

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

: A When identifying the ethical issues of the situation, the nurse should encourage the patient to share his wishes with his family. It is not the position of the nurse to try to change the patient's mind or force him to remain a "full code." The nurse should respect the patient's wishes and document them accordingly. PTS: 1 DIF: Cognitive Level: Application REF: p. 424 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

7. A nurse has just moved to a new state and wants to know the names of the state senator(s), state representative(s), federal senator(s), and federal representative(s). How can the nurse find this information? a. Call the Democratic Party headquarters. b. Call the Republican Party headquarters. c. Call the public library. d. Call the local newspaper. e. Call Congress.

: A, B, C The best action would be for the nurse to call the county Democratic or Republican Party headquarters or the public library. Calling the newspaper or Congress would not help the nurse find the information needed. PTS: 1 DIF: Cognitive Level: Application REF: p. 385 OBJ: List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system. TOP: Contacting political officials MSC: NCLEX®: Not applicable MATCHING

5. The nurse judges that the disease management program has been successful when the patient (Select all that apply.) a. assumes responsibility for their own health. b. learns how to maintain good health. c. can state how to manage their chronic condition. d. relies on the health care team for maintenance of health. e. can state how to avoid worsening of health.

: A, B, C, E The disease management program has been successful when the patient assumes responsibility for their own health, learns how to maintain good health, can state how to manage their chronic condition, and can state how to avoid worsening of health. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 331 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost.TOP:Case management MSC: NCLEX®: Safe and effective care environment

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

: A, B, C, E There are many actions that take place in organizations to monitor quality improvement. These include evaluation of what nurses are doing for patients, development of policies and procedures, employee evaluations, ongoing monitoring, and continuing education. PTS: 1 DIF: Cognitive Level: Application REF: p. 453 OBJ: Take an active role in improving the quality of health care as required by legal standards. TOP:Risk management and quality improvement MSC: NCLEX®: Safe and effective care environment

6. The nursing shortage is projected to reach 1.2 million by 2020. Which actions can hospitals take to retain nurses? (Select all that apply.) a. Create a health care system that supports nursing advancement. b. Encourage a work environment that fosters workgroup cohesion. c. Allow nurses to have autonomy. d. Reduce the number of managers within the health care system. e. Allow nurses a variety of specialties to choose from.

: A, B, C, E To retain nurses, hospitals must take actions that will attract nurses to their institutions. These actions can include creating a health care system that supports nursing advancement, encouraging a work environment that fosters workgroup cohesion, allowing nurses to have autonomy, and allowing nurses a variety of specialties to choose from. PTS: 1 DIF: Cognitive Level: Application REF: p. 334 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including shortage of health care professionals.TOP:Shortage of nurses MSC: NCLEX®: Safe and effective care environment

1. Which type of nursing delivery models would be appropriate in a rural area that would require fewer numbers of registered nurses? (Select all that apply.) a. Functional nursing b. Team nursing c. Primary care nursing d. Patient-focused care e. Transitional care

: A, B, D When you have a limited number of nurses, then functional nursing, team nursing, and patient-focused care are useful because you can deliver quality care by using more ancillary staff. Primary care is usually 24-hour nurse coverage, and transitional care is when advanced practice nurses (APRNs) conduct assessments and—with physicians—design and coordinate patient care and discharge plans. PTS: 1 DIF: Cognitive Level: Application REF: pp. 342-343 OBJ:Discuss patterns of nursing care delivery systems. TOP:Patterns of nursing care delivery MSC: NCLEX®: Safe and effective care environment—management of care

3. The nurse understands the importance of participation in politics when stating which of the following? (Select all that apply.) a. "It is important for nursing to be presented in a positive light." b. "Nurses should fight for better health care for all patients." c. "Nurses should only worry about what is occurring where they practice nursing." d. "Nurses should lobby for the availability of health care." e. "The public should see what nurses really do."

: A, B, D, E It is important that the nurse understand how important political participation is. The following statements indicate understanding: "It is important for nursing to be presented in a positive light," "Nurses should fight for better health care for all patients," "Nurses should lobby for the availability of health care," and "The public should see what nurses really do." The statement "Nurses should only worry about what is occurring where they practice nursing" does not indicate understanding of the importance of political participation. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 378 OBJ: Define politics and political involvement. TOP: Politics MSC: NCLEX®: Not applicable

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

: A, B, D, E Risk management becomes involved when incidents and untoward events occur. Risk managers gather evidence surrounding the event and interview those involved. Risk management does not become involved to discipline the nurse. PTS: 1 DIF: Cognitive Level: Application REF: p. 479 OBJ: Take an active role in improving the quality of health care as required by legal standards. TOP:Risk management and quality improvement MSC: NCLEX®: Safe and effective care environment

2. What action makes up a nurse's political savvy? (Select all that apply.) a. Analyzing a situation b. Participating in a constructive way c. Following directions d. Voicing an opinion e. Presenting a possible resolution

: A, B, D, E The actions that make up a nurses political savvy include the ability to analyze a situation, participate in a constructive way, voice an opinion, and present a possible resolution. The ability to follow directions does not make up the nurse's political savvy. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 380 OBJ: Define politics and political involvement. TOP: Politics MSC: NCLEX®: Not applicable

6. A new graduate is preparing for a job interview. Which questions would be appropriate to ask the manager in regards to health care economics? (Select all that apply.) a. How is the acuity of patients factored into staffing? b. What is the turnover rate on this unit? c. How long are the breaks for staff on this unit? d. What is the overtime rate on this unit? e.z What are the budgeted hours per patient day on this unit?

: A, B, D, E The new graduate should consider asking how the acuity of patients is factored into staffing, what the turnover rate is, what the overtime rate is, and what the budgeted hours per patient day are for the unit. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 367 OBJ: Discuss strategies you will use to achieve fiscal responsibility to the employing organization. TOP: Fiscal responsibility to the employing organization MSC: NCLEX®: Not applicable

5. In what ways can the nurse lobby? (Select all that apply.) a. Upon meeting the candidate for the first time and assessing knowledge b. Meet face-to-face with the candidate to discuss the issues. c. The nurse cannot lobby a candidate. d. Write a letter to the candidate. e. Email the candidate.

: A, B, D, E The nurse can lobby a candidate in different ways. Meeting a candidate allows the nurse to assess that person as a potential office holder. Nurses can also write letters or email a candidate to discuss issues. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 383-384 OBJ: List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system. TOP: Lobbying MSC: NCLEX®: Not applicable

3. Which action by the nurse shows fiscal responsibility to the employing organization? (Select all that apply.) a. Wash hands after each patient contact. b. Turn patients every 2 hours. c. Round on patients. d. Toilet patients frequently to prevent falls. e. Use resources of the institution wisely.

: A, B, D, E The nurse can show fiscal responsibility to the employing organization by washing hands after each contact, turning patients every 2 hours to prevent bed sores, toileting patients frequently to prevent falls, and using resources of the institution wisely. PTS: 1 DIF: Cognitive Level: Application REF: p. 370 OBJ: Discuss strategies you will use to achieve fiscal responsibility in clinical practice. TOP:Fiscal responsibility to the employing organization MSC: NCLEX®: Safe and effective care environment

4. Which action by the nurse demonstrates fiscal responsibility to the employing organization? (Select all that apply.) a. Only bringing needed supplies into a patient's room b. Accurately documenting the patient's condition c. Minimally documenting in the patient's chart d. Taking breaks as scheduled e. Remaining healthy and able to function on the job

: A, B, D, E The nurse shows fiscal responsibility to the employing organization by only bringing needed supplies into the patient's room, accurately documenting the patient's condition, taking breaks as scheduled, and remaining healthy and able to function on the job. PTS: 1 DIF: Cognitive Level: Application REF: p. 370 OBJ: Discuss strategies you will use to achieve fiscal responsibility to the employing organization. TOP:Fiscal responsibility to the employing organization MSC: NCLEX®: Safe and effective care environment

5. Which action by the nurse shows fiscal responsibility to the payer of care? (Select all that apply.) a. Understand Medicare and Medicaid insurance coverage. b. Efficiently and effectively use resources to provide patient care. c. Document minimally in the patient chart. d. Select interventions which are cost effective. e. Document the patient's plan of care.

: A, B, D, E To show fiscal responsibility to the payer of care, the nurse should understand Medicare and Medicaid insurance coverage, efficiently and effectively use resources to provide patient care, select interventions that are cost effective, and document the patient's plan of care as well as condition. PTS: 1 DIF: Cognitive Level: Application REF: p. 372 OBJ: Discuss strategies you will use to achieve fiscal responsibility to the employing organization. TOP:Fiscal responsibility to the payer of care MSC: NCLEX®: Safe and effective care environment

2. The nurse understands cost containment when stating which of the following? Major elements of the law that support cost containment include (Select all that apply.) a. "increased governmental regulation of insurers." b. "less use of technology." c. "increasing incentives for coordination of care." d. "emphasis on physician centered care." e. "decreasing consumer out of pocket costs."

: A, C Major elements of the law that supports cost containment include increased governmental regulation of insurers, increased use of technology, increasing incentives for coordination of care, emphasis on patient-centered care, and increased consumer out-of-pocket costs. These measures are in an effort to reduce the overall cost of health care. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 328 OBJ: Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost. TOP: Cost of health care MSC: NCLEX®: Not applicable

3. Which action can the hospital administrator take to reduce health care costs? (Select all that apply.) a. Hire case managers to see all patients who have extensive medical needs. b. Reduce the number of patients the hospital can accommodate. c. Ensure that appropriate staff is available. d. Encourage the use of evidence-based practice. e. Accept only patients with health insurance.

: A, C, D To reduce health care costs, the hospital administrator can take different actions. The hospital administrator can hire case managers to see all patients with extensive medical needs, ensure that appropriate is available, and encourage the use of evidence based practice. It is not realistic for the hospital administrator to reduce the number of patients that the hospital can accommodate. It is illegal to turn away patients without health insurance. PTS: 1 DIF: Cognitive Level: Application REF: p. 328 OBJ: Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost. TOP: Strategies to control costs MSC: NCLEX®: Not applicable

1. What actions can nurses take that would demonstrate the skills necessary to move a vision? (Select all that apply.) a. Elect decision makers. b. Refrain from political involvement. c. Testify before legislative committee hearings. d. Compromise. e. Become elected officials.

: A, C, D, E Leavitt and colleagues (2005) stated that the future of nursing health care depends on nurse's skills in moving a vision. The skills involve electing decision makers, testifying before legislative committee hearings, compromising, and becoming elected officials. These actions will help nurses protect the future of nursing and health care. PTS: 1 DIF: Cognitive Level: Application REF: p. 384 OBJ: Define politics and political involvement. TOP: Political action in nursing MSC: NCLEX®: Not applicable

1. It is important for the nurse to understand strategies that promote a fiscally responsible clinical practice. From the following listing, select those strategies that would achieve a fiscally responsible clinical practice. (Select all that apply.) a. Completes charge slips or scans bar code of nursing supplies used when changing a surgical dressing b. Participates in the annual hospital fund-raising activity c. Visits the Centers for Medicare & Medicaid Services to understand what services are provided during an inpatient visit d. Immediately reports any development of a patient medical complication to the health care provider e. Volunteers to participate in a hospital program initiative to reduce central line associated bloodstream infection (CLABSI) f. Completes a patient's discharge plan on the morning of discharge

: A, C, D, E The following is a listing of strategies to promote a fiscally responsible clinical practice: • Provides quality nursing care that prevents complications and documents condition accurately • Makes conscious decisions about the allocation of professional nursing time • Understands Medicare and Medicaid insurance coverage • Engages in evidence-based practice and follows best practice guidelines • Shares information with patients and families about the costs of care and alternatives • Assigns assistive personnel (nurse aides, certified medical assistants) appropriately to help with care • Works with the members of other health care professions to promote fiscal responsibility for clinical practice • Begins discharge planning on admission; otherwise, if not available or prepared until the day of discharge, there may be confounding factors (lack of transportation) that require the patient to stay an additional hospital day • Completes charge slips for patient supplies if required (Answer A) • Avoids burnout by taking scheduled breaks, meal times, and vacations • Engages in safe clinical practice that will avoid personal injuries The participation in a fund-raising activity does not directly impact the clinical practice. It does build a sense of camaraderie among staff. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 368-372 OBJ: Describe what is meant by the term fiscal responsibility in clinical practice. TOP: Fiscal responsibility in clinical practice MSC: NCLEX®: Not applicable

4. The nurse has an adequate understanding of power when listing which of the following as laws of power? (Select all that apply.) a. Power invariably fills any vacuum. b. Power is invariably public. c. Power is based on a system of ideas and philosophy. d. Power is exercised through and depends on institutions. e. Power is invariably confront with and acts in the presence of a field of responsibility.

: A, C, D, E The laws of power are: Law #1: Power invariably fills any vacuum; Law #2: Power Is Invariably Personal; Law #3: Power Is Based On a System of Ideas and Philosophy; Law #4: Power Is Exercised Through and Depends on Institutions; and Law #5: Power Is Invariably Confronted with and Acts in the Presence of a Field of Responsibility. PTS: 1 DIF: Cognitive Level: Application REF: pp. 381-382 OBJ:Discuss different types of power and how each is obtained. TOP: Laws of power MSC: NCLEX®: Not applicable

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

: A, C, D, E The nurse should avoid putting conclusions, blame, judgment, and opinions on the incident report. The nurse should only relay facts. It would be appropriate for the nurse to list the patient's name. PTS: 1 DIF: Cognitive Level: Application REF: p. 479 OBJ: Take an active role in improving the quality of health care as required by legal standards. TOP:Risk management and quality improvement MSC: NCLEX®: Safe and effective care environment

4. Which statement by the nurse indicates understanding of the case manager's role? The case manager (Select all that apply.) a. "guides patients through the health care delivery process." b. "ensures quicker discharge for patients without insurance." c. "coordinates care for the patient." d. "assists patients in achieving goals effectively and efficiently." e. "collaborates with the health care team."

: A, C, D, E The role of the nurse case manager includes guiding patients through the health care delivery process, coordinating care for the patient, assisting patients in achieving goals effectively, and efficiently and collaborating with the health care team. Patients without insurance do not necessarily have a quicker discharge process. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 330 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost.TOP:Case management MSC: NCLEX®: Safe and effective care environment

7. What action can the registered nurse take to control personal practice? (Select all that apply.) a. Improve the professional practice of nurses and nursing assistants. b. Refrain from shared governance. c. Implement peer review. d. Identify and recommend elimination of hazards in the workplace. e. Identify and recommend processes that work to ensure the safety of patients.

: A, C, D, E To control personal practice, the registered nurse can improve the professional practice of nurses and nursing assistants, implement shared governance, implement peer review, identify and recommend elimination of hazards in the workplace, and identify and recommend processes that work to ensure the safety of patients. PTS: 1 DIF: Cognitive Level: Application REF: p. 411 OBJ:Identify barriers to control of professional practice. TOP:How can nurses control their practice? MSC: NCLEX®: Safe and effective care environment

5. The nurse believes that an adequate understanding of arbitration through the traditional collective bargaining unit has been obtained. Which of the following statements supports this belief? a. "Arbitration is a management technique to discharge an employee." b. "Arbitration is useful to resolve conflicts having a basis in the labor-management" contract. c. "Arbitration is always used before the formal grievance process." d. "Arbitration is a process used to establish nursing standards."

: B Arbitration has also been used to resolve issues involving the "integrity of the bargaining unit." Arbitrators have been asked to decide whether nurses remain eligible for bargaining unit coverage when jobs are changed and new practice models are implemented. Mediation, arbitration, and fact finding have all been used to resolve conflicts in union contracts. Nurses usually fare well when contract enforcement issues are submitted to an arbitrator and facts, not power or public relations, determine the outcome. Arbitration is used after a formal grievance process has not reached a resolution to the issue. Arbitration does not establish nursing standards because that is the purpose of national organizations to write and develop nursing standards of practice. PTS: 1 DIF: Cognitive Level: Application REF: p. 408 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Arbitration MSC: NCLEX®: Not applicable

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

: B As an advocate for the patient, the nurse should advocate for the patient with the attending physician and family by facilitating communication. It would be best for all parties to be in a room together so that a discussion can take place. It would not be appropriate to send the order to pharmacy, try to convince the patient to receive chemotherapy, or to tell the patient that the drug must be given because it was already ordered. PTS: 1 DIF: Cognitive Level: Application REF: p. 424 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

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

: B Beneficence is the ethical principle of actively doing good for patients. Allowing patients to make their own health care decisions is autonomy. Doing no harm to the patient is nonmaleficence. Justice involves treating all patients equally. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 422 OBJ: Define terminology commonly used in discussions about ethical issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

12. Which statement by the nurse indicates understanding of collective bargaining in the workplace? a. "Collective bargaining is not useful in the workplace." b. "Collective bargaining is used by nurses to control their practice." c. "Collective bargaining is used by managers to control nurses." d. "Collective bargaining is always an adversarial process in the workplace."

: B Collective bargaining is used by nurses to control their practice by redistributing power within the health care organization. It is not used by managers to control nurses. It is used in the workplace. Traditional collective bargaining has been considered an adversarial process. Nontraditional collective bargaining or interest-based bargaining (IBB) attempts to problem-solve issues between staff and management in a shared governance approach. PTS: 1 DIF: Cognitive Level: Application REF: p. 403 OBJ:Identify the positive and negative aspects of traditional and nontraditional collective bargaining.TOP:The debate over collective bargaining MSC: NCLEX®: Not applicable

10. The nurse understands "scope of nursing practice" when making which of the following statements? a. "The scope of nursing practice includes acts that permit some overlap between nursing and medicine." b. "The scope of nursing practice includes activities that are legally permissible for a nurse to perform in a particular state." c. "The scope of nursing practice are the specific duties the nurse owes to a patient." d. "The scope of nursing practice involves hose activities for which a nurse can be held liable for malpractice."

: B Defining the scope of nursing practice is part of the responsibility of the state board of nursing. This involves determining the specific activities for each level of nursing and who can perform what functions. The duty that a nurse owes to a patient is part of the professional nurse-patient relationship. Any nursing activity that is outside the scope of nursing practice can be grounds for malpractice or negligence. PTS: 1 DIF: Cognitive Level: Application REF: p. 450 OBJ: Relate the Nurse Practice Act to the governance of your profession. TOP:Scope of practice MSC: NCLEX®: Safe and effective care environment—management of care

3. A nurse manager is preparing a presentation on health care economics for unit staff. How would the nurse manager explain the definition of economics as it relates to health care to the staff? a. Economics refers to how the health care system is going to care for the older segment of the population. b. Health care is a limited resource; economics refers to how this resource is going to be allocated. c. Health care economics refers to the budgeting and financial management of the institution providing the care. d. Economics is the balance of the utilization of health care services and the monies obtained for the services provided.

: B Economics is the allocation of scarce resources. Health care economics is the distribution of the limited resource of health care. Economics includes not only the older adult segment but all age groups. Economics is not about using health care services and the monies obtained but instead how they will be distributed. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 358 OBJ: Define economics and health care economics. TOP: Health care economics MSC: NCLEX®: Not applicable

9. A nurse is educating coworkers on the establishment of collective bargaining. The nurse knows the teaching has been successful when a coworker states: a. "Collective bargaining is still not recognized by hospitals." b. "Nurse activists believed in a unified voice for nurses." c. "Nurse activists wanted to option of working more hours." d. "Collective bargaining is not effective."

: B Nurse activists created the United America Nurse because they believed in the creation of a powerful, national, independent, and unified voice for union nurses. Collective bargaining is recognized in hospitals in states where it is effective. The other statements are not accurate of collective bargaining. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 399 OBJ:Identify the milestones in the history of collective bargaining. TOP: The evolution of collective bargaining in nursing MSC: NCLEX®: Not applicable

6. A staff nurse is scheduled to work 3 to 11 pm in the cardiac step-down unit. The staff nurse realizes they are the only RN that will be on duty. The staff nurse calls the supervisor to say that help will be needed. The supervisor replies that there are no available nurses to assign to this unit. What should the nurse do? a. Leave and go home rather than assume this responsibility. b. Protect themself by filing a written objection to the assignment. c. Call a temporary agency and arrange for coverage by a registered nurse. d. Call the state health department to investigate the staffing issue.

: B Nurses who disagree with an assignment should submit their objection in writing when the assignment could violate the patient protection language of the state nurse practice act. An assignment-despite-objection report is submitted to the nursing administrator and the bargaining agent simultaneously, thus officially registering the complaint. This procedure is used both in the traditional and in the nontraditional collective bargaining units. Professional responsibility would be staying with the assignment and not abandoning the work (i.e., patients). The staff nurse does not have the authority or power to contact a temporary agency for obtaining staffing. The state department of health does not review or investigate staffing issues. PTS: 1 DIF: Cognitive Level: Application REF: p. 401 OBJ: Identify the conditions that may cause nurses to seek collective bargaining representation. TOP:Patient care assignments MSC: NCLEX®: Safe and effective care environment—management of care

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

: B People are willing to give power to someone interested in restoring order to situations of discomfort. Therefore, someone will eventually step forward to handle the dilemma (Law 1: Power Invariably Fills Any Vacuum). As an individual, one can easily feel powerless and unable to deal with the complex problems facing a hospital, community, or state. Through a nursing service organization, a state nurses association, or a similar organization, an individual can garner the resources needed to magnify their power (Law 4: Power Is Exercised Through and Depends on Institutions). A person exercises power by providing the leadership or spark to create the strategy to carry out such an initiative, thus inspiring people to contribute to the effort (Law 2: Power Is Invariably Personal). Actions taken speak to the other nurses for who nurses act and, most important, the patients for who nurses advocate. The individual in the power position is acting on behalf of the group (Law 5: Power Is Invariably Confronted With and Acts in the Presence of a Field of Responsibility). PTS: 1 DIF: Cognitive Level: Application REF: p. 386 OBJ:Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable

1. Which statement best describes when collective bargaining by nurses can occur? a. Only when the nurses in the group are members of a union b. Whenever nurses see a need to organize to take collective action c. Only when the state nurses association is willing to represent nurses at a specific agency d. Whenever the state nurses association agrees that both wages and working conditions are inappropriate

: B Professional nurses organize themselves. This may occur because administrators and nursing supervisors fail to recognize and address nurses' individual and collective needs. Collective bargaining can be addressed through a formal union representative or through interest-based bargaining (IBB). The state nurses association may or may not be involved with collective bargaining. PTS: 1 DIF: Cognitive Level: Application REF: p. 406 OBJ: Identify the conditions that may cause nurses to seek collective bargaining representation. TOP: Collective bargaining MSC: NCLEX®: Not applicable

12. A nurse is educating a group of students about reward power. The nurse knows the teaching has been effective when one of the students says: a. "Reward power does not actually exist anymore." b. "Reward power may cause a person to behave in a manner that benefits someone else." c. "Nurses are not susceptible to reward power." d. "Reward power only benefits nurses."

: B Reward power occurs when a person behaves in a manner that benefits someone else upon receiving a reward. Reward power does exist in today's society, although it is more closely monitored than in the past. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 386 OBJ:Discuss different types of power and how each is obtained. TOP: Reward power MSC: NCLEX®: Not applicable

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

: B The Code of Ethics is a moral statement of accountability for practicing nurses and for student nurses. It is a statement to society that outlines the values, concerns, and goals of the profession, thereby addressing accountability. The code provides direction for ethical decisions and behavior by repeatedly emphasizing the obligations and responsibilities that the nurse-patient relationship entails. It lacks legal enforceability and is not a legal document like licensure laws PTS: 1 DIF: Cognitive Level: Analysis REF: p. 428 OBJ: Discuss the moral implications of the ANA and ICN codes of ethics. TOP: Ethics MSC: NCLEX®: Not applicable

9. What action might be taken on a nurse who commits an infraction of the Nurse Practice Act? a. The nurse is subject to discipline by a court of law. b. The nurse is subject to discipline by the state board of nursing. c. The nurse is subject to discipline by the local chapter of the state nurses association. d. The nurse is subject to discipline by the National League for Nursing.

: B The Nurse Practice Act is regulated and enforced by the state board of nursing. State Nurse Practice Acts regulate nursing by controlling the scope of practice and determining the specific activities for each level of nursing. Some states control who may use the titles registered nurse (RN) and licensed practical nurse (LPN) or licensed vocational nurse (LVN). The Nurse Practice Act is regulated and enforced by the state board of nursing. The National League of Nursing is involved with nursing program accreditation. The local state nurses association does not provide discipline for infarctions to the Nurse Practice Act. Only if the infarction is of a criminal nature will the state board of nursing refer the case to the local court of law. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 477 OBJ: Understand functions of a state board of nursing. TOP: Nurse Practice Act MSC: NCLEX®: Not applicable

5. Which strategy is least effective in formulating political action? a. Ability to communicate information in concise terms b. Living and practicing in several different states c. Determining who should be contacted and for what political action d. Having the ability to use different channels of information

: B The least effective strategy in formulating a political action is living and practicing in several different states. Communication, the ability to determine who should be contacted, and knowing how to use the different channels of information are all important in political action. PTS: 1 DIF: Cognitive Level: Application REF: p. 384 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Political action MSC: NCLEX®: Not applicable

16. A nurse is covering for a coworker who is on a lunch break. While administering medications, the nurse notices a bag of antibiotic hanging with another patient's name on it. The nurse immediately stops the infusion. What should the next step be? a. Say nothing about the error because the patient is fine. b. Speak with the coworker about the error and fill out the proper paperwork for documentation. c. Tell the other coworkers about the error. d. Tell the patient about the error.

: B The next step that the nurse should take is to speak to the coworker about the error and then fill out paperwork for documentation. The nurse needs to have a "crucial conversation" with this coworker to alert him or her about the error. This allows for a decrease in the number of errors and a safer health care environment. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 337 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including patient safety.TOP:Patient safety MSC: NCLEX®: Safe and effective care environment

4. What would the nurse identify as a primary difference between traditional and nontraditional collective bargaining? a. Traditional collective bargaining is not organized through the state nursing association. b. Traditional collective bargaining units are organized and members belong to the National Nurses United. c. Nontraditional collective bargaining units are not recognized by health care organizations as a collective bargaining agency. d. Nontraditional collective bargaining has a long history and is based on the support of organizations throughout the country.

: B The nontraditional collective bargaining activities in nursing are organized and supported by the Center for American Nurses, which is affiliated with the American Nurses Association. The traditional unit in the past was the United American Nurses (UAN). This union has joined other traditional bargaining units and has become the National Nurses United, which is a relatively new union (started in 2009). PTS: 1 DIF: Cognitive Level: Application REF: p. 400 OBJ: Compare traditional and nontraditional collective bargaining models. TOP: Traditional and nontraditional collective bargaining MSC: NCLEX®: Not applicable

17. A nurse is striving to control personal nursing practice. Which action should the nurse avoid? a. Recommend a new system for bedside report. b. Refrain from participating in peer review. c. Create a unit presentation on how to increase patient safety. d. Identify ways to reduce hazards.

: B The nurse can control personal nursing practice by recommending a new system for bedside report, participating in peer review, creating a unit presentation on how to increase patient safety, and identifying ways to reduce hazards. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 411 OBJ:Identify barriers to control of professional practice. TOP: How can nurses control their practice? MSC: NCLEX®: Not applicable

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

: B The nurse failed to act in a reasonable and prudent fashion and thus is liable for malpractice. The most common errors include failure to administer the right drug to the right patient, in the right amount, by the right route, at the right time, and with the right documentation. Claims involving medication errors are augmented when the nurse fails to record the medication administration properly, fails to recognize side effects or contraindications, or fails to know a patient's allergies. There is no justification for the nurse to bring about a countersuit for the nurse who took the medication history because it was clearly noted in all critical areas of the chart. PTS: 1 DIF: Cognitive Level: Application REF: p. 467 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Medication errors MSC:NCLEX®: Physiological integrity—pharmacological therapies

15. The nurse has an adequate understanding of capital budget when stating: a. "A capital budget is part of the expected expenses of the unit." b. "A capital budget is used to purchase or replace equipment costing more than $5000." c. "A capital budget is used to pay for nurses to work in the hospital." d. "A capital budget is used to purchase lunch for employees."

: B The nurse has an adequate understanding of capital budget when the nurse states that the budget "is used to purchase or replace equipment costing more than $5000." The capital budget is the beginning point of the budget cycle. It is not used to pay for nurses to work in the hospital and is not used to purchase lunch for employees. The capital budget is not part of the expected expenses of the unit. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 364 OBJ: Describe what is meant by operating budget, personnel budget, and capital budget. TOP: Types of budgets MSC: NCLEX®: Not applicable

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

: B The nurse practice act defines the scope of practice for each level of licensure. It is a type of state statutory law and can be obtained from the state board of nursing or online. It does not defend any action the nurse may take, detail pay raises, or discuss vacation time. PTS: 1 DIF: Cognitive Level: Application REF: p. 450 OBJ: Relate the Nurse Practice Act to the governance of your profession. TOP:Legal control over nursing practice MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE

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

: B The nurse should contact the board of nursing in the state the nurse just moved to in order to determine what needs to be done to obtain licensure to practice in that state. The nurse should not begin practicing without an updated license even on a part-time basis. Each state may require a new license, and the nurse will not be covered by a license issued in another state unless the state is part of the nurse licensure compact. Either way, the nurse will need to contact the board of nursing first. PTS: 1 DIF: Cognitive Level: Application REF: p. 451 OBJ: Describe your responsibilities for obtaining and maintaining your license. TOP:Legal control over nursing practice MSC: NCLEX®: Safe and effective care environment

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

: B The patient's chart is a legal document. Changing or tampering with the chart would be in violation of the standards of practice, and the Nurse Practice Act and would not be considered "what a reasonable nurse would do." The nurse is expected to perform as a reasonable nurse would. If your actions are not those of a reasonable nurse and this causes someone to be injured, you can be sued. Being discourteous on the witness stand may not be professional. It is also not appropriate to discuss the case with the plaintiff or hide information; however, tampering with the chart is a more serious error in judgment. PTS: 1 DIF: Cognitive Level: Application REF: p. 464 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Legal risks MSC: NCLEX®: Safe and effective care environment—management of care

11. A female patient is admitted to the labor and delivery unit, where she is assigned a registered nurse who will manage her care for the duration of her hospitalization. What type of nursing care delivery model is represented in this nursing unit? a. Functional care c. Patient-focused care b. Primary care d. Case management

: B This is an example of primary care nursing, in which the nurse is the principal or primary person to manage and coordinate the patient's care around the clock. Patient-focused care is an interdisciplinary approach to patient care. Functional care is the provision of care by nursing and nursing ancillary staff rather than by an all-nursing staff as seen in primary care nursing. Case management is a model of care delivery in which a nurse case manager coordinates and collaborates with other health services when a patient has complicated health care needs, but the case manager may not be involved in the daily care activities of the patient. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 336 OBJ:Discuss patterns of nursing care delivery systems. TOP:Patterns of nursing care delivery MSC: NCLEX®: Safe and effective care environment—management of care

6. The ethical principle of autonomy is not applicable in which patient situation? a. The patient does not speak or understand the English language. b. The patient is unaware of who or where he or she is. c. The patient has been in a long-term care facility for 10 years. d. The patient has values that conflict with the caregiver's values.

: B This principle assumes rational thinking on the part of the individual, and being unaware of who and where the patient is, is not indicative of the ethical principle of autonomy. Autonomy is a patient's right to self-determination implies the freedom to make choices and decisions about one's own care without interference even if those decisions are not in agreement with those of the health care team. In the other situations, the patient has rational thinking even though he or she may not understand or speak English because an interpreter could assist. PTS: 1 DIF: Cognitive Level: Application REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Not applicable

14. A group of nurses are concerned about access to health care in rural communities. Which action should they take to voice their concerns? a. Complain to their coworkers. b. Form a coalition to be combat the issue. c. Independently discuss the issues with other staff. d. Attend monthly staff meetings.

: B To be effective, the nurses should form a coalition to combat the issues associated with access to health care in rural communities. Complaining to coworkers and working independently would not be as effective as forming a coalition. PTS: 1 DIF: Cognitive Level: Application REF: p. 384 OBJ:Discuss different types of power and how each is obtained. TOP: Building coalitions MSC: NCLEX®: Not applicable

18. A nurse has been assigned as team leader for the day and is working with two LPNs and two unlicensed personnel. What should the nurse do to ensure success in caring for patients? a. Give the assignments for the day out to the team and plan to meet right before the end of shift. b. Continuously communicate with the members of the team throughout the entire day. c. Report changes in a patient's condition to the health care provider only. d. Revise each patient's plan of care once a shift.

: B To ensure success for the day, the nurse should continuously communicate with the members of the team throughout the entire day. The nurse should be sure to update all members of the team on any change in patient status. The LPN can also report changes in a patient's condition to a health care provider because it doesn't have to be the team leader. Revisions of each patient's plan of care should be done continuously has changes arise and not just once a shift. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 337 OBJ:Trace the history of the use of nursing care delivery models. TOP: Team nursing MSC: NCLEX®: Safe and effective care environment

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

: B To protect themself from a malpractice claim, the nurse can implement fall precautions on an older adult patient. These include supervising the patient when getting out of bed, keeping the floor clear, and placing the bed in the lowest position. Reducing work status to part time would not guarantee that the nurse wouldn't be named in a lawsuit. PTS: 1 DIF: Cognitive Level: Application REF: p. 454 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Preventing malpractice claims MSC: NCLEX®: Safe and effective care environment

1. A nurse is educating an adult patient on patient rights, according to the American Hospital Association. The teaching has been effective when the adult states that the patient's rights include: a. "choice of diet to be eaten during hospitalization." b. "considerate and respectful care from all care providers." c. "medical care regardless of ability to pay." d. "information from nurses about diagnosis and prognosis."

: B When you are a patient in the hospital, you have the right to receive considerate and respectful care. The American Hospital Association published a Patient's Bill of Rights, which is now revised and called The Patient Care Partnership. This document reflects acknowledgment of patients' rights to participate in their health care and was developed as a response to consumer criticism of paternalistic provider care. The statements detail the patient's rights with corresponding provider responsibilities. This document reflects the increasing emphasis on patient autonomy in health care and defines the limits of provider influence and control. It does not contain information on diets, nursing diagnosis, or the ability to pay for medical care. PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 421-423 OBJ: Discuss the moral implications of the ANA and ICN codes of ethics. TOP:Patient rights MSC: NCLEX®: Safe and effective care environment—management of care

6. A nurse believes that the patient assignment received is unsafe. Which action should be taken to correct this? (Select all that apply.) a. Leave the hospital. b. Submit a report about the assignment following protocol. c. Report the assignment to a supervisor immediately. d. Accept the assignment. e. Accept the assignment and only perform the skills that the nurse is comfortable with.

: B, C The nurse should immediately report the assignment to the nurse supervisor and submit a report about the assignment following protocol. The nurse should not leave the hospital or accept the assignment if they cannot provide competent care. PTS: 1 DIF: Cognitive Level: Application REF: p. 402 OBJ:Identify conditions that may lead nurses to seek traditional or nontraditional collective bargaining.TOP:Common issues MSC: NCLEX®: Safe and effective care environment

2. Which action by the nurse demonstrates fiscal responsibility to the patient? (Select all that apply.) a. Discharging a patient home with prescriptions and no health insurance to cover the cost b. Assessing the patient's resources and determining their ability to pay for prescriptions c. Setting the patient up for Meals on Wheels d. Giving the patient information on free support groups e. Calling local churches to see what services they can offer the patient

: B, C, D, E The nurse demonstrates financial responsibility to the patient by assessing the patient's resources and determining the ability to pay for prescriptions, setting the patient up for Meals on Wheels, giving the patient information on free support groups, and calling local churches to see what services they can offer the patient. PTS: 1 DIF: Cognitive Level: Application REF: p. 368 OBJ: Discuss strategies you will use to achieve fiscal responsibility in clinical practice. TOP: Fiscal responsibility to the patient MSC: NCLEX®: Safe and effective care environment

4. The nurse manager has an adequate understanding of the common issues in nursing when stating which of the following? (Select all that apply.) a. "There are no common issues in nursing." b. "Mandated staffing is a common issue." c. "Unsafe patient assignments are a common issue." d. "Lack of overtime is a common issue." e. "Negotiations are a common issue."

: B, C, E Mandated staffing, unsafe patient assignments, and negotiations are common issues faced by nurses today. Lack of overtime is not considered to be a common issue in nursing. PTS: 1 DIF: Cognitive Level: Application REF: pp. 401-403 OBJ:Identify conditions that may lead nurses to seek traditional or nontraditional collective bargaining.TOP:Common issues MSC: NCLEX®: Safe and effective care environment

2. Which action can the nurse take during a job interview to ensure job satisfaction in the future? (Select all that apply.) a. Ask about benefits associated with the job. b. Assess the potential employer's mission. c. Determine wages and pay increases. d. Ask questions to determine the culture of the organization. e. Question the hours that are required for a full-time status.

: B, D In the job interview, it is important that the nurse focuses on questions that will help determine which job is right and will ensure job satisfaction in the future. The nurse should be prepared to assess the potential employer's mission and culture in order to determine if the job will support the nurse's professional practice and growth. Although information about compensation, benefits, and hours are needed, these are not best predictors of job satisfaction. PTS: 1 DIF: Cognitive Level: Application REF: p. 411 OBJ:Identify the milestones in the history of collective bargaining. TOP: Job satisfaction MSC: NCLEX®: Not applicable

5. A nurse believes that an assignment is unfair and refuses to care for the assigned patients. What could be the outcome if the nurse abandoned the patient assignment? (Select all that apply.) a. The nurse would be assigned to another group of patients. b. Untoward patient outcomes c. Other nurses would take on the nurse's assignment. d. Disciplinary action by the Board of Nursing e. Disciplinary action by the nurse's employer

: B, D, E Abandoning a patient assignment risks untoward patient outcomes and can result in disciplinary action by the nurse's employer and the Board of Nursing. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 402 OBJ:Identify conditions that may lead nurses to seek traditional or nontraditional collective bargaining.TOP:Common issues MSC: NCLEX®: Safe and effective care environment

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

: B, D, E The American Medical Association opposes physician-assisted suicide (PAS) because it violates the most basic ethical principle: First, do no harm. Physicians have traditionally cared for living patients, and PAS threatens to destroy this fundamental relationship. On the other hand, quality of life advocates support PAS as an example of personal autonomy and control. Nurses working with physicians involved in PAS should be aware of the legal and ethical implications of administering legal dosages of medications. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 436 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Moral/ethical principles MSC: NCLEX®: Safe and effective care environment

6. A nurse is educating coworkers on power. The nurse knows the teaching has been effective when the coworkers state: The sources of power are (Select all that apply.) a. reward b. coercive c. punishment d. expert e. legitimate f. referent

: B, D, E, F There are five types of power: reward, coercive, expert, legitimate, and referent. Punishment is not one of the five types of power. PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 381-382 OBJ:Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable

2. In which situation would the traditional type of collective bargaining (union) help nurses attain their goals? a. Management has agreed to no nursing layoffs for one year after reorganization. b. Nursing has received a 4% salary increase this year and next year. c. Nurses have identified workplace safety issues and health hazards. d. Management has arranged for nurse practitioners to have admitting privileges.

: C A conflict regarding safety between administration and nursing is a situation that could benefit from a nurses' union. Many nurses support collective bargaining in the workplace as a way to control their practice by redistributing power within the health care organization. Salary increases, no nursing layoffs, and nurse practitioners having admitting privileges typically do not represent conflict. PTS: 1 DIF: Cognitive Level: Application REF: p. 400 OBJ: Identify the conditions that may cause nurses to seek collective bargaining representation. TOP: Collective bargaining MSC: NCLEX®: Not applicable

1. The state nurses association writes a new version of the Nurse Practice Act, secures a sponsor in the legislature, and lobbies legislators to adopt the bill. Which of the laws of power would the nurse label this situation? a. Power is invariably personal. b. Power invariably fills any vacuum. c. Power is exercised through and depends on institutions. d. Power is best exercised via large financial donations to individual legislators.

: C As an individual, one can easily feel powerless and unable to deal with the complex problems facing a hospital, community, or state. Through a nursing service organization, a state nurses association, or a similar organization, an individual can garner the resources needed to magnify their power (Law 4: Power Is Exercised Through and Depends on Institutions). Initiatives such as this start with one person creating a new approach to a problem. That person exercises power by providing the leadership or spark to create the strategy to carry out such an initiative, thus inspiring people to contribute to the effort (Law 2: Power Is Invariably Personal). When a problem or issue arises, the prevailing desire is for peace and order. People are willing to give power to someone interested in restoring order to situations of discomfort. Therefore, someone will eventually step forward to handle the dilemma (Law 1: Power Invariably Fills Any Vacuum). Power is best exercised via large financial donations to individual legislators is not one of the five Sanford's laws of power. PTS: 1 DIF: Cognitive Level: Application REF: p. 382 OBJ:Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable

4. Which statement by the nurse manager is accurate regarding case management? The two tools that support case management are a. "clinical pathways and patient classifications." b. "clinically oriented and business-oriented pathways." c. "clinical pathways and disease management protocols." d. "centralized and decentralized system models."

: C Both of these tools (clinical pathways and disease management protocols) support case management by coordination and delivery of high-quality care. Clinical pathways (also known as care maps) are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for patients with a particular diagnosis, procedure, or symptom. Disease management protocols involve a system of coordinated health care interventions and communications for persons with conditions in which self-care is important in controlling the disease. PTS: 1 DIF: Cognitive Level: Application REF: p. 330 OBJ:Discuss patterns of nursing care delivery systems. TOP: Patterns of nursing care delivery MSC: NCLEX®: Not applicable

12. The nurse is reviewing upcoming discharges. Which patient would a case manager be assigned to? a. A 55-year-old woman post hysterectomy, who has adequate support from family b. A 42-year-old man post appendectomy, who is able to change his own dressing c. A 60-year-old man post sepsis, in need of nursing home placement d. A 38-year-old woman, post shoulder repair, who needs to follow up with the orthopedic surgeon

: C Case managers become involved when patients have complicated health care needs are receiving care that is expensive or are receiving care from multiple providers. The patient that is post sepsis is likely to be seeing a team of doctors and will need that care transferred over to the nursing home setting. The case manager can bridge that care so that the transition is smooth for the patient. The other patients need minimal support and therefore would not qualify for case management. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 330 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost.TOP:Case management MSC: NCLEX®: Safe and effective care environment

18. Which statement would be accurate of nurses who support collective bargaining? a. "Collective bargaining has set nursing back." b. "In general, collective bargaining is ineffective." c. "Collective bargaining forces positive change in the practice setting." d. "Collective bargaining forces negative change in the practice setting."

: C Collective bargaining is highly effective and forces positive change in the practice setting because individuals are forced to look at and address situations together. Collective bargaining has helped nursing move forward because of advancements made during negotiations. PTS: 1 DIF: Cognitive Level: Application REF: p. 392 OBJ:Discuss selected issues affecting nursing: multistate licensure, nursing and collective bargaining, and equal pay for work of comparable value. TOP: Nursing and Collective bargaining MSC: NCLEX®: Not applicable MULTIPLE RESPONSE

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

: C Each state's Nurse Practice Act is regulated by state laws. It would be important for the politically active nurse to contact state lawmakers and advise them of the pending legislation and the ramifications that would occur if institutional licensure replaced individual licensure—for instance, lack of regulation of safe nursing practice. The Nurse Practice Act is not regulated by city, county (parish), or federal legislative bodies. PTS: 1 DIF: Cognitive Level: Application REF: p. 386 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Political action MSC: NCLEX®: Not applicable

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

: C If the nurse were to uphold the ethical principle of veracity, the nurse would inform the patient of the diagnosis and involve the physician in the discussion. The nurse should not lie to the patient or withhold information at the family's request; the patient has a right to know information regarding his or her health care. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 423 OBJ: Define terminology commonly used in discussions about ethical issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

19. The nurse has an adequate understanding of patient-focused care when stating which of the following? a. "Patient-focused care includes the physician, who supervises care." b. "Patient-focused care decreases productivity." c. "In patient-focused care, the nurse supervises delivery of care." d. "The patient is not an active participant in patient-focused care."

: C In patient-focused care, the nurse (not a physician) supervises delivery of care. This system increases productivity and encourages the patient to be an active member of the health care team. Patients are encouraged to be active participants in the planning of their care. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 344 OBJ:Trace the history of the use of nursing care delivery models. TOP: Patient-focused care MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE

6. Which of the following statements shows the nurses understanding of primary nursing? a. "Primary nursing involves planning and directing of patient care over 24 hours." b. "Primary nursing involves care for 48 hours or more." c. "Primary nursing involves one nurse planning care for the patient." d. "Primary nursing is the only method of care used today."

: C In primary nursing, the fragmentation between shifts and nurses is eliminated because one nurse is accountable for planning the care of the patient around the clock. Primary nursing is not the only method of care used today. Functional nursing is when nursing care is broke into a series of tasks performed by many people, which results in a fragmented, impersonal kind of care. Fragmentation of care caused patient problems to be overlooked because they did not fit into a defined assignment. In team nursing, groups of patients are assigned to a team headed by a team leader, usually an RN, who coordinates the care for a designated group of patients. In primary nursing, a nurse plans and directs the care of a patient over a 24-hour period. This approach is designed to reduce or eliminate the fragmentation of care between shifts and nurses because one nurse is accountable for planning the care of the patient around the clock. In a patient-focused care system, the patient comes into contact with fewer people, and the RN, who is familiar with the patient's plan of care, supervises the delivery of care. This model also moves RNs to a higher level of functioning because they are now accountable for a fuller range of services for the patient. PTS: 1 DIF: Cognitive Level: Application REF: p. 342 OBJ:Discuss patterns of nursing care delivery systems. TOP: Patterns of nursing care delivery MSC: NCLEX®: Not applicable

12. A nurse understands informed consent when making which of the following statements? a. "Informed consent is a binding agreement." b. "Informed consent involves filling out an incident report." c. "Informed consent occurs when the patient receives information about a procedure before giving consent." d. "Informed consent is a name for a written legal policy."

: C Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for it to be done. Informed consent is not a binding agreement, an incident report, or a written legal policy. PTS: 1 DIF: Cognitive Level: Application REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Informed consent MSC: NCLEX®: Safe and effective care environment—management of care

3. The clinical nurse leader makes out the daily assignments. One staff nurse tells another, "Last week I was asked to change my days off so the clinical nurse leader could go to a play in another city. I told the clinical nurse leader I couldn't do it. Ever since then, I've been given the most difficult patients on the unit for my assignment." The staff nurse can label this type of power as: a. Inherent c. Legitimate b. Referent d. Expert

: C Legitimate power is the power or the influence that comes with role and position. In this situation, the clinical nurse leader has legitimate power and authority because of the position to make the patient assignments. Referent power is power a person has because others closely identify with that person's personal characteristics. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Inherent power is not a specific type. PTS: 1 DIF: Cognitive Level: Application REF: p. 382 OBJ:Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable

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

: C Nurse practice acts are great resources that provide information to nurses, including how and when to renew a nursing license. The nurse practice acts do not describe how to prepare for the NCLEX exam or provide a list of job openings. PTS: 1 DIF: Cognitive Level: Application REF: p. 451 OBJ: Relate the Nurse Practice Act to the governance of your profession. TOP:Legal control over nursing practice MSC: NCLEX®: Safe and effective care environment

13. What action can nurses take to be fiscally responsible? a. Give patients their discharge instructions and let them determine if the cost of their medications fit into their budget. b. Allow nurses to work on the unit when the census drops. c. Use proper hand hygiene. d. Document minimally on each patient.

: C Nurses can be fiscally responsible in many different ways. This includes fiscal responsibility to the patient, such as assessing the patient's resources for purchasing medication. The nurse is also expected to have fiscal responsibility for the organization. This includes sending nurses home or to another unit when the census drops and using proper hand hygiene to prevent infections, which would result in increased health care spending to treat. The nurse should also consider fiscal responsibility to the payer of care and practice documenting thoroughly to show the patients need for the care given. PTS: 1 DIF: Cognitive Level: Application REF: pp. 368-372 OBJ: Describe what is meant by the term fiscal responsibility in clinical practice. TOP: Fiscal responsibility MSC: NCLEX®: Not applicable

15. A nurse is actively involved in the political arena and is educating a colleague about becoming involved in the election process. The nurse knows that their teaching has been effective when a colleague states: a. "Nurses are discouraged from becoming involved in politics." b. "The election process has nothing to do with nursing." c. "It is easy for a nurse to become involved in the election process." d. "Political campaigns never need any help."

: C Political campaigns typically need help folding letters, stuffing envelopes, looking up addresses, and preparing bulk mailings. It would be easy for nurses to become involved once they find a candidate that they wish to support. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 385 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Election process MSC: NCLEX®: Not applicable

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

: C States have many statutes that require health care providers to report certain incidences or occurrences. If the provider fails to report as required and a person is injured, there can be negligence per se. It important for nurses to be aware of the reporting statutes in the state in which they are practicing. In most states, it is the law to report evidence of child or adult abuse. It is not appropriate to chart a decision that the child is a victim of abuse but rather to accurately describe injuries and comments that are made. Nurses should listen to what the patient has to say—whether the patient is a child or adult. PTS: 1 DIF: Cognitive Level: Application REF: p. 471 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Reportable cases MSC: NCLEX®: Safe and effective care environment—management of care

2. A nurse manager is teaching the purpose of the nurse's Code of Ethics to a group of high school students. Which statement by one of the students indicates that the teaching has been effective? The purpose of the nurse's Code of Ethics is a. "to assist in clarifying the individual nurse's personal values and goals." b. "to differentiate between moral and immoral acts." c. "to guide the behavior of the professional nurse." d. "to identify acts that are legal for the nurse to perform."

: C The American Nurses Association (ANA) Code of Ethics (2001) is a statement to society that outlines the values, concerns, and goals of the profession. It should be compatible with the values and goals of each nurse. It does not outline moral or immoral acts or make statements regarding legal aspects of nursing. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 428 OBJ: Discuss the moral implications of the ANA and ICN codes of ethics. TOP: Ethics MSC: NCLEX®: Not applicable

16. How does the Political Action Committee support candidates? a. "Buys" a candidate b. Lobby's elected officials c. Evaluates candidates on nursing and health concerns only d. Does not endorse candidates for public office

: C The Political Action Committee supports candidates by endorsing them for public office, providing them with financial supported need to win elections, and evaluating candidates on nursing and health concerns only. Political action committees do not "buy" candidates or lobby elected officials. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 386 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Election process MSC: NCLEX®: Not applicable

10. The case manager is educating the nurse about health care costs. The case manager knows that the education has been effective when the nurse states: a. "Health care costs are increasing because demand is decreasing." b. "Health care costs are steadily decreasing." c. "The aging population is requiring more health care services, causing the costs to increase." d. "The aging population is requiring less health care services, causing the costs to decrease."

: C The case manager would know that the teaching was effective if the nurse states: "Health care costs are continuing to increase because the aging population requires more health care services." The other statements are false regarding health care costs. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 357 OBJ: Define economics and health care economics. TOP: Intrinsic factors MSC: NCLEX®: Not applicable

19. What action must occur to prove a breach of duty? a. Liability testimony of physician b. Testimony from state board of nurses c. Expert testimony d. Testimony of coworkers

: C The duty of a nurse is to act as a reasonable nurse would under the same or similar circumstances. An expert witness may testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. Testimony from a physician, the state board of nursing, or coworkers does not establish a breach of duty. The state board of nursing provides the statues and laws that govern nursing practice. PTS: 1 DIF: Cognitive Level: Application REF: p. 455 OBJ: Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim. TOP: Breach of duty MSC: NCLEX®: Not applicable

7. What is the nurse's fiscal responsibility to the patient? a. To provide the best health care that the patient can afford b. To provide the best health care that the insurance company will allow c. To use the most cost-efficient resources to provide maximum health care to the patient d. To use the most efficient method of providing nursing care to patients whose resources are limited

: C The fiscal responsibility of nursing is to maximize the health benefits within the most cost-efficient combination of resources. In clinical practice, fiscal responsibility does not relate to insurance or how the patient is paying for service. The fiscal responsibility of nursing is to maximize the health benefits within the most cost-efficient combination of resources. Providing the best health care is about quality improvement. PTS: 1 DIF: Cognitive Level: Application REF: p. 368 OBJ: Describe what is meant by the term fiscal responsibility in clinical practice. TOP: Fiscal responsibility in clinical practice MSC: NCLEX®: Not applicable

2. In transcribing orders for a patient, the nurse finds a new order for aspirin, 500 mg, QID. The patient has a long history of gastrointestinal bleeding. What is the best nursing action? a. Give the medication. b. Withhold the medication and chart why it was not given. c. Call the physician and question the order in light of the patient's history. d. Ask if the patient is allergic to aspirin.

: C The nurse should call the physician and question the medication order for aspirin based on the patient's history of gastrointestinal (GI) bleeding. Claims involving medication errors are augmented when the nurse fails to recognize side effects or contraindications or fails to know a patient's allergies. The nurse would withhold the medication until the physician is notified and the order clarified. Giving the medication could cause the patient to start bleeding. Although asking for allergies is an important nursing action, the important aspect in this situation in the medical history of GI bleeding. PTS: 1 DIF: Cognitive Level: Application REF: p. 456 OBJ:Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim.TOP:Doctor's orders MSC:NCLEX®: Physiological integrity—pharmacological therapies

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

: C The nurse should immediately call the physician to report the patient's decision. The nurse should not administer the blood against the patient's wishes or try to talk the family into signing the consent. The nurse should continue all care for the patient except administration of the blood. PTS: 1 DIF: Cognitive Level: Application REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Moral/ethical principles MSC: NCLEX®: Safe and effective care environment

17. The nurse assesses the quality of patient care to be higher in the Total Patient Care model because: a. Patients are able to perform the majority of their own care. b. Nurses are required to perform less care. c. Nurses are able to focus all of their care on one patient. d. Nurses are hired to care for two patients.

: C The quality of care is higher in the Total Patient Care model because nurses are able to focus all of their care on one patient instead of juggling the care of two or more. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 341 OBJ:Trace the history of the use of nursing care delivery models. TOP: The effects of various patterns of nursing care delivery: a historical perspective MSC: NCLEX®: Safe and effective care environment

13. What action should the student nurse taken to begin networking? a. Begin networking shortly after starting a new job. b. Avoid networking and establish a career based on reputation. c. Begin networking upon graduation. d. Begin the networking process when a new position is needed.

: C The student nurse should begin the networking process upon graduation to assist with future educational and career undertakings. PTS: 1 DIF: Cognitive Level: Application REF: pp. 383-384 OBJ:Discuss different types of power and how each is obtained. TOP: Networking among colleagues MSC: NCLEX®: Not applicable

18. In a legal suit, what element is necessary to prove a tort has been committed? a. Intent c. Injury b. Assault d. Malpractice

: C There are four elements that need to be present in a malpractice case, one of which is patient injury. The patient will have to prove that the specific nursing action caused injury or harm. The nurse, as a defendant, does not have a "burden of proof." PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 472 OBJ: Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim. TOP: Malpractice, tort MSC: NCLEX®: Not applicable

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

: C To ensure care for the patient without violating the nurse's ethical principles, the nurse should find another nurse to care for the patient. Because the patient has rights, it would be inappropriate to try to talk the patient out of receiving the medication or to deny the patient's access to the medication. PTS: 1 DIF: Cognitive Level: Application REF: p. 421 OBJ:Discuss the role of the nurse in ethical health care issues. TOP:Controversial ethical issues affecting nursing MSC: NCLEX®: Safe and effective care environment

12. To provide quality care, the Affordable Care Act of 2010 a. reduced the number of patients accepted into Medicaid. b. kept the Medicaid system the same. c. made changes to slow growth in spending. d. increased Medicaid spending to ensure adequate patient care.

: C To provide quality care, the Affordable Care Act of 2010 made changes to slow growth in spending. Other changes were aimed at improving Medicaid benefits and improving delivery of care. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 359 OBJ: Define economics and health care economics. TOP: Intrinsic factors MSC: NCLEX®: Not applicable

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

: C Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Civil, as opposed to criminal, actions are also called torts. Remember that civil actions occur when a plaintiff files a lawsuit to receive compensation for damages he or she suffered as a result of a perceived wrong. Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Defamation (libel and slander) refers to causing damage to someone else's reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:TortsMSC:NCLEX®: Not applicable

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

: C When a nurse shares knowledge regarding nursing and nursing care, this is an example of expert power, which is the weakest in the power structure. The strongest power source is reward power as noted by tell staff nurses that once they are finished with their care plans, they may have some additional compensation time. Legitimate power is demonstrated by the nursing instructor sending a student to the skills lab for further practice. When student nurses discuss with the head nurse issues they are having on the unit and the head nurse discusses this with the chief nursing officer, this is considered an example of referent power. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 387 OBJ:Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable

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

: C When you become a registered nurse, you will have a license to practice nursing. This license sets certain standards, which you must follow as a nurse in the state. Should you not live up to these standards, your state can take away your ability to practice as a nurse. The best way to maintain those standards to practice professionally is to stay updated on skills and knowledge. Refusing to care for patients does not prevent you from being named in other malpractice suits. Carrying professional liability insurance does not prevent a malpractice suit but may provide assistance and monies in paying out claims. Although it is important to check with a supervisor about questions concerning nursing care, it may not prevent you from being named if you perform a procedure or intervention incorrectly. PTS: 1 DIF: Cognitive Level: Application REF: pp. 466-471 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Malpractice MSC: NCLEX®: Safe and effective care environment—management of care

3. Which action by hospitals in the 1940s began the journey to collective bargaining for nurses? (Select all that apply.) a. Allowed nurses to work 40-hour work weeks b. Compensated nurses for overtime c. Scheduled nurses to work 50- to 60-hour work weeks d. Subjected nurse to arbitrary schedules e. Did not offer sick or personal time

: C, D, E During the 1940s, nurses working in hospitals were subjected to arbitrary schedules, did not have sick or personal time, and were scheduled to work 50- to 60-hour work weeks. PTS: 1 DIF: Cognitive Level: Application REF: p. 399 OBJ:Identify the milestones in the history of collective bargaining. TOP: The evolution of collective bargaining in nursing MSC: NCLEX®: Not applicable

1. A nurse manager is speaking to a group of nurses about how to choose their representative if they wish to participate in traditional or nontraditional collective bargaining. The nurse manager knows the teaching has been effective if the nurses select which of the following as ways to choose their representative? (Select all that apply.) a. Service Employees International Union b. The National League for Nursing c. Their state nurses association d. The American Federation of Teachers e. National Nurses United (NNU) f. Center for American Nursing (CAN)

: C, E, F The professional association has the means and responsibility to represent nurses. The national professional organization for nursing is the American Nurses Association (ANA) with its constituent units, the state and territorial nursing associations. Nurses can enjoy the benefit of representation by nurses either through a traditional organized union, such as the National Nurses United (NNU), or through nontraditional interest-based bargaining, such as the Center for American Nurses (CAN). PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 400 OBJ: Identify steps nurses would take to initiate collective bargaining representation. TOP: Representation MSC: NCLEX®: Not applicable

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

: D A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. It is helpful for developing a department budget. It is not a formula for unit staffing and does not measure all the needs of the patients. PTS: 1 DIF: Cognitive Level: Application REF: p. 367 OBJ:Describe strategies to coordinate care and reduce costs. TOP: Coordination of care and cost control MSC: NCLEX®: Not applicable

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

: D A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. This system does not measure the needs of all patients, is not used an as absolute formula for unit staffing, and is not used to make patient assignments. Patient acuity is the measure of categorizing patients based on their nursing care requirements. Patient classification systems, particularly with increased computerization and the ability to access the system online, provide many benefits. Specifically, they can be used to improve patient care outcomes, identify appropriate staffing, track budget compliance and costs, and maintain nurse retention through their ability to impact staffing through assessment of patients' conditions. PTS: 1 DIF: Cognitive Level: Application REF: p. 348 OBJ:Describe strategies to coordinate care and reduce costs. TOP:Coordination of care and cost control MSC: NCLEX®: Safe and effective care environment—management of care

12. A nurse is educating themself on the ANA Code of Ethics. Which action by the nurse would be unethical, according to the ANA Code of Ethics? a. Joining unions or bargaining units b. Engaging in lobbying related to health care issues c. Reporting an incompetent or impaired colleague d. Refusing to care for a patient who is diagnosed as HIV positive

: D ANA Code 1: The nurse provides services with respect for human dignity and the uniqueness of the patient unrestricted by considerations of social or economic status, personal attributes, or the nature of the health problem. Nurses have the right to engage in collective bargaining and lobbying for health care issues. Nurses have a legal responsibility based on the Nurse Practice Act in their states to report an incompetent of impaired colleague. PTS: 1 DIF: Cognitive Level: Application REF: p. 428 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Safe and effective care environment—management of care

14. A nurse is educating a new nurse on grievance mechanisms. The nurse judges that the teaching has been effective when the new nurse states: a. "Nurses should attend any meeting where they believe discipline may be given without representation" b. "The nurse must ask a supervisor to file a grievance" c. "As a new nurse, I cannot file a grievance" d. "Any nurse can file a grievance"

: D Any nurse can file a grievance. The nurse does not have to ask permission from a supervisor. The nurse should be represented in any meeting where discipline may be given. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 408 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Resolution of grievances MSC: NCLEX®: Not applicable

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

: D Asking the patient (not the family unless the patient is a minor child) what he or she understands regarding the procedure is an effective way to validate informed consent. Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for the procedure to be done. The piece of paper is simply evidence that the informed consent process has been completed. Determining from the physician what was discussed does not guarantee that the patient understands what was explained. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Informed consent MSC: NCLEX®: Safe and effective care environment—management of care

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

: D Autonomy implies the freedom to have choices and make decisions about one's own care without interference. Just because this patient is slow does not mean he or she cannot make choices and participate in self-care. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Veracity is the duty to tell the truth. Fidelity involves keeping information confidential and maintaining privacy and trust. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Not applicable

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

: D Autonomy implies the freedom to make choices and decisions about one's own care without interference even if those decisions are not in agreement with those of the health care team. Veracity is the duty to tell the truth. Beneficence is the duty to actively do good for patients. Speaking out on behalf of the patient is an essential part of the advocacy role of the nurse. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Safe and effective care environment—management of care

2. Which statement regarding characteristics of clinical pathways shows the nurses understanding? a. "Clinical pathways focus on patient outcomes." b. "Clinical pathways use a timeline with sequenced interventions." c. "Clinical pathways collaborate efforts by health care professionals." d. "Clinical pathways involve nurse-centered orientation."

: D Clinical pathways help reduce expensive variations in care. Clinical pathways are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for patients with a particular diagnosis, procedure, or symptom. Clinical pathways are not a nurse-centered orientation. PTS: 1 DIF: Cognitive Level: Application REF: p. 322 OBJ:Discuss patterns of nursing care delivery systems. TOP:Patterns of nursing care delivery MSC: NCLEX®: Safe and effective care environment—management of care

11. A union nurse is educating a new nurse on common issues faced by nurses today. The union nurse knows that the teaching has been effective when the new nurse states: a. "There are no common issues; nurses faces different issues based on their job." b. "Today, there are no issues because of the advancement of technology." c. "Hospitals are fully staffed at all times." d. "Hospitals frequently mandated nurses due to staffing shortages."

: D Common issues today include staffing shortages that lead to mandating nurses to work overtime. Nursing shortages create issues that cannot be fixed by advances in technology and leave hospitals inadequately staffed. Although each nurse faces different issues based on the job, collectively nurses experienced many of the same issues in their day-to-day nursing activities. PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 401-403 OBJ: Identify conditions that may lead nurses to seek traditional or nontraditional collective bargaining. TOP: Common issues MSC: NCLEX®: Not applicable

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

: D Deontology is rule-bound and inflexible, obtaining moral authority from absolutes revealed by God. To preserve the sanctity of life, the nurse cannot participate in this situation. Advising the patient of providers to see is working from a teleological viewpoint because the end (patient death) might be seen as outweighing the means (helping the patient find a provider to provide a lethal prescription of drugs). Assessing the situation to see how the patient is affected (versus how some other patient would be affected) is situational. Determining financial status is not related to a specific philosophical outlook but might violate the principle of justice. PTS: 1 DIF: Cognitive Level: Application REF: p. 424 OBJ:Discuss the role of the nurse in ethical health care issues. TOP:Communication and Documentation MSC: NCLEX®: Safe and effective care environment—management of care

4. The nurse would identify which of the following as an example of a strategy that represents fiscally responsible clinical nursing practice? a. Begin discharge planning as soon as it is evident when a patient will be discharged. b. Encourage patients to consider being admitted the evening before a major surgical procedure. c. Use unlicensed personnel as much as possible in the delivery of nursing care. d. Accurately document the current status of a patient with regard to the patient's ongoing needs.

: D Documentation that accurately reflects the current status of the patient is critical to the institution obtaining reimbursement for the care of the patient. For example, if there are "no problems" with a patient, then perhaps the patient could be cared for in a less expensive environment. Use of unlicensed personnel is important but only to the extent of their training, and this is not a relevant factor in a great deal of nursing care. Discharge planning considerations should begin when the patient is admitted and not left until the patient is about to be discharged. It would be unnecessary and costly to have the patient admitted the evening before surgery because this would cost an extra day of hospitalization. PTS: 1 DIF: Cognitive Level: Application REF: p. 372 OBJ: Discuss strategies you will use to achieve fiscal responsibility in clinical practice. TOP: Fiscal responsibilities of nursing MSC: NCLEX®: Not applicable

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

: D Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity means to tell the truth. Autonomy involves the patient making an informed decision and implies the freedom to make choices and decisions about one's own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 422 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Not applicable

8. A nurse is giving a lecture on the primary problem that decreases the power of both types of collective bargaining models. The nurse knows that the teaching has been effective when a colleague states: a. "The small number of states that recognize either type of collective bargaining" b. "The political influences of the American Hospital Association on nursing organizations" c. "The adversarial goals of each of the respective organizations or models" d. "The lack of membership of the majority of practicing nurses"

: D Lack of membership of the majority of practicing nurses decreases the power of both types of collective bargaining models. Most people join an organization in response to a particular need. Almost 80% of nurses do not belong to any professional nursing organization. The traditional union based model is more adversarial than the nontraditional model. The American Hospital Association's political influence does not decrease or increase power in either model. The other options do not accurately show the primary problem that decreases the power of the collective bargaining models. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 409 OBJ: Compare traditional and nontraditional collective bargaining models. TOP:Nontraditional versus traditional collective bargaining units MSC: NCLEX®: Not applicable

13. Which definition, given by the nurse indicates understanding of malpractice? a. "Malpractice is a criminal act committed against society." b. "Malpractice means doing something a reasonable person or nurse would not do." c. "Malpractice is an intentional professional act of negligence." d. "Malpractice is a professional act or failure to act that leads to injury of a patient."

: D Malpractice may be defined as doing something outside your scope of practice or something that is unsafe for the patient and could cause injury. A criminal act committed against society may be a felony or a misdemeanor. Negligence is the failure to act as an ordinary prudent person when such failure results in harm to another. PTS: 1 DIF: Cognitive Level: Application REF: p. 454 OBJ:Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim.TOP:Malpractice MSC: NCLEX®: Safe and effective care environment—management of care

8. A nurse is interested in case management. Which statement indicates an understanding of the primary work environment of case manager? a. "They work most often in acute care institutions." b. "Their work is focused on community activities and is based within the community." c. "They typically work for insurance companies, providing coordination of care." d. "All types of health care organizations, as well as organizations with health-related functions, hire case managers."

: D Nurses who are case managers work in all types of health care institutions. They may also work for insurance or utilization review companies or in health-related areas of various types of large businesses. Registered nurses, social workers, and therapists may all be case managers, but how they perform their role depends on the scope of practice of their discipline. All case managers must be skilled at communication, critical thinking, negotiation, and collaboration. They must be knowledgeable about resources available to patients. The case manager not only deals with individual patients but also with family and other support systems of the patient; however, a case manager's work is not focused on just the community. PTS: 1 DIF: Cognitive Level: Application REF: p. 342 OBJ: Describe challenges facing health care that impact the delivery of nursing care. TOP: Case managers MSC: NCLEX®: Not applicable

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

: D States may regulate nursing practice by controlling the scope of practice and determining the specific activities for each level of nursing. In most states, the Nurse Practice Act provides definitions and scope of practice for each level of nursing practice. The power of the board to discipline can have an adverse effect on the nurse's ability to practice. Practicing beyond the scope of practice does not demonstrate what a good nurse the person is and does not provide enriched services. Other nurses would not be angry at increased expectations but at the foolishness of the nurse practicing beyond the scope of practice. PTS: 1 DIF: Cognitive Level: Application REF: p. 454 OBJ: Understand functions of a state board of nursing. TOP: Scope of practice MSC: NCLEX®: Safe and effective care environment—management of care

10. Which of the following best describes the concept of evidence-based practice? a. It is a method of improving nursing care and effectively maintaining cost containment. b. Insurance companies review the evidence of the health care practice for reimbursement. c. It achieves large-scale economics while providing cost-effective care. d. It provides for the use of recent research in current nursing practice.

: D The IOM reported that it took 17 years for research to be reflected into daily practice. Evidence-based practice is the use of the current best evidence to provide care and make decisions regarding patient care. Evidence-based practice is not a method of improving nursing care and maintaining costs containment. Insurance companies do not review the evidence of health care practice for reimbursement. Evidence-based practice does not achieve large-scale economics while providing cost-effective care. PTS: 1 DIF: Cognitive Level: Application REF: p. 333 OBJ: Describe evidence-based care. TOP: Evidence-based practice MSC: NCLEX®: Not applicable

14. A case manager is educating a patient on health care insurance. Which statement by the patient shows that the teaching has been effective? a. "All health care is covered by insurance." b. "Insurance does not cover inpatient hospital stays." c. "All health care coverage is the same." d. All health insurance companies have rules about what services will be covered."

: D The case manager will know that teaching has been effective when the patients states: "All health insurance companies have rules about what services will be covered." Each insurance company is different and will provide different coverage depending on the plan and the patient's preexisting conditions. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 357 OBJ: Use basic knowledge of health care economics to analyze trends in the health care delivery system. TOP: Payer allocation decisions MSC: NCLEX®: Not applicable

1. How does managed care affect the economics of health care delivery? a. Provides incentives for smaller private or individual hospitals b. Increases the tax bases for the community c. Uses corporate economics to achieve a profit d. Decreases duplicate processes and redundant facilities

: D The corporatization of health care amalgamates the smaller health care operations into the larger organizations to decrease duplicate and redundant health care provisions. For example, one hospital would provide a high level of cardiac care, and another hospital would focus on oncology. Managed care does not increase community tax base because the costs are paid by the patients and their insurance. Managed care is more of an incentive for larger hospitals and corporations. The focus is to reduce duplication of services, not to use corporate economics to achieve a profit. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 328 OBJ: Differentiate between a centralized and a decentralized organizational structure. TOP: Organizational structure MSC: NCLEX®: Not applicable

18. Which statement by the nurse is accurate regarding the current health care American's receive? a. "The distribution of services is efficient across the population." b. "The distribution of care is even across the population." c. "Access to care related to income is improving." d. "Many Americans receive care that causes harm."

: D The nurse with an adequate understanding of current health care would state that many Americans receive care that causes harm. The distribution of services is inefficient and uneven across the population, and access to care related to income is worsening. PTS: 1 DIF: Cognitive Level: Application REF: p. 358 OBJ:Define economics and health care economics. TOP: Economics of the health care delivery system MSC: NCLEX®: Not applicable MULTIPLE RESPONSE

14. Which of the following statements about evidence-based practice shows that the nurse has an adequate understanding? a. "Evidence-based practice is the hospital's protocol for providing care." b. "Evidence-based practice is based on community need." c. "Evidence-based practice is a set of guidelines determined by each hospital unit." d. "Evidence-based practice is the use of current best evidence in making decisions about patient care."

: D The statement "Evidence-based practice is the use of current best evidence in making decision about patient care" shows that the nurse has an adequate understanding. The other statements about evidence-based practice are false. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 330 OBJ: Describe challenges facing health care that impact the delivery of nursing care, including evidence-based care. TOP: Evidence-based practice MSC: NCLEX®: Safe and effective care environment

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

: D The study of genetics and genomes has increased the ability of health care professionals to assist patients in improving health outcomes. Nurses involved in this area of health care educate patients; provide support and treatments based in the most current research. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 440 OBJ:Recognize the role of genetics and genomics in nursing practice. TOP: Moral/ethical principles MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE

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

: D There are almost 110,000 Americans on the transplantation list, and the majority of them will die without a transplant because of the shortage of available organs. PTS: 1 DIF: Cognitive Level: Application REF: p. 438 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Moral/ethical principles MSC: NCLEX®: Safe and effective care environment

13. Which action by the case manager would be required under the full immersion model? a. The case manager would see only the patients with the most extensive health care needs. b. The case manager would see all patients that come into the hospital. c. The case manager would only see the patients with health insurance. d. The case manager would conduct a daily chart review of patients he or she is assigned to.

: D Under the full immersion model, the case manager would be required to conduct a daily chart review on all patients he or she is assigned to. The nurse would then meet with the health care providers and nurses caring for these patients to discuss their care. The purpose of this model is to enhance communication and decrease cost of care by shortening hospital stays. PTS: 1 DIF: Cognitive Level: Application REF: p. 330 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost.TOP:Case management MSC: NCLEX®: Safe and effective care environment

3. Which provision—if labor management included it in a contract—would not be to nursing's advantage? a. A workforce retraining provision b. Seniority rights c. A grievance procedure d. Wage adjustments based on bed occupancy

: D Unions may stimulate better hospital management by fostering formal, central, and consistent personnel policies with better lines of communication. Consistent personnel policies include a consistent wage base, regardless of bed occupancy. Workforce retraining, seniority rights, and a grievance procedure would be important provisions in a labor contract that would be advantageous to nursing. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 407 OBJ: Identify the conditions that may cause nurses to seek collective bargaining representation. TOP: Contracts MSC: NCLEX®: Not applicable

4. Which ethical principle is applied when the nurse acts to safeguard the patient and the public by reporting poor nursing practice? a. Autonomy c. Justice b. Fidelity d. Veracity

: D Veracity—the duty to tell the truth—is represented in this situation. Autonomy is the right of the patient to make an informed decision. Fidelity means to act in a way that is loyal, such as keeping information private and confidential. Justice requires the nurse to treat all patients fairly without regard to age, socioeconomic status, or other variables. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 423 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Safe and effective care environment—management of care

Identify the type of power base associated with each of the following. a. Joining a coalition to lobby for a national health insurance plan b. Organizing nurses to work for the opponent in the next election c. The dean of the school discussing the educational program d. Testifying before a committee on a bill e. A political action committee's endorsement or financial contribution 1. Reward 2. Coercive (punishment) 3. Expert (informational) 4. Legitimate 5. Referent (mentor)

:E:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable 2.B:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable 3.D:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable 4.C:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable 5.A:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained. TOP: Power MSC: NCLEX®: Not applicable