Management EXAM 5 Cherry & Jacob

A nurse who is interested in graduate school wants to learn about recently passed legislation regarding changes in Medicare reimbursement for care provided by clinical nurse specialists. The best source for information on changes in federal programs is the ________________.

ANS: Federal Register The Federal Register is the best source of information about proposed rules and regulations for newly enacted legislation and about changes to existing rules for federal programs

The occupational health and safety nurse would like to develop programs designed to decrease mortality and morbidity among the workforce. When considering factors related to mortality among health care workers, the nurse should focus efforts on prevention of: a. suicide. b. violence related injury. c. bloodborne disease. d. ergonomic hazards.

ANS: B A summary of research by the National Institute for Occupational Safety and Health (2014) found that health care workers have almost five times the risk of experiencing a violence-related workplace injury requiring time off from work than individuals in the overall workforce. DIF: Application REF: p. 249

With the crisis in health care and the nursing shortage, why is the image of nursing still important? a. Nursing care is often delivered during a time of uncertainty, and the image of nurses during this time can reinforce trust in the nurse-patient relationship. b. Physicians have a distinctive body of knowledge that identifies them as professionals, whereas nursing has yet to develop a unique body of knowledge on which to base practice. c. Nurses must present a unified image if they hope to ever establish nursing as a profession. d. The dynamic state of today's health care requires nurses to move from a caring image to one of technologic competence.

ANS: A A person who seeks health care is entering a world of uncertainty. The nurse provides continuity and compassion and stabilizes the environment of the patient.

An RN with a diploma preparation wants to participate in decisions about health care and decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering self-scheduling and a self-paced curriculum. This nurse is taking advantage of: a. educational mobility. b. a traditional nursing program. c. training for advanced practice nursing. d. credit by examination.

ANS: A Education mobility is the progressive movement from one level or type of education to another—in this instance, diploma to BSN. Programs are aimed to make the transition possible through creative flexible scheduling. DIF: Application REF: p. 56

When focusing on addressing issues identified by the 2000 Institute of Medicine report, the nursing faculty will access information associated with which initiative? a. Quality and Safety in Nursing Education b. Competency Outcomes and Performance Model (COPA) c. The National Organization of Nurse Practitioner Faculties (NONPF) d. Academic Center for Evidence-Based Practice (ACE)

ANS: A In response to the Institute of Medicine report (IOM, 2000), The Robert Wood Johnson Foundation funded a national initiative, Quality and Safety in Nursing Education (QSEN), to help nursing programs reorganize curricula to focus on patient safety and quality care.

A group of nurses meet with a state representative to explain the importance of allowing registered nurses the right to sign death certificates for patients who were under their care. As constituents and nurses, they requested that the senator vote against the bill restricting this practice. These nurses are serving as: a. lobbyists. b. policymakers. c. officials with regulatory power. d. advocates for the Patient Safety and Quality Improvement Act.

ANS: A Lobbyists hope to educate and convince policymakers to respond positively to a particular position on an issue or to follow a particular course of legislative or regulatory action.

Which nurse best portrays nursing as a "knowledge worker"? a. Nurse in matched scrubs with lab coat, hair back, small stud earrings b. Nurse in mismatched scrubs, no lab coat, large hoop earrings c. Nurse in white uniform with apron with no jewelry/hair back d. Nurse with nose ring and eyebrow piercing with starched white uniform and cap

ANS: A Nursing scrubs have become a popular alternative to the traditional white uniform; clean wrinkle-free matching scrubs presented a professional image. Small stud earrings reduce risk of injury to nurse when caring for confused or combative patients.

.A new trend in nursing education that is consistent with real-world practice is focused on: a. outcomes. b. objectives. c. goals. d. subjective appraisals

ANS: A Outcomes and criteria establish real expectations for clinical practice and have a powerful influence on nursing education and practice at all levels. Outcomes are used in all areas of nursing in the nursing process. DIF: Knowledge REF: p. 43

A student nurse is preparing a presentation that requires identification of outcomes for the care of heart failure patients. Which is a correctly written outcome? a. Develop a teaching program to address physical activities that result in improved cardiac function. b. Discuss the clinical manifestations associated with Level 4 heart failure. c. List the most common pharmaceutical approaches to reduce preload in heart failure patients. d. Recognize the economic impact that recidivism has on the patient and health care facility.

ANS: A Outcomes use action words, actions that nurses actually do, such as develop, plan, implement, integrate, plan, or conduct.

Time is becoming crucial for the nurse to address issues related to sponsoring programs to include hearing aid costs as part of Medicare coverage. The nurse involved in grassroots political actions realizes that the least timely method of reaching elected officials would be via: a. letter. b. telephone. c. e-mail. d. facsimile (fax).

ANS: A Sending letters is the least timely mode by which to communicate with elected officials; because of the anthrax decontamination process that is now in place, delivery of U.S. mail to Congress and to the White House may be delayed by as long as 3 months, making letters an inefficient means of communicating with policymakers.

Although the use of technology and the Internet provides nursing faculty and students with unlimited resources and current information, an outcome associated with this trend is that: a. users of electronic resources spend a disproportionate amount of time looking for pertinent content. b. additional time is available to study and revise curricula because special skills are not needed to access information via the Internet. c. immediate results and outcomes are expected from students and faculty, thus enhancing time management. d. skills that require problem solving and reflective abilities are developed.

ANS: A Students can easily become distracted by pursuit of the intriguing web of links they encounter while they search websites to complete assignments or find pertinent content. DIF: Analysis REF: pp. 41-43

If a nurse practicing in a mental health agency could only belong to one professional organization, what criteria could be used to select the organization with the biggest impact? a. The American Nurses Association has a strong voice representing the nation's entire RN population. b. Specialty organizations such as the American Psychiatric Nurses Association lobby for higher education requirements for nurses. c. State nursing associations have limited power because they can lobby only state representatives. d. Professional organizations such as The American Association for the History of Nursing (AAHN) record the history of mental health nursing.

ANS: A The American Nurses Association is the voice for all registered nurses.

A nurse is concerned about older persons living alone at home without telephone service to contact emergency services. The nurse is advised to take part in grassroots efforts to address the situation. The nurse would: (select all that apply) a. post signs to support the county's political candidates whose platform support services for poor and underserved person such as older adults. b. visit with local politicians running for office and ask specific questions such as, "Would you support providing free emergency telephone service for older adults living alone?" c. limit voting to only presidential elections in which a candidate promises to initiate health care reform related to Medicare for older adults. d. join the American Nurses Association and constituent member association. e. contact representatives from surrounding states to garner support for free medical alert systems for older adults.

ANS: A, B, D Working in local political campaigns is an effective grassroots effort. Visiting, e-mailing, calling, and faxing local politicians to support free emergency telephone service for older adults is a grassroots tactic. Joining ANA and state nursing associations supports these organizations' lobbying efforts and is thus a way for individual nurses to influence the issues that nursing associations support.

. Managers at an acute care facility value the contributions of their aging nursing workforce and make recommendations to accommodate for an aging nursing workforce. They institute for which changes? (select all that apply) a. Supplies such as dressing change and Foley catheter kits are placed on the nursing unit. b. Teamwork and development of new roles such as admission nurse are encouraged. c. Daycare centers for sick children are put into place to prevent the stress of having to find alternative daycare. d. Assistive devices for lifting as recommended by ANA's Handle with Care are made available. e. A work-design consultant is hired to redesign the nursing unit to reduce wasted motion.

ANS: A, B, D, E Placing supplies in a decentralized area prevents the fatigue that would be caused by the need to retrieve items from a distant location. Nurses are integral to quality and their contributions should be noticed. Ill-designed units contribute to fatigue and inability of aging nurses to perform efficiently. Mentoring is one way to acknowledge skills of the aging workforce.

A nurse is concerned that the policy of using povidone-iodine (Betadine) to clean foot ulcers may lead to unwarranted allergic reactions and drying of surrounding tissue. A literature review is performed to determine the "best practice" related to care of foot ulcers. This nurse: (select all that apply) a. is applying evidence-based practice to the clinical setting. b. is using critical thinking to change procedures performed in the care of foot ulcers. c. is minimally educated at the master's level and participating in research to provide cost-effective care (soap is less expensive than povidone-iodine). d. lacks clinical competence in health assessment and in application of theory to the clinical setting. e. is using information to problem-solve and ensure safe, competent care.

ANS: A, B, E Critical thinking is an essential part of applying evidence-based practice—that is using research findings to guide actual practice.

The Nurses of America's media campaign raised awareness of which aspects of nursing? (select all that apply) a. Nurses are expert clinicians. b. A higher nurse/patient ratio is needed. c. Nurses are invisible in the news media. d. Nurses are caring. e. Nurses are well paid

ANS: A, C The campaign was designed to convey to the public that nurses are expert clinicians. A strategically important part of the campaign raised consciousness among nurses of the invisibility of nursing in the news media. DIF: Comprehension REF: p. 28

A group of new graduate nurses is asked to speak to a group of politicians to describe the current state of professional nursing and how best to alleviate the nursing shortage. Which statements accurately portray professional nursing today and tomorrow? (select all that apply) a. More RNs attain a bachelor's degree than an associate degree or diploma. b. Because of pressure to shorten length of stay in hospitals, more RNs practice in outpatient settings and home health than in acute care settings. c. The most popular advanced practice specialty is nurse anesthesia. d. White nurses are more likely to enter graduate school than nurses from other ethnic groups. e. Nursing represents the largest health care professional group, followed by medical doctors.

ANS: A, E Recipients of BSN degrees represent the largest graduating educational profile (47.2%). Nurses make up the largest group of health care professionals.

Political action committees (PACs) are established for the purpose of: a. financially supporting candidates. b. persuading policymakers to support certain policies. c. lobbying legislators. d. recommending health care policy.

ANS: B A PAC is an arm of an organization, association, or labor union that is formed to persuade a policymaker to support a certain policy or program or, more often, to ensure the election or reelection of policymakers who support the organization's goals.

A concerned nursing student calls the office of an elected official to voice support for the bill to ban smoking in all public places. The secretary asks, "Are you a constituent?" What does the term constituent mean? a. A member of a professional organization who supports the organization's political issue b. A citizen who is registered and is eligible to vote for a representative c. An elected official who proposes legislation to be considered as a potential law d. A member of the House of Representatives who is seeking support for a particular bill

ANS: B A constituent is a citizen who has the opportunity to vote for candidates in elections for representation at local, state, and federal government levels.

Hospitals surveyed nurses who terminated their employment to determine why they chose to leave. One of the most common reasons for leaving was: a. decreased pay for alternative shifts. b. that the nurse/patient ratio prevents safe care. c. that most facilities are choosing an all-RN staff, which decreases opportunities for advancement. d. that agency and foreign nurses are favored by administration over full-time nursing staff.

ANS: B A number of studies in the late 1990s focused on the work environment as a significant contributor to the difficulties involved in recruiting and retaining RNs. One of the primary factors for the increasing nurse turnover rate was identified as workload and staffing patterns. A more recent study by Aiken (2002) reported higher rates of patient complications and increased death rates when fewer nurses are assigned per patient. DIF: Comprehension REF: p. 242

A nurse executive is concerned that the mortality rate in his or her hospital exceeds the national average and searches the literature finding Aiken's 2011 Survey on the effects of nurse staffing and education on mortality, including work environment. If Aiken's recommendations are followed, which change would be most effective? a. Increasing staffing ratios to include more nurses of all levels of educational preparation on all shifts b. Employing bachelor's prepared nurses who participate in interprofessional rounds with attending physicians where their voices are heard c. Ensuring nurse managers and administrators have at minimum a master's degree d. Encouraging all unlicensed assistive personnel to attend educational programs to be certified

ANS: B Aiken (2011) found that simply increasing the number of RNs was not the only answer to reduce mortality. Increasing the number of BSN-prepared nurses along with developing a positive work environment had the most impact on reducing mortality. The impact on reducing mortality by increasing the educational level of nurse managers/administrators and certified unlicensed assistive personnel was not documented.

Studies conducted to determine enrollment trends in nursing schools have found that in the last years: a. a greater number of individuals chose nursing as a career but could not meet entrance requirements. b. more young people chose to enter the profession of nursing. c. fewer career opportunities exist in the profession of nursing and fewer opportunities are projected to exist for women. d. men have dominated the profession, and women feel that they have experienced discrimination.

ANS: B An unexpected number of young people entered the nursing workforce from 2002 to 2009, causing faster growth in the supply than anticipated.

A nursing student scores 95% on the written examination for the adult health course. To be successful in this course, this same student must then perform an indwelling catheter insertion and wound care in a simulated environment meeting core competencies. The student asks, "What are core competencies?" The nursing instructor replies, "Core competencies are: a. a trend used in nursing education to reduce attrition in prelicensure students." b. those skills necessary for safe, competent nursing practice." c. educational opportunities that provide remediation when student is unable to perform psychomotor skills correctly." d. critical thinking exercises aimed to improve reading and math skills."

ANS: B Core competencies are those skills and elements that are fundamental and essential for safe, competent practice. DIF: Comprehension REF: pp. 39-40

When preparing to complete a competency examination involving a neurologic assessment in a simulation laboratory, the nurse reviews the critical elements, which consist of: a. those steps that result in life or death of a client. b. required criteria that must be incorporated into the assessment for the desired outcome. c. fundamental strategies unique to complex dynamic care environments. d. objective data that can be used to determine the likelihood that the client will recover.

ANS: B Critical elements include the application of mandatory principles that must be used according to established practice standards.

Members of a state's constituent member association meet at a local restaurant to plan a Nurse Walk to support the local food bank. When entering the restaurant, the nurses note the environmental inspection report shows deficiencies because food handlers were not wearing hairnets and rodents were spotted, resulting in a score of 60 out of 100. This certificate of inspection is health policy enforced at which level of government? a. Local b. State c. Federal d. International

ANS: B Health policy at the state level is responsible for ensuring food safety in restaurants.

The first university to offer nursing graduates a baccalaureate degree was: a. Columbia Teachers College. b. Yale University. c. Harvard University. d. the New York Regents Program.

ANS: B In 1924, Yale University offered the first separate Department of Nursing, whose graduates earned a baccalaureate degree. DIF: Knowledge REF: p. 53

A nurse realizes that a health care concern related to globalization was: a. the emergence of epidemic hepatitis A. b. the pandemic of H1N1 "swine flu." c. reemergence of polio. d. an increase in chronic illnesses.

ANS: B In 2009, there was a pandemic of H1N1 on every continent and a reemergence of Staphylococcus aureus (MRSA).

A person interested in employment in the health care sector has less than 1 year to pursue his or her education and wants to focus on functional aspects of patient care. He/she desires to work in a long-term facility. Which type of nursing program should this person request information about? a. Bachelor's degree in nursing (BSN) b. Licensed practical nurse (LPN) c. Associate degree in nursing d. Master's degree in nursing

ANS: B LPN programs provide basic technical bedside care and employment opportunities at hospitals, nursing homes, home care, and doctor offices.

1When reading about nursing as a career, a student is interested in learning about violence in the profession. Which statement accurately reflects violence in health care and the profession of nursing? a. Nursing is the most trusted profession and therefore violence is rare. b. All nurses should be advocates for violence prevention programs. c. Physical violence between peers constitutes lateral violence; however, verbal assault is not recognized as violence. d. Professional organizations have recognized a need to evaluate all nurses for the risk of committing acts of violence.

ANS: B Nurses in all settings must proactively advocate for interventions that ensure personal safety and a safe work environment.

What effect did the movie One Flew Over the Cuckoo's Nest have on health care? a. Funding for mental health care increased, allowing the point of care to change from the community to standardized institutional care. b. The public and the nursing profession were made aware of the rights of vulnerable populations. c. Nurses were seen as advocates for individuals who cannot advocate for themselves. d. Funding for nursing traineeships was eliminated.

ANS: B One Flew Over the Cuckoo's Nest reminded us that all individuals have rights and that it is the responsibility of the public and health care professionals to ensure that these rights are protected. DIF: Comprehension REF: p. 26

Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by 2020? a. Positions that historically required registered nurses will be filled by unlicensed personnel. b. The job growth rate for RNs will surpass job growth in all other occupations. c. The need for hospital nurses will dramatically decrease. d. Hospitals will finally achieve the required RN workforce.

ANS: B With an employment rate expected to increase by more than 19%, job production for nurses is projected to grow faster than the average of all occupations (11%) until 2020. DIF: Knowledge REF: pp. 23-24

What is the best way for the individual nurse to maintain the most effective professional image? a. Change out of their work attire before running errands. b. Renew membership in a nursing organization. c. Earning an advanced nursing degree. d. Developing effective nurse-physician relationships.

ANS: B Professional nurses recognize that their greatest benefit—and one of the most efficient and powerful uses for their money—is less than 1% of their salary they spend for membership in the ANA, the National League for Nursing, Sigma Theta Tau International, and their specialty organization. They look forward to annual meetings because such meetings provide an excellent opportunity to meet colleagues and discuss issues and practice innovations. DIF: Application REF: pp. 33-34

Charles Dickens' character Sairy Gamp: a. portrayed nurses as trained professional individuals who put others before themselves. b. chose nursing because she had no other avenue for employment. c. was a prostitute who took advantage of sick old men. d. characterized nurses as being at the forefront of technology and autonomy.

ANS: B Sairy Gamp endured nursing because of the lack of other opportunities.

A bill is pending in the state legislature that will mandate teaching health promotion related to smoking cessation. Which action by the nurse should have the greatest impact on passage of the bill? a. Explain the rationale for the bill to the school board. b. Contact the elected representative's office by telephone to request support for the bill. c. Support a health advocate to run for election as state representative. d. Tell all students about the bill.

ANS: B Telephone calls are an effective means of communicating your support for a bill, next to a face-to-face meeting; ask to speak to the staff person assigned to the bill or issue for which the call is being made. After introducing yourself, give a brief and simple message such as, "Please tell Senator/Representative [name] that I support [bill number]."

Throughout the history of health care in our nation, one particular piece of federal legislation provided funds for hospital construction. As the number of hospitals rapidly increased, the need for nurses to staff hospitals also increased, and the shift from community-based nursing care to hospital-based nursing care began. This fundamental piece of legislation was the: a. Sheppard-Towner Act. b. Hill-Burton Act. c. Veterans Bill. d. Access to Health Care Bill.

ANS: B The Hill-Burton Act, also known as the Hospital Survey and Construction Act, was enacted in 1950. This act provided funding that resulted in a boom in the construction of hospitals across the country. As the number of hospitals increased rapidly, so did the need for nurses to staff the hospitals. Thus the nurse's role was shifted from community and public health settings to the acute care setting.

The Institute of Medicine report (2011): a. recommended that only physicians have the legal privilege to prescribe medications. b. called for increasing the number of baccalaureate-prepared nurses in the workforce to 80% by 2020. c. called for a minimum staffing ratio be in place in no later than 10 years. d. called for nurse technicians to provide care during the nursing shortage.

ANS: B The IOM report (2011) addresses the evolving complexities of the current health care system and a need for 80% of the nursing workforce to be baccalaureate prepared by 2020. DIF: Comprehension REF: p. 241

The practice of nurses, nursing students, and faculty is affected by demographic changes due to: a. the growing percentage of adults ages 50 to 55 years. b. increasing numbers of obese children and adults. c. changes by which families are becoming more nuclear. d. social programs that are essentially eliminating poverty.

ANS: B The United States is experiencing an epidemic of obesity with major consequences for health and the health care system. DIF: Knowledge REF: p. 46

When the policy process is compared with the nursing process, identifying the issue is consistent with which step of the nursing process? a. Assessment b. Diagnosis c. Planning d. Implementation

ANS: B The diagnosis step in the nursing process is consistent with identification of the targeted issue in the political process. As politically active nurses soon discover, effective involvement in policy development and political activities requires efforts similar to those used in the nursing process. The policy process and the nursing process are systematic approaches that use the nursing process for decision making. DIF: Application REF: p. 405

The number of reported medical errors demonstrates a need for what priority intervention? a. Simulation experiences b. Performance competency exercises c. Comprehensive instructor-constructed examinations d. Detailed care planning exercises

ANS: B The increase in reported medical-related errors vividly emphasizes the need for more effective validation of performance competence in schools and the workplace.

It is important for nurses to know the functions of the branches of the federal government. At a local meeting of the state nurses' association, an officer reminds members that the branch that is capable of originating major policy initiatives is the _____ branch. a. executive b. legislative c. judicial d. administrative

ANS: B The legislative branch possesses the sole federal power to enact legislation; the legislative branch originates and promotes major policy initiatives and has the power to override a presidential veto. DIF: Comprehension REF: p. 403, Table 23-2

A nurse is concerned because novice nurses are having their orientation period shortened and are being placed in charge nurse positions. The nurse has documented unsafe care and decisions by these novice nurses. To be protected from retaliation by the employer, this nurse must "blow the whistle" by: a. holding a public forum in the agency cafeteria to discuss concerns. b. reporting concerns to state and/or national agencies regulating the agency. c. calling coworkers outside the workplace to informally discuss wrongdoing. d. contacting The Joint Commission to report unsafe conditions.

ANS: B The whistle-blower is not protected until concerns are reported to the state or national regulatory agency. DIF: Comprehension REF: p. 247

A nurse would like to obtain background information and learn the political platform of a candidate who is running for national office. The nurse should contact the: a. National Registry for Candidates. b. American Nurses Association Nurses Strategic Action Team (N-STAT). c. National League of Nurses. d. National Council of State Boards of Nursing.

ANS: B Through legislative updates, N-STAT keeps members up-to-date about background information and the platforms of candidates who are running for national office; N-STAT also provides updates about key bills as they move through the legislative process.

A nurse is interviewing for a job and recently read the American Nurses Association's (ANA) recommendation for questions to ask regarding before accepting employment. Which questions should the nurse ask? a. Do you have flexible scheduling? b. What are the expectations for advancement? c. How long do staff nurses stay before resigning? d. What is the mission of the parent organization? e. Does the organization have a means for staff nurses to have an active role in decision making by participation and accountability for the outcomes of practice decisions?

ANS: B, C, E According to the ANA recommendations, applicants for nursing positions should ask about the opportunities for advancement exist in the organization. According to the ANA recommendations, applicants for nursing positions should ask about the organization's turnover rate and average longevity of staff nurses. According to the ANA recommendations, applicants for nursing positions should ask about whether the organization has a shared governance model. DIF: Comprehension REF: p. 244, Box 13-3

Which actions would result in a greater number of nurses entering and staying in practice, given today's state of nursing? (select all that apply) a. Determine why few black women enter graduate school. b. Provide incentives for minorities and men to enter nursing. c. Obtain grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs. d. Survey nurses to determine why their job satisfaction in lower than that of other health care professions. E. Develop ad campaigns that target younger students.

ANS: B, C, E Core solutions to the nursing shortage include providing incentives for minorities and men to enter nursing. Core solutions to the nursing shortage include obtaining grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs. Core solutions to the nursing shortage include developing ad campaigns that target younger students.

1. According to current data related to the nursing shortage: (select all that apply) a. salaries of nurses are competitive with those of other professionals such as teachers. b. only 19% of nurses are minorities. c. overall, nurses are satisfied with their jobs but leave the profession because of fear of contracting fatal diseases. d. the employment opportunities for nurses continue to be strong. e. staff nurses are returning to school to obtain certificates to teach nursing.

ANS: B, D Only 19% of nurses are minorities. RNs have one of the highest growth rates of employment of all occupations. DIF: Knowledge REF: pp. 23-24 |p. 29

A nurse is interested in learning more about health policy and how it might impact nursing practice. She is especially interested in The Patient Protection and Affordable Care Act (PPACA) and how it will travel through the three branches of the federal government. She researches the roles of the legislative branch of the federal government and learns that this branch: (select all that apply) a. determines which laws are constitutional, such as recently deciding the PPACA is constitutional because it is a form of taxation. b. has the exclusive power to determine where federal dollars will be spent, such as supporting the PPACA. c. consists of the Office of the President and 15 executive departments that supported the PPACA. d. has the power to veto laws found constitutional by the Supreme court and therefore could veto the PPACA. e. can override a Presidential veto, making it possible to amend the PPACA even without approval of the President.

ANS: B, E The legislative branch possesses the sole power to enact legislation, tax citizens, and allocate federal spending. The legislature can override a presidential vote.

Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever during the Spanish-American War? a. Florence Nightingale b. Margaret Hoolihan c. Clara Maas d. Sairy Gamp

ANS: C Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever. DIF: Knowledge REF: p. 26

A nursing student asks, "I wonder if the reason that the nursing shortage is so severe is that registered nurses are unhappy with their jobs." To research the answer, the National Survey of Registered Nurses was reviewed and found: a. registered nurses change employers every year to prevent burnout and to keep the nursing shortage from increasing. b. nursing faculty are aging or leaving academia due to increased work demands and generational difference from students. c. practicing registered nurses are satisfied with their job and most remain with same employer they worked for the previous year. d. registered nurses were the least satisfied with their job of all health care providers.

ANS: C According to the latest National Sample Survey of Registered Nurses (NSSR), 79.8% of practicing RNs were satisfied with their job and 88.4% were with the same employer as they had been in the preceding year (U.S. Department of Health and Human Services, 2010). Among all RNs, nursing faculty are the most satisfied (86.6%).

Which nursing model is referred to as the "class without walls"? a. Articulation b. Career ladder (2 + 2) c. External degree d. Second degree

ANS: C An external degree does not require attendance and provides no course classes; it enrolls thousands and is accessible regardless of geographic location.

A registered nurse is on break and checking e-mails. One e-mail contains a picture of a celebrity who is a patient in the hospital, and on the same floor, where the nurse works. Included with the photo is a message, "check out my Facebook," which contains additional photographs of the patient. The nurse immediately deletes the picture to prevent having to report the "friend" to supervisors. Based on the action of the nurse who received the message, which statement is correct? a. The nurse is not at risk for having his or her license suspended since removing the photos made them temporary and invisible to all others. b. Because the nurse did not send the message and immediately deleted the photo, there is no risk for discipline. c. Failing to report receiving the message demonstrates poor ethical and legal role-modeling as well as placing the nurse at risk for discipline. d. Because the patient is on the same floor as the one on which the nurse works, the information can be ethically and legally shared.

ANS: C Failing to report the image can result in discipline.

One of the major trends that currently influences nursing education and practice is: a. increased technology in the field of critical care. b. a narrowing scope of practice for nurses. c. incivility or disregard of others' rights in social interactions. d. a decrease in ethnicity due to international programs allowing students to study from a distance.

ANS: C Incivility has escalated and can be demonstrated by the common practice of text-messaging during class and an increase in academic dishonesty. DIF: Comprehension REF: pp. 46-47

A physician complains to administration that the nurse working last evening is unethical, based on observing the nurse educate the patient about a new medication ordered. The physician demanded the nurse be reprimanded and reminded that only physicians have the educational background to teach patients about new medications. Which comment and action by the administrator would be most effective in changing nurse-physician relationships in this instance? a. Inform the nurse, "You will be suspended for 3 days for going beyond your job description," and enforce the 3-day suspension because the physician did not write the order to "teach the patient about the new medication" b. Advise the physician that only nurses can teach patients about medications; the physician's role is to only prescribe. No action will be taken against the nurse. c. After investigating the situation, thank the physician while also providing information that patient education related to medication is within the scope of practice of registered nurses. Share the physician's concern and administrator's response with the nurse so both parties are aware of the resolution of the concerns. d. Contact the patient's family and ask, "Do you prefer that all teaching related to medications be performed by the physician rather than the nurse" to determine what action to take.

ANS: C Investigating the situation to provide evidence is the first step. Once the facts are known, action can be taken. In this instance, including the ethics committee would help ensure an unbiased decision. DIF: Application REF: pp. 31-32

A new graduate nurse is applying for the exciting first position and states, "I am only applying to Magnet hospitals because those work environments: a. attract physicians who are the best health care providers to improve quality of care." b. require all registered nurses to be certified in the area of practice." c. not only attract but also retain professional nurses." d. discourage nurses from advancing their current level of education and I don't want to return to school for many years."

ANS: C Magnet hospitals have been identified as both attracting and retaining professional nurses. Magnet hospital nurses have higher levels of autonomy, greater control over the practice setting, and better relationships with physicians.

.In the near future, the largest segment of the population will be those over age 65 years. To advocate for this vulnerable population, a nurse was a strong supporter for the Medicare Modernization Act (Medicare Part D), which: a. provided vision care benefits to elderly persons who were diagnosed as legally blind. b. removed limits to access to mental health/substance abuse services which are the most commonly used service in this population. c. provided coverage for medications for Medicare enrollees that constituted a huge expense for the elderly. d. expanded the practice opportunities for advanced practice registered nurses (APRN) who provide the majority of care for this population.

ANS: C The Medicare Modernization Act provided medication benefits to Medicare recipients and encouraged policymakers to have oversight to ensure drug effectiveness.

The NCLEX® examination is created and administered by the: a. American Association of Colleges of Nursing (AACN). b. American Nurses Association (ANA). c. National Council of State Boards of Nursing (NCSBN). d. National League for Nursing (NLN).

ANS: C The NCSBN coordinates licensure activities on a national level and creates and administers the licensure examination (NCLEX®).

Although the media portrayed nursing in a negative light in M*A*S*H through the character of a promiscuous, uncaring nurse, it also provided Americans with a promising glimpse of: a. nurses who can be promiscuous and still help doctors. b. the fact that caring is not as important as the desire to serve one's country. c. the ability of nurses to cope with the dreadfulness of war by using humor. d. the contributions of male military nurses.

ANS: C The sitcom M*A*S*H did show humor as a coping mechanism for nurses in a war setting.

What was the purpose of the Nurse Reinvestment Act of 2002? a. Provided disability insurance to RNs who contract a life- threatening illness while on duty b. Funded public service announcements that promote unlicensed caregivers as an alternative to professional nurses c. Focused on nurse retention and safety enhancements grants to address the current nursing shortage D. Provided pediatric nursing training grants

ANS: C This act provided nursing scholarships, public service announcements promoting nursing as a career, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. DIF: Knowledge REF: pp. 23-24

A current trend is for students to be evaluated to determine whether they demonstrate competence in the actual client care environment or with a standardized patient. This process occurs in addition to or instead of traditional pencil-and-paper evaluations. This type of evaluation is referred to as: a. core practice competencies. b. continuing competence. c. distance learning. d. performance-based assessment.

ANS: D Performance-based assessment is the evaluation of abilities based on an objective demonstration of specific required competencies. This may include performance in actual or simulated situations. DIF: Knowledge REF: p. 44

A nurse would like to advocate for increased protective services and reporting mechanisms for elder abuse and attends the "meet the candidate" session at the town hall meeting. This is an important time for the nurse to: a. educate the public about the nurse's political platform. b. be spontaneous and not deliver a rehearsed speech. c. address the person as "candidate" rather than using a first name that implies a working relationship. d. learn what the key issues are in the candidate's platform.

ANS: D Town hall gatherings with nurses allow the candidate to talk about his or her platform to a group of interested voters and afford nurses an opportunity to understand the candidate's vision and to voice their opinions and concerns about health care issues. DIF: Application REF: p. 406

A student is planning to enroll in prerequisite courses after graduating from high school and is researching options for nursing programs. During a career fair the student compares different types of nursing education programs and discovers that: a. diploma programs focus on family and community, with an emphasis on health promotion. b. most practicing RNs graduated from diploma programs because this was the first type of RN program. c. baccalaureate programs focus on technical and hands-on nursing skills in diverse community settings. d. master's programs such as that for the clinical nurse leader provide entry into practice with a focus on interdisciplinary and bedside nursing care for complex client populations.

ANS: D A clinical nurse leader oversees the care coordination of groups of clients and actively provides direct client care in complex situations, evaluates client outcomes, and has the decision-making authority to change care plans when necessary.

Which situation would be considered a workforce advocacy issue that is reportable to the state nurses association or the Center for American Nurses if it is not resolved at the local level? a. Nurses prefer to wear navy blue scrubs, but the institution requires burgundy scrubs, which interferes with autonomy. b. The cafeteria often serves fried vegetables rather than healthier baked vegetables, causing the potential for hyperlipidemia. c. The hospital pharmacy does not fill employee prescriptions upon receiving them; instead, they fill employee prescriptions after all inpatient prescriptions have been filled. d. The key needed to change the sharps container is locked in the supervisor's office after 3 PM on weekdays and all day on weekends, which prevents changing of the container when needed and places nurses at risk for needlesticks.

ANS: D A safe work environment is imperative for the safety of both nurses and patients. Correcting this work environment issue promotes job satisfaction and good patient outcomes.

Qualified nursing school applicants have continued to be turned away, limiting enrollment due to a shortage of faculty, which is attributed to several factors, including: a. nursing faculty are subject to high levels of burnout and job dissatisfaction. b. only the number of faculty in Associate Degree programs remain stable. c. the mean age of nursing faculty continues to decrease and older faculty mentors have left the profession. d. increasing job competition from higher paying clinical sites, even as the economy recovers

ANS: D Academic institutions, especially those faced with budget cuts, generally cannot compete with nonacademic employers. Faculty salaries continue to be a major contributor to the nursing shortage.

Nurses can combat the nursing shortage by: a. joining unions, which influence employers to provide incentives such as pay raises and free child care, thus encouraging the large percentage of nonworking nurses to return to the workforce. b. demanding that the requirements of the qualifying examination for foreign nurses should be reduced, so they are eligible to sit for the licensure examination. c. working more hours with a higher nurse/patient ratio. d. advocating for funds to pay for nursing education and a safer work environment.

ANS: D Advocating for funds to pay for nursing education and a safer work environment is a positive strategy, as can be seen by results attained after the Reinvestment Act P.L. 107-205 provided $20 million for nursing scholarships, public service announcements, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This is the best defense against the nursing shortage. Nursing graduates in many states have increased in number, and enrollment in nursing schools is also on the rise.

The demographics of the twenty-first century nursing population indicate that: a. individuals entering nursing are second-degree students who average 45 years of age. b. more white nurses enter and obtain graduate degrees than any other ethnic group. c. the highest level of nursing education for most RNs is an associate degree. d. the majority of nurses practice in hospitals.

ANS: D Fifty-six percent of nurses practice in hospitals.

A person who is covered by Medicaid moves from one state to another and asks the nurse at the health department why the benefits changed. The correct response by the nurse is: a. "Local government controls which benefits each county can provide to Medicaid recipients." b. "The federal government does not fund any part of Medicaid, so each state must find ways to pay for benefits." c. "Each state determines benefits on the basis of the present economy." d. "Medicaid is funded by both state and federal governments, but benefits vary from state to state."

ANS: D Medicaid is a program that is funded through a combination of state and federal funds; thus benefits vary from state to state.

When an RN is asked to accept an assignment that he or she may not be qualified to perform, the nurse should: a. accept the assignment as appropriate if assigned by a legitimate power. b. be primarily concerned with the number of patients being assigned. c. ask how other nurses have handled the assignment in the past. d. determine whether he or she is familiar with the types of patients being assigned.

ANS: D Nurses should always think critically about assignments so they can communicate what makes them uncomfortable about a particular assignment. If nurses do not have the knowledge or experience required for particular patient assignments, then modification of the assignments is in order to ensure patient safety. DIF: Application REF: p. 245, Box 13-5

A nurse is concerned about safe staffing levels at a facility and observes that several units have no RN coverage but instead have RNs who float among several units. In determining whether this staffing concern should be reported to an outside agency, the nurse understands that, with whistle-blowing: a. reporting unsafe staffing levels to The Joint Commission provides protection from the employer. b. keeping copies of documented inappropriate staffing patterns in the nurse's personal file is illegal. c. when observing inappropriate staffing, the nurse should record her personal thoughts concerning the outcomes. d. one should seek guidance from a trusted individual who can provide an objective point of view.

ANS: D One of the many guidelines regarding whistle-blowing specifies that one should seek counsel from a trusted individual outside the situation to gain an objective perspective.

The key to organizational success for health care facilities is: a. hiring younger, more energetic nurses. b. offering incentives such as sign-on bonuses. c. hiring highly qualified advanced practice nurses. d. retaining professional nurses.

ANS: D Past nursing shortages have proved that retention of professional nurses is the key to any organization's success. Nurses want to work in an environment that supports decision making and effective nurse-physician relationships. The ability of an organization to retain nurses primarily depends on the creation of an environment that is conducive to professional autonomy. DIF: Comprehension REF: p. 241

Nurses entering the workforce at a large urban hospital soon began volunteering for excessive overtime. A focus group found that upon graduation, many of these nurses purchased expensive cars and furniture. They lacked skills in managing their checkbook and were often unable to pay recurring bills; this finding would be relevant to which component of the Workforce Advocacy Ecosystem Model? a. Staffing b. Workflow design c. Organizational factors d. Personal and social factors

ANS: D Personal and social factors include stress, job satisfaction, and professionalism and financial literacy.

A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates caring by holding a soldier's head is an artistic representation of nurses who served in which war? a. World War I b. World War II c. Spanish-American War d. Vietnam War

ANS: D This statue represents the caring provided by nurses during the Vietnam War.

A member of a nursing students study group comments, "I wish our instructor would just tell us the important information that we will be tested on in our course and on NCLEX®. Instead, we spend some time early in the class discussing key facts then the most of the time working through case studies, then practicing on the simulator rather than caring for 'real' patients." This teaching-learning style represents: a. memorization of basic facts presented early in the lecture. b. Objective Structured Clinical Examinations (OSCE). c. peer-to-peer learning. d. practice-based competency.

ANS: D Practice-based competency includes active engagement and application in real practice situations and interactive strategies such as case studies and simulation. DIF: Application REF: pp. 43-44

Which trend is an effect of the nursing shortage on nursing education? a. Only devoted qualified nurses are continuing to provide bedside nursing because of the complexity of care required, resulting in excellent preceptorships for students. b. The number of applicants to nursing programs has risen, but enrollment is limited because of a decrease in the number of available scholarships and grants. c. With an increase in the number of nurses who are entering graduate school to escape bedside nursing, students will soon enjoy a lower faculty/student ratio. d. Students may be assigned to preceptors who have not yet developed expertise in the field of interest.

ANS: D Qualified preceptors are few.

The priority intervention to improve work-related quality of life for nurses is to: a. provide safe harbors for unjust or unsafe work assignments. b. improve nurse physician communications. c. require professional development courses for bedside nurses. d. determine strategies to improve vertical working relationships between staff nurses and nursing administration.

ANS: D RNs ranked their relationships with administration and management the lowest in the workplace. DIF: Application REF: p. 241

One workplace issue—the nursing shortage—is caused by several complex issues, including: a. movement of nurses into acute care settings. b. the use of unlicensed assistive personnel to replace RNs. c. a mass of Baby Boomers who have chosen nursing as a career. d. an aging nursing workforce.

ANS: D Research validates that an aging population and an aging nursing workforce are significant contributors to the nursing shortage issue. DIF: Comprehension REF: p. 241

A nurse is concerned about a trend in the hospital to regularly "float" nurses to different areas of the hospital based on staff shortage regardless of recent experience in caring for the population on the unit. When deciding to accept a staffing assignment in this situation, the nurse considers a "safe harbor." What is meant by "safe harbor"? a. In an emergency situation, nurses may move patients to one location designated to be areas safe from natural disasters or acts of terrorism. b. Nurses work in teams to care for patients who have no communicable disease and do not pose a safety issue due to infection. c. Horizontal violence is not tolerated and nurses report any form of violence to administration. d. It is written a notice about recurrent staffing issues that allows nurses to continue to care for patients placed in their care but protects their nurse's license while an investigation is conducted.

ANS: D Safe harbor does not mean a nurse can refuse an assignment unless it would violate the nurse practice act, but it does provide an avenue for nurses to report unsafe staffing by filing a written report that is investigated by administration.

According to the Needlestick Safety and Prevention Act (2000): a. employers ask nurses in managerial positions to evaluate safe needle devices. b. registered nurses who sustain a needle stick are required to pass a test before resuming medication administration. c. each state must determine the type of safe needle devices to be used. d. employers are required to document how and where a sharps injury occurred, including the brand if device that was involved

ANS: D The Needlestick Safety and Prevention Act, passed at the federal level, requires the use of safer needle devices to protect from sharps injuries; the law requires employers to maintain a sharps injury log that contains, at a minimum, the brand of device involved in the incident, the department or work area where the exposure incident occurred, and an explanation of how the incident occurred. DIF: Comprehension REF: p. 248

In order to best improve patient outcomes on an acute care hospital unit, which intervention should the nursing staff advocate for? a. Staffing only 8 hour shifts on the unit b. Decreasing the number of patients cared for on any specific unit c. Increasing salaries for experienced nurses d. Increasing staffing on the evening shift

ANS: D The data clearly indicate that decreased nurse-patient ratios have been associated with higher rates of mortality, shock, urinary tract infections, sepsis, hospital acquired pneumonia, and failure to rescue, especially among surgical patients.

A newly hired nurse is asked to serve on a committee formed to recruit and retain nurses. At the committee meeting, the nurse learns that: a. older nurses are being encouraged to retire so that younger, more efficient nurses can practice. b. Magnet hospitals are able to attract nurses with sign-on bonuses and flexible work hours but fail to retain nurses because insufficient autonomy over professional practice is provided. c. multitasking is seldom desired by the younger generation of nurses. d. many younger workers are less concerned with longevity and are willing to change institutions to achieve professional advancement and flexible work hours.

ANS: D The emerging workforce, ages 18 to 35 years, has compensation expectations that differ from those of previous generations. This younger generation prefers to work in an outcomes-based environment, where pay is based on achievement or merit, not on longevity.

An acute care facility values job satisfaction among its registered nurses.by implementing a shared governance model. Which element is a fundamental characteristic of this model? a. Administration has an open door policy b. Established dispute resolution process c. Implementation of mandatory reporting d. Nurses have an active role in patient care decision making

ANS: D The importance of shared governance is that such models provide an organizational framework for nurses in direct care to become committed to nursing practice within their organizations. The implementation of such models allows nurses to have an active role in decision making by providing maximal participation and accountability for the outcomes of those decisions. DIF: Application REF: p. 252, Box 13-9

What does the Spirit of Nursing statue honor? a. Florence Nightingale's accomplishments in public health b. Edith Cavell's attempt to help the victims of the Tuskegee experiment seek treatment c. Clara Maas, who found the cure for yellow fever during WWII d. All military nurses for their bravery and compassion

ANS: D The statue the Spirit of Nursing was created to honor all military nurses.

Which experience is best designed to support a nursing student's preparation for interprofessional team participation? a. Attending a seminar on interprofessional team cooperation b. Completing a preceptorship with an advanced practice nurse c. Carrying for three patients with varying medical diagnoses d. Presenting patient information at the daily care planning meeting on a mental health unit

ANS: D While interprofessional educational experiences are encouraged for all health care disciplines, Delunas and Rouse (2014) cite the importance of preparation of students for interprofessional educational experiences, and the need for regular meetings when students are engaged in learning as a member of a health care team.

According to Lenburg, the use of practice-based assessments in nursing education is aimed toward the target of __________.

ANS: competence The target that students need to meet to practice safely in today's complex health environment is achieving critical competencies and demonstrating of practice-based skills.

Another name for an eligible voter is a _________.

ANS: constituent

The oldest, most traditional type of program that prepares a candidate for RN licensure is the hospital-based _________ program.

ANS: diploma The earliest training programs for nurses were hospital based and designed to meet the needs of the particular institution; these were referred to as diploma programs.

The greatest barrier to access to health care for a poor Hispanic person living in downtown Chicago is lack of health ____________________.

ANS: insurance Lack of health insurance is the greatest barrier to access to health care and it has a tremendous impact on an individual's health. Studies have consistently found that the uninsured receive less than adequate health care.

Nurses who are expected to work overtime as dictated by their employer are being subjected to a ___________ hazard in the workplace.

ANS: psychological Hazards in the workplace are categorized as follows: biologic, ergonomic, chemical, physical, and psychological. Included in psychological hazards are issues such as stress, shift work, mandatory overtime, and verbal abuse by patients and other health care providers