nursing final

7. Nursing involves close interaction between nurses and patients, a situation which can create the potential for boundary violations. Which of the following situations most clearly constitutes a boundaries violation? A) A community health nurse continues weekly visits to a former client despite the fact that the client is no longer receiving care. B) A nurse states that she is willing to advocate to the patient's employer than the patient was genuinely ill and not feigning health complaints to gain time off work. C) A nurse attends a family meeting at the hospital in which the patient and his family discuss the patient's code status. D) A nurse contacts a social worker without the patient's knowledge because of admissions the patient has made about her substandard living conditions.

A) A community health nurse continues weekly visits to a former client despite the fact that the client is no longer receiving care.

12. There are differing viewpoints surrounding the withholding and withdrawal of treatment. Which of the following situations constitutes the most acceptable application of the withholding and/or withdrawal of treatment? A) A competent patient expresses a desire that hydration and nutrition be discontinued. B) The potential benefits of a patient's antibiotic therapy exceed the likely risks. C) A patient's family will be forced to pay out-of-pocket for the patient's life support due to a lack of insurance coverage. D) A patient's children wish to discontinue the patient's treatment because they have lost faith in the care team.

A) A competent patient expresses a desire that hydration and nutrition be discontinued.

11. A nurse who provides care in a long-term care facility is charged with improving the safety of residents. Which of the following measures has the greatest potential to reduce the incidence of injuring among residents? A) A comprehensive falls prevention program B) A program aimed at eliminating resident-to-resident violence C) An automated medication administration system D) An algorithm that guides the delegation of tasks among the care team

A) A comprehensive falls prevention program

1. Several national organizations have addressed the issue of adverse events in healthcare settings. The National Quality Forum (NQF) of 2002 included which of the following? A) A list of serious reportable events that was aimed at increasing public accountability B) A cross reference of standards for nursing care with the most common adverse events in healthcare C) A list of aims for improving the overall quality of the American healthcare system D) An algorithm for responding appropriately to safety violations in healthcare settings

A) A list of serious reportable events that was aimed at increasing public accountability

1. A goal of community nursing is to provide primary prevention from disease. Which of the following nursing actions reflect this goal? A) A nurse creates a pamphlet discussing heart-healthy foods and distributes it in the neighborhood community center. B) A nurse starts an intravenous line on a dehydrated baby who has been brought to the emergency department. C) A nurse performs range-of-motion exercises for a patient in traction. D) A nurse repositions an elderly patient confined to a wheelchair to avoid the formation of pressure ulcers.

A) A nurse creates a pamphlet discussing heart-healthy foods and distributes it in the neighborhood community center.

12. A nurse is transcribing a physician's new drug order on to a patient's medication administration record. In light of the potential for drug errors, how should the nurse best record the drug order? A) Digoxin 0.125 mg PO daily B) Digoxin .125 mg PO daily C) Digoxin 0.1250 mg PO daily D) Digoxin .1250 mg PO daily

A) Digoxin 0.125 mg PO daily

9. "Failure to rescue" has been defined as "deaths per 1,000 patients having developed specified complications of care during hospitalization" (AHRQ, 2007). A hospital that wishes to reduce the rate of failure to rescue should prioritize what measure? A) Encouraging nurses to spend a greater amount of time at the bedside. B) Implementing mandatory continuing education programs. C) Improving the communication between members of different health disciplines. D) Reducing distractions to nurses while they are providing care.

A) Encouraging nurses to spend a greater amount of time at the bedside.

6. A nurse on a palliative care unit has attended an educational inservice on ethics. Which of the following statements most accurately describes the concept of ethics? A) Ethics offers a process that can be used to guide behavior. B) Ethics is the expression of social and culture values, priorities, and norms. C) Ethics is the basis for evaluating personal character. D) Ethics is the tangible application of religious and spiritual truths.

A) Ethics offers a process that can be used to guide behavior.

10. A nurse has identified glaring inefficiencies in the way that care is organized on a medical unit. Which of the following tasks will this nurse perform if he or she is to act as a change agent? A) Informing others about the need for change B) Ensuring that others comply with any change that is implemented C) Establishing punishments and rewards to foster compliance with change D) Evaluating the long-term outcomes associated with change

A) Informing others about the need for change

6. There is an increasing trend for nursing care to move from the hospital setting into the community. Nurses who are to provide excellent care in a community setting should prioritize which of the following? A) Integrating culture and family into the planning and delivery of care B) Becoming more assertive in client education and the planning of client care C) Encouraging clients to limit their interactions with physicians D) Teaching clients to replace biomedical interventions with complementary therapies

A) Integrating culture and family into the planning and delivery of care

4. The nursing leadership in the local hospital has recognized the need to minimize the number of sentinel events that occur in the hospital by implementing a number of practice improvements. These nurse leaders should recognize that the largest proportion of sentinel events involve which of the following? A) Lapses in communication B) Violence C) Violations of care providers' scopes of practice D) Gaps in education and training

A) Lapses in communication

10. A client with a long-standing diagnosis of chronic obstructive pulmonary disease (COPD) has been enrolled in a disease management program. Which of the following activities will be prioritized in this program? A) Providing comprehensive and evidence-based care of the client's COPD B) Creating collaborative relationships between the client and the care team C) Ensuring that the client qualifies for Medicare and Medicaid D) Liaising between the client and his health maintenance organization (HMO)

A) Providing comprehensive and evidence-based care of the client's COPD

5. A nursing student finds that she has difficulty with procrastination. Which of the following is a recommended guideline to help this student manage her time? A) Start working on a project for 10 minutes, and quit if tired or bored. B) Schedule 2 or 3 days a week in which to concentrate her tasks. C) Avoid spending the time it takes to make to-do lists. D) Schedule down-time first and work second.

A) Start working on a project for 10 minutes, and quit if tired or bored.

1. Which of the following statements accurately reflects the nurse's responsibility for patient outcomes in today's workplace? A) Tasks can be delegated, but accountability cannot be delegated. B) In today's environment, authority is more often given to management. C) Most nurses who are accountable have the authority to affect the situation or effect change. D) Nurses are protected against legal action being taken in cases of malpractice in the hospital setting.

A) Tasks can be delegated, but accountability cannot be delegated.

7. A registered nurse is responsible for overseeing the care that is provided in a long-term care facility. The skills mix at the facility includes the registered nurse, a practical nurse, and several unlicensed assistive personnel (UAP). Which of the following statements is true of the delegation that the RN performs? A) The RN is accountable for the care that the other members of the team provide. B) The RN may only delegate tasks that are outside of her own scope of practice. C) The RN can delegate tasks that are outside the PN's or UAPs' scope of practice if she first provides adequate teaching. D) Once a task is delegated, the person who performs the tasks is solely responsible for the outcomes.

A) The RN is accountable for the care that the other members of the team provide.

7. In spite of the important role that hospitals play in American healthcare, there is growing importance of community-based healthcare and community-based nursing. Which of the following statements best conveys a central aspect of the philosophy of community care? A) The client is in charge of his or her health and healthcare in the community. B) Nurses maximize their scope of practice in noninstitutional settings. C) Community settings allow for the greatest number and variety of treatment options. D) The nurse becomes the key member of the healthcare team in a community setting.

A) The client is in charge of his or her health and healthcare in the community

9. A nurse who provides care in a busy ambulatory clinic knows that there are numerous occupational hazards associated with the provision of nursing care. What is the employer's responsibility in minimizing the nurse's risk of experiencing an injury or infection? A) The employer must provide all the necessary supplies and equipment to prevent injuries and infections. B) The employer must ensure that staffing levels are maintained at a level specified by the state board of nursing. C) The employer must have dedicated occupational health officers present at all times. D) The employer must release nurses from tasks that may present a threat to their health.

A) The employer must provide all the necessary supplies and equipment to prevent injuries and infections.

8. In vitro fertilization (IVF) is an example of assisted reproductive technology (ART) that has become more common in recent decades. However, IVF is not without controversy. Which of the following aspects of IVF is most often contentious? A) The number of fertilized ova normally exceeds the number of children that a woman desires. B) The success or failure of IVF rests on the genetic characteristics of sperm that comes from a man unknown to the woman undergoing the procedure. C) IVF is most common among women who have a history of elective abortion. D) IVF is often undertaken without the consent of a woman's partner.

A) The number of fertilized ova normally exceeds the number of children that a woman desires.

14. Tom is a nurse who provides care on a busy medical unit. One of Tom's colleagues has just confided in him that she erroneously gave her patient 16 mg of immediate-release hydromorphone instead of 16 mg of extended-release hydromorphone. She tells Tom that she does not want to report the incident and so she plans to simply monitor the patient's level of consciousness and respiratory status closely for the next several hours. Which of the following statements best describes Tom's required response to this situation? A) Tom has a professional and legal responsibility to report this. B) Tom should strongly encourage his colleague to document this error. C) Tom is obliged to assist his colleague with follow-up assessments. D) Tom has no legal obligation to respond, but he should take advantage of this teaching opportunity.

A) Tom has a professional and legal responsibility to report this.

14. Alex is a nurse who has been taken aside by a colleague and the colleague has described another nurse as a "backstabber" and "battleaxe". The colleague has gone on to give Alex details of ongoing conflict between the colleague and this nurse. Which conflict management technique should Alex apply in this situation? A) Withdrawing from conflict B) Accommodating the conflict C) Negotiating D) Collaborating

A) Withdrawing from conflict

11. A nurse has responded to a patient's call light for the fourth time in the past hour only to be berated by the patient for taking so long to come to the bedside. Rather than responding in a confrontational tone the nurse has paused to think of the best response to the patient's statements. In doing so, the nurse has exhibited A) self-regulation. B) sympathy. C) manipulation. D) self-strategy.

A) self-regulation.

13. The nurse manager of a busy medical unit prioritizes effective communication with the employees of the unit. In recent years, an increasing amount of this communication has involved e-mails and text messages. When using these communication media, the nurse should A) take action to ensure that patient confidentiality is maintained. B) "cc" upper management and human resources with all e-mails. C) avoid using a smartphone on the unit whenever possible. D) follow up e-mails with a paper copy of important messages.

A) take action to ensure that patient confidentiality is maintained.

9. Kurt Lewin's force-field theory of change is one of the most widely accepted and remains in current use today. The central concepts of this theory of change include A) the forces that govern intrinsic and extrinsic motivation. B) the relationship between driving forces and restraining forces. C) the forces of resilience and inertia in an organization. D) the relationship between the will for change and the ability to effect change.

B) the relationship between driving forces and restraining forces.

8. Healthcare is a field that continues to undergo constant and profound change, both planned and unplanned. Which of these situations is an example of reactive change? A) Hospital administrators have announced a desire to implement the principles of evidence- based practice. B) A hospital's accreditation review revealed systemic problems and the hospital has been directed to resolve these. C) The introduction of automated medication dispensing machines at a hospital is scheduled for later this year. D) A transition will soon begin whereby the practical (vocational) nurses will begin to practice within their full scope.

B) A hospital's accreditation review revealed systemic problems and the hospital has been directed to resolve these.

15. The approach that a nurse chooses in the management of a conflict is entirely dependent on many of the factors and variables involved in the specific conflict. In which of the following situations would the nurse be most likely justified in forcing the issue or competing? A) A nurse is embarrassed that a colleague discovered the nurse's medication error and completed an incident report. B) A nurse observed a colleague remove an opioid analgesic from the locked medication cupboard and put it in her pocket. C) A nurse disagrees with a colleague about the need for increased staffing levels. D) A nurse has received constructive criticism from his manager during his latest performance appraisal.

B) A nurse observed a colleague remove an opioid analgesic from the locked medication cupboard and put it in her pocket.

6. Researchers have noted a high incidence of burnout among nurses. Which of the following nurses most likely faces the highest risk of burnout? A) An experienced nurse who has long neglected her own physical health and who leads a sedentary lifestyle. B) A nurse who provides pediatric palliative care and who is disillusioned with the overall quality of care on the unit. C) A nurse who has recently graduated with an ADN degree and begun working in a busy, inner-city emergency department. D) A nurse who is few months away from retirement from her current position in community health.

B) A nurse who provides pediatric palliative care and who is disillusioned with the overall quality of care on the unit.

2. A nurse is aware that sentinel events that occur in the care setting must be followed up in a timely and thorough way. Which of the following occurrences would be considered a sentinel event? (Select all that apply.) A) A nurse's shift is cancelled at short notice. B) A patient accesses the medication chart and takes a medication. C) The family member of a patient physically threatens a nurse. D) A physician makes sexually inappropriate comments to a nurse. E) A nurse places a patient on a bedpan despite the fact that the patient can ambulate with assistance.

B) A patient accesses the medication chart and takes a medication. C) The family member of a patient physically threatens a nurse. D) A physician makes sexually inappropriate comments to a nurse.

13. Healthcare institutions are frequently the site of conflict. Which of the following situations exemplifies interpersonal conflict? A) A nurse is undecided whether to pursue a management position or to continue providing bedside care. B) A recent graduate and a more experienced nurse disagree on the thoroughness of the recent graduate's assessments. C) A cohort of experienced nurses have concerns about the way that younger nurses dress and present themselves. D) The nurses on a unit are having difficulty getting physicians to return pages.

B) A recent graduate and a more experienced nurse disagree on the thoroughness of the recent graduate's assessments.

12. Nurses have the potential to positively impact the health of communities. Which of the following actions is most likely to improve the health of a community? A) Publicizing the consequences of unhealthy lifestyles B) Advocating politically for laws and policies that foster community health C) Ensuring that nurses are practicing to the full extent of their scope of practice D) Providing nursing care to individuals who are not patients or clients

B) Advocating politically for laws and policies that foster community health

5. A client asks a nurse for help in obtaining an alternative healthcare provider. Which of the following is an accurate fact regarding alternative care that the nurse should share with this client? A) Most alternative healthcare practitioners do not have education-based credentials to practice their medicine. B) Alternative providers are not usually included in the federal HIPAA legislation that mandates confidentiality in conventional healthcare settings. C) The cost of alternative therapy is never covered by insurance carriers or healthcare plans. D) It is easy to find accurate safety and efficacy data for alternative medicine on the Internet.

B) Alternative providers are not usually included in the federal HIPAA legislation that mandates confidentiality in conventional healthcare settings.

4. A registered nurse is responsible for organizing the care at a facility that has several UAPs. Which of the following tasks can an RN delegate to a UAP? A) Performing an ongoing assessment B) Answering call lights C) Administering medications D) Counseling clients

B) Answering call lights

12. The care providers and administrators of a hospital have struggled to find an appropriate response to a patient who has a long history of being admitted to hospital and then leaving against medical advice. Under the direction of the hospital ethics committee, a plan was created and implemented. What action should the care providers and the ethics committee take after the plan has been implemented? A) Continue to implement the plan when necessary B) Assess the outcomes of applying the plan C) Seek input from the hospital's risk manager D) Report to the state board of nursing about the manner in which the situation was handled

B) Assess the outcomes of applying the plan

11. A nurse is aware that there are numerous bioethical issues involved in the practice or euthanasia. Which of the following events most clearly constitutes active euthanasia? A) A woman chooses not to phone 911 when her elderly husband become unconscious in the home. B) At his and his wife's request, a doctor provides a man with a fatal dose of phenytoin. C) A nurse withholds cardiopulmonary resuscitation (CPR) from a patient in light of the patient's DNR order. D) A family decides against treating their mother's sepsis because of her low potential for recovery.

B) At his and his wife's request, a doctor provides a man with a fatal dose of phenytoin.

10. An obstetrical-gynecological nurse has moved to a new region and is seeking employment. The nurse opposes the ethics of elective abortion and refuses to participate in the procedures. However, the only hospital in the immediate area is the site of numerous elective abortions. How should the nurse account for this fact when seeking employment? A) Ask the hospital administrators to exempt her from participating in any aspect of abortion. B) Consider applying for a nursing position that will not involve abortion. C) Begin working at the hospital and attempt to change the hospital politically. D) Accept a position at the hospital and then make her position known to supervisors.

B) Consider applying for a nursing position that will not involve abortion.

14. It has been a frantic morning on the hospital unit and the nurse is unsure whether she will be able to complete her required tasks on time before her scheduled lunch break. Which of the following is the nurse's most appropriate response to this problem? A) Skip lunch or trade her lunch break with a colleague who is scheduled for a later break. B) Determine if more of her tasks could be delegated to another member of the care team. C) Ask the unit manager for advice. D) Explain to a colleague that she will likely be unable to complete her required work.

B) Determine if more of her tasks could be delegated to another member of the care team

2. A client has advance directives for a DNR code (do not resuscitate). When the nurse is caring for this client, the client's wife asks him to "do everything in your power to keep my husband alive." This nurse is most likely to experience which of the following moral challenges? A) Values clarification B) Ethical dilemma C) Values conflict D) Nonmaleficence

B) Ethical dilemma

8. A busy operating room has begun using time outs in an effort to reduce errors and promote patient safety. What action will the care team perform during a time out? A) Systematically teaching the patient about the risks of surgery while the patient is still in the preoperation area B) Gathering each member of the surgical team to acknowledge and confirm that the correct surgery will be performed on the correct patient C) Pausing to review the patient's diagnosis and the indications for surgery D) Completing a checklist that reviews the major areas for preoperative assessment and which contains the patient's consent for the procedure

B) Gathering each member of the surgical team to acknowledge and confirm that the correct

4. A hospital manager is accused of quid pro quo sexual harassment. Which of the following is an action that might have been involved? A) Making persistent unwanted attempts to initiate a personal relationship B) Granting job-related benefits in return for sexual favors C) Using suggestive or obscene language D) Making direct sexual advances

B) Granting job-related benefits in return for sexual favors

3. What is the primary objective of a performance appraisal? A) Establish written documentation of incompetent behavior to facilitate dismissal B) Maintain and develop employee performance C) Establish criteria for accreditation standards D) Determine who receives pay raises

B) Maintain and develop employee performance

8. Mr. Hammond is a 70-year-old man with a diagnosis of type 1 diabetes who developed a diabetic foot ulcer earlier this year. He has recently been discharged from the hospital and now requires regular wound care. Karen is a community health nurse who provides wound care for Mr. Hammond twice weekly. Which of Karen's actions is most likely to empower Mr. Hammond? A) Encourage Mr. Hammond to acknowledge his contribution to the development of his wound. B) Provide information to Mr. Hammond that matches his expressed needs. C) Encourage Mr. Hammond to involve members of his family in his care. D) Delegate wound care to Mr. Hammond and reduce the frequency of her visits.

B) Provide information to Mr. Hammond that matches his expressed needs.

5. Which of the following best describes the term rationing of healthcare? A) Providing healthcare only to those who can afford it. B) Providing a planned approach to the use of limited resources. C) Asking consumers to prioritize their use of healthcare resources. D) Requiring consumers to carry private insurance to cover healthcare not covered by the public sector.

B) Providing a planned approach to the use of limited resources.

2. A novice nurse apprehensively reflects on what she considers to be an impossible task of delivering quality care on her ward as it is assigned to her. What is the name of this phenomenon first coined by Marlene Kramer? A) Burnout B) Reality shock C) Culture shock D) Job disorientation

B) Reality shock

15. After working for several months on a geriatric subacute medicine unit, a nurse has come to the conclusion that substandard care has become accepted as the norm by the majority of nurses as well as their immediate supervisors. The nurse's attempts to discuss and address some significant and persistent lapses in care have been rebuffed by nurses and supervisors alike. What should the nurse do next? A) Enlist the support of current and previous patients B) Resign from the unit C) Contact media outlets D) Further discuss the benefits of practice improvements with the nurses

B) Resign from the unit

8. Experts have identified a close relationship between the practice of transformational leadership and the empowerment of employees. What action should a nursing leader take to foster employee empowerment? A) Have the performance of each employee appraised by his or her peers rather than by a manager or leader. B) Share information as openly as possible in order to make employees aware of problems. C) Adopt a hands-off approach in order to allow leadership to organically emerge from within the group of employees. D) Eliminate the practice of conducting performance appraisals of employees.

B) Share information as openly as possible in order to make employees aware of problems.

2. Which of the following statements accurately describes a characteristic of the stem cell? A) Stem cells are not able to renew themselves. B) Stem cells give way to specialized cells. C) Stem cells are committed to conduct a specific function. D) Pluripotent stem cells are derived from the patient's own DNA.

B) Stem cells give way to specialized cells.

6. During the various clinical placements that a nursing student has had during a baccalaureate program, the student has become increasingly aware of how significant bioethical issues are in the delivery of healthcare. Which of the following factors has contributed most significantly to the importance of bioethical issues in healthcare? A) Increased health literacy among healthcare consumers B) The development of new healthcare technologies C) The politics of proposed universal healthcare in the United States D) Increased incidence and prevalence of chronic health problems

B) The development of new healthcare technologies

15. All performance evaluations, whether formal or informal, should be based on appropriate standards of performance. In the context of a performance appraisal, which of the following are appropriate performance criteria? (Select all that apply.) A) The manager's experience base B) The nurse's written job description C) The institution's policies and procedures D) Nursing standards of practice E) The nurse's career goals

B) The nurse's written job description C) The institution's policies and procedures D) Nursing standards of practice

13. A nurse who provides care in an acute medical unit is aware of the importance of thorough discharge planning. The discharge planning process should begin A) once the patient has stabilized and is assured of positive outcomes. B) as soon as possible after the patient is admitted. C) once the patient has received a discharge order from his or her primary care provider. D) 48 to 72 hours before the projected date of discharge.

B) as soon as possible after the patient is admitted.

3. One of the safe practices identified by the National Quality Forum (NQF) is to match healthcare needs with service delivery capability. This practice is demonstrated by A) matching the health status of a community with the specific mandate of the local hospital. B) conducting high-risk procedures in hospitals that perform a large numbers of the same procedure. C) encouraging Americans to seek care in healthcare institutions that have the fewest number of adverse events. D) ensuring that hospitals are equipped and staffed to provide neither too much nor too little care.

B) conducting high-risk procedures in hospitals that perform a large numbers of the same procedure.

10. A recent nursing graduate has asked an expert nurse how best to foster her leadership abilities, since she wishes to explore leadership opportunities later in her career. How should the expert nurse best respond? A) "Even if you don't trust a decision that you have to make, act like you chose the best option." B) "Become as specialized as possible in your nursing experience." C) "Develop your interpersonal skills by having a wide variety of interactions." D) "Become as assertive as you can and take every opportunity to guide the behavior of others."

C) "Develop your interpersonal skills by having a wide variety of interactions."

9. An elderly female client who resides in the community tends to defer decisions regarding her care to her eldest son. How should the community health nurse respond to the client's reluctance to make independent decisions? A) Discuss this observation with the client and her son in an open manner and explore alternatives. B) Organize care so that it takes place at times when the son is not present in the home. C) Accommodate this aspect of the client's family dynamics when planning and carrying out care. D) Teach the client assertiveness skills that she can apply in her interactions with her son.

C) Accommodate this aspect of the client's family dynamics when planning and carrying out care.

7. Melissa is a nurse who graduated earlier this year with a baccalaureate degree in nursing and immediately began working on a busy surgical unit with a high turnover of both the patients and the staff. As a result, Melissa has found the adjustment to full-time employment particularly stressful. Which of the following actions should Melissa take in order to manage the stress in her life? A) Schedule a vacation for later in the year and focus on this upcoming trip when she is experiencing high levels of stress. B) Reduce her workload to part-time and supplement this with casual employment on a lower- stress unit. C) Be vigilant in personal habits that result in adequate rest, a healthy diet, and adequate physical exercise. D) Reduce or eliminate the specific interactions in the clinical setting that cause her the most stress.

C) Be vigilant in personal habits that result in adequate rest, a healthy diet, and adequate physical exercise.

9. Jennifer is a registered nurse who works in a busy emergency department. As one of her goals for the current year, Jennifer has resolved to develop her emotional intelligence. How should Jennifer best meet her goal? A) Try to remove emotion from her clinical decision-making whenever possible. B) Become more assertive when responding to the emotional responses of patients, families, and coworkers. C) Become more aware of the way that her emotions function and how they influence her actions. D) Try to limit her expressions of emotion to times when she is not interacting with others.

C) Become more aware of the way that her emotions function and how they influence her actions

3. A counselor diagnoses a critical care nurse with having the syndrome known as burnout. Which of the following is a characteristic of this condition? A) Burnout occurs when a nurse first enters the workplace and is overwhelmed by the workload. B) All of the symptoms of burnout are psychological in nature. C) Burnout is accompanied by a decreased ability to function on the job and at home. D) Burnout occurs less often in high-energy areas, such as critical care or burn units.

C) Burnout is accompanied by a decreased ability to function on the job and at home.

1. The nature of healthcare requires the development of healthcare teams and collaboration among its members. Which of the following statements represents an element of this teamwork? A) Each group member of a team is the leader of the team. B) The organization sets the goals for its teams. C) Communication patterns in teams flow both up and down. D) Team members are not legally responsible for decisions and outcomes.

C) Communication patterns in teams flow both up and down

1. A nurse begins to feel comfortable on her unit and views client care in terms of long-range goals. She is able to prioritize among clients and deliberately plan her actions, which may still lack speed and flexibility. Which of Benner's levels of function has this nurse achieved? A) Novice B) Advanced beginner C) Competent D) Proficient

C) Competent

3. A nurse will soon become a member of a newly-established care team. Which of the following is a goal of team building? A) Acknowledging individual achievements B) Providing client care based on the direction of the team leader C) Creating a type of synergy when addressing client care D) Allowing care to be determined by nurses who are not "too close" to the situation

C) Creating a type of synergy when addressing client care

15. A nurse who works in a busy, university hospital is committed to improving patient safety at the hospital. In order to meet this goal, what action should the nurse prioritize? A) Advocating for continuing education programs and funding of nurse educators B) Encouraging patients to be active participants in their care by communicating their expectations to caregivers C) Critically examining systems and processes at the hospital with the aim of suggesting improvements D) Teaching unlicensed care personnel about safety in the hospital setting

C) Critically examining systems and processes at the hospital with the aim of suggesting improvements

5. A hospital manager evaluates the workplace to ensure that ergonomics are working. Which of the following statements describes this scientific theory? A) Ergonomics is the study of client outcomes related to economic theories in healthcare. B) Ergonomics empowers clients to have a voice in their own plan of care. C) Ergonomics ensures that jobs are fitted to the physical abilities of the employees. D) Ergonomics provides guidelines for delegating responsibilities for client care.

C) Ergonomics ensures that jobs are fitted to the physical abilities of the employees.

15. A hospital patient who suffered a spinal cord injury has expressed an interest in exploring complementary/alternative therapies. The nurse should encourage the patient to begin this process by doing which of the following activities? A) Asking practitioners of different therapies to provide lists of satisfied clients B) Asking the patient's primary care provider for permission to explore nonbiomedical treatments C) Finding reliable evidence regarding the safety and effectiveness of therapies D) Determining whether the patient's health insurance would cover the cost of alternative/ complementary therapies

C) Finding reliable evidence regarding the safety and effectiveness of therapies

6. A senior nurse on a medical unit is aware of the role that she can play in establishing a culture of safety on the unit. What characteristic is most important to care settings that possess a culture of safety? A) Anticoagulants, opioids, and insulin are cosigned by two nurses. B) Physicians' orders are entered into a computerized system rather than a handwritten section of patients' charts. C) Nurses feel that they can report errors, near misses, and adverse events without being punished or denounced. D) Direct patient care is provided by ADN and baccalaureate nurses rather than practical (vocational) nurses.

C) Nurses feel that they can report errors, near misses, and adverse events without being punished or denounced.

6. A nurse is aware of the pivotal role that motivation plays in the formation of effective teams and the provision of excellent nursing care. Which of the following actions is most likely to motivate a team member? A) Ensure that the consequences of substandard performance are well-known. B) Publicize those individuals who have made exceptional contributions and point out those who have failed to perform adequately. C) Openly acknowledge team members who have made a particularly valuable contribution. D) Be clear that only the highest levels of performance are acceptable to the team.

C) Openly acknowledge team members who have made a particularly valuable contribution.

5. Which of the following is an accurate guideline for reporting the chemical dependency of a colleague? A) Confront the person you suspect, and offer assistance in obtaining treatment. B) Be sure beyond any doubt that a problem exists. C) Rely on an informed supervisor to assume responsibility for the problem. D) Be aware that help and rehabilitation are only offered to the person need it following disciplinary proceedings.

C) Rely on an informed supervisor to assume responsibility for the problem.

8. A few weeks ago, a nurse worked a shift with a colleague during which three oxycodone tablets went missing from the narcotic cupboard. As well, the nurse has noted that the colleague has sometimes documented the administration of oxycodone to patients only to have the patients continue to complain of pain. The nurse suspects that the colleague is taking the oxycodone from the unit for personal use. How should the nurse best follow up these suspicions? A) Organize coworkers and the colleague's family members to carry out an intervention B) Contact representatives from the state board of nursing C) Report these suspicions to the unit supervisor D) Confront the colleague with these suspicions

C) Report these suspicions to the unit supervisor

12. Jessica is a recent nursing graduate who was able to secure a position on the postsurgical unit where she completed the final preceptorship of her baccalaureate degree. Jessica has just received word that there will be sweeping changes in the organization of care on the unit, a development that she finds intimidating since she has only recently become adept at working in the existing system. How should Jessica best respond to this news? A) Elicit support from nurses who support maintaining the existing system B) Learn as much as she can about the proposed system C) Research alternatives to the change that has been proposed D) Express her concerns about the proposed change to the nurse manager

C) Research alternatives to the change that has been proposed

5. A nurse recognizes the importance of safely and efficiently delegating tasks in order to achieve a high standard of care. Which of the following is one of the NCSBN's five "rights" of delegation? A) Right education B) Right assessment C) Right circumstances D) Right motivation

C) Right circumstances

4. A nurse is called into work to perform triage in the aftermath of an earthquake. Which of the following are the expected responsibilities of this nurse? A) Set up and monitor IV lines. B) Prepare the emergency room for multiple victims. C) Screen victims to prioritize treatment. D) Check available blood products and assist with transfusions.

C) Screen victims to prioritize treatment

14. The Human Genome Project (HGP) has been the subject of extensive attention, both in the healthcare community and in the public at large. Which of the following bioethical issues is most applicable to the HGP? A) The HGP was conducted with little participation from developing countries. B) The HGP did not result in the number or quality of medical applications that were originally hoped. C) The HGP provides information that has the potential to influence the selection of behavioral attributes. D) The HGP calls into question many of the practices that have been accepted in Western medicine.

C) The HGP provides information that has the potential to influence the selection of behavioral attributes.

7. The history of family planning in the United States has been characterized by controversies, many of which continue to the present day. Which of the following statements most accurately conveys an aspect of these controversies? A) Protestant Christianity advocates a careful and deliberate control of the size of a population. B) The Church of Jesus Christ of Latter Day Saints (Mormons) teach that only nonhormonal contraceptive methods may be used. C) The Roman Catholic church states that the purpose of all sexual activity is the creation of new life. D) Judaism teaches that family planning should be the exclusive domain of wives.

C) The Roman Catholic church states that the purpose of all sexual activity is the creation of new life.

10. Alana is a registered nurse with an ADN degree who floats between several different medical and surgical units of a hospital. Today was Alana's fifth 12-hour shift in a row and she committed a medication error while providing care for one of the four patients to whom she was assigned. What factor is most likely to have contributed to this adverse event? A) The fact that Alana has an ADN degree B) The fact that Alana floats between several units C) The fact that Alana was working overtime D) The fact that Alana was responsible for four patients

C) The fact that Alana was working overtime

4. Which of the following is a characteristic of an effective performance evaluation system? A) The appraisal system operates outside of the scope of administration. B) Employees do not know in advance who will be evaluating them. C) The final disposition of the appraisal is shared with the employee. D) Evaluation concentrates on the personality of the employee.

C) The final disposition of the appraisal is shared with the employee

1. A doctor performs an abortion on a woman who is unable to carry a fetus to term because of a severe risk to her health. What is the term for this type of abortion? A) Spontaneous abortion B) Elective abortion C) Therapeutic abortion D) Legal abortion

C) Therapeutic abortion

11. A nurse leader has been commissioned to implement a new electronic documentation system in a hospital, replacing the existing paper-based system that has been in place for decades. What is the first step that this nurse should take toward facilitating this change? A) Enlist the support of the physicians and advanced practice nurses in the hospital. B) Publicize the deficits of the existing documentation system. C) Understand how and why individuals are often resistant to change. D) Begin the process of evaluation before the change is implemented.

C) Understand how and why individuals are often resistant to change.

11. A patient with a long-standing diagnosis of renal failure has declared her intention to stop hemodialysis. Because of the ethical ramifications of this, the care team has begun the process of making an ethical decision. This process should begin by A) eliciting input from impartial individuals from outside the hospital setting. B) explaining the major concepts of ethics to the patient and her family. C) clearly identifying the essential elements of the ethical problem. D) confirming the patient's cultural and religious background.

C) clearly identifying the essential elements of the ethical problem.

13. A hospital has recently implemented a barcode point of care (BPOC) system. This system will require the nurse to A) scan barcodes on patients' charts and their wristbands before administering drugs. B) cross-check physicians' orders and patients' medication administration records. C) scan patient wristbands and medication containers prior to medication administration. D) provide an electronic record of his or her nursing activities over the course of a shift.

C) scan patient wristbands and medication containers prior to medication administration.

15. Gene therapy has been touted as one of the most promising therapies for healthcare in the 21st century. At present, gene therapy is primarily limited by A) the dynamic nature of the human genome. B) objections to gene therapy that are posed by religious groups. C) the difficulty in producing safe, consistent therapeutic results. D) the fact that only around a dozen known human diseases have a genetic basis.

C) the difficulty in producing safe, consistent therapeutic results.

10. After several rounds of unsuccessful in vitro fertilization (IVF), a couple has chosen to explore the use of a surrogate mother. In most states, this would involve A) a civil court case in which a judge grants permission for the couple to proceed with surrogacy. B) the use of a surrogate who is selected from a state-recognized list of approved surrogates. C) the drafting of a detailed contract between the surrogate mother and the couple. D) a covert and illegal arrangement between the couple and the potential surrogate mother.

C) the drafting of a detailed contract between the surrogate mother and the couple.

12. A patient is receiving a transfusion of packed red blood cells and consequently requires frequent vital signs. A set of vital signs was just due during the nurse's scheduled lunch break and so a colleague took the patient's vital signs. After returning from lunch, the nurse confirmed with the colleague that the scheduled vital signs were taken, to which the colleague replied, "Yes, it seems like I'm covering you a whole lot lately." How should the nurse best respond to the colleague's statement? A) "I don't think that's a fair thing to say because I can't help when a set of vitals are due." B) "If you're implying that I don't pull my weight I think that you're badly mistaken." C) "Well, what goes around comes around, right?" D) "Could you explain what you mean by that?"

D) "Could you explain what you mean by that?"

7. A county hospital has recently implemented a practice change in which the SBAR technique is now used to communicate between nurses and physicians. The nurse has contacted an elderly patient's physician to report the patient's adventitious lung sounds and decreased oxygen saturation. Which of the following statements best exemplifies the "R" component of the SBAR tool? A) "Mr. Young has a do-not-resuscitate order." B) "Mr. Young's oxygen saturation is 86% on oxygen at 3 liters per minute by nasal prongs." C) "Mr. Young was admitted on January 14 with a diagnosis of failure to thrive." D) "I think that we should decrease Mr. Young's IV rate."

D) "I think that we should decrease Mr. Young's IV rate."

11. One of the expressed goals of Healthy People 2020 is to achieve health equity and eliminate disparities. What health indicator can most accurately gauge whether this goal is being achieved? A) Environmental quality B) Injury and violence C) Mental health D) Access to healthcare services

D) Access to healthcare services

7. The manager of a hospital unit has unilaterally decided on a change in the way that overtime is distributed among the nursing staff and has followed up this decision with an e-mail to all employees. What leadership style is exemplified by this manager? A) Participative leadership B) Permissive leadership C) Laissez-faire leadership D) Autocratic leadership

D) Autocratic leadership

9. Mr. Bains is a 70-year-old man who has been recently diagnosed with colon cancer. Mr. Bains is adamant that he does not want to undergo chemotherapy or radiotherapy, citing the unpleasant side effects and the absence of a guaranteed cure. His wife, however, is distraught that he would "give up so quickly" and begs the nurse to convince him to pursue treatment. Which of the following ethical principles would underlie the nurse's decision to respect Mr. Bains' informed choice? A) Beneficence B) Nonmaleficence C) Fidelity D) Autonomy

D) Autonomy

5. The Joint Commission has taken action to encourage healthcare organizations to reduce the incidence and impact of errors. How has the Joint Commission acted to facilitate these improvements in care? A) By delineating the scope of practice for registered nurses and practical (vocational) nurses B) By providing a forum for patients to report errors and substandard care C) By funding safety education in medical schools and nursing schools D) By standardizing the measures by which safety in hospitals is gauged

D) By standardizing the measures by which safety in hospitals is gauged

2. A nurse decides to pursue a career in community-based nursing. Which of the following statements represents the environment in which the nurse will be working? A) Community-based nursing is limited to work in public clinics, schools, and industry. B) The key to community-based settings is that the nurse is in charge. C) The nurse serves as an educator, guide, and resource person and determines the action taken by the client. D) Care in the community is cost-effective.

D) Care in the community is cost-effective.

13. A nurse is working a shift with a colleague who has a nursing student participating in the care of the colleague's patients. The nurse notices that the colleague has spent much of the morning on the computer at the nurse's station and is allowing the student to perform every aspect of the patients' care. How should the nurse best respond to this colleague? A) Speak directly to the colleague about these observations. B) Ask the nursing student if she feels like the colleague's patients are receiving good care. C) Report the colleague to the supervisor of the unit. D) Create a written report recording the facts of the morning.

D) Create a written report recording the facts of the morning.

3. A nurse is asked to obtain informed consent for a procedure to be performed on a patient who has not yet been told her cancer is terminal. Which of the following is an issue surrounding guidelines to the amount of information that should be given to this patient? A) Under a paternalistic model of care, the locus of decision-making resides with the patient's family, who are responsible for informing the patient. B) Physicians basically agree on the amount and nature of the information that should be provided to the patient, but disagree on its delivery. C) It is the responsibility of the nurse to inform the patient of matters that have not been discussed with the physician. D) In some cultures, both physicians and families strongly believe that those who are ill should be protected from bad news.

D) In some cultures, both physicians and families strongly believe that those who are ill should be protected from bad news.

2. A client receives the care of a physician, a nurse, an occupational therapist, and a counselor working together as a team. What is the term for this type of healthcare? A) Cross-discipline healthcare B) Comprehensive healthcare C) Holistic healthcare D) Interdisciplinary healthcare

D) Interdisciplinary healthcare

2. Which of the following statements accurately describes a basic guideline for using communication skillfully? A) Managers should communicate how to perform a task even if it is something the subordinate has already learned. B) Managers should not be afraid of making judgmental statements when dealing with a subordinate who has broken policy rules. C) Managers should attempt to formulate a response to an individual who is still speaking to avoid awkward pauses in the conversation. D) Managers should present direction as briefly as possible while still providing adequate data.

D) Managers should present direction as briefly as possible while still providing adequate data.

4. Which of the following guidelines supports current practice when using behavior control on a client? A) Methods of influence that decrease a person's ability to think rationally should only be used when a client is not acting in his or her own best interest. B) In many cases, the use of psychosurgery to effect a permanent change is recommended over drug therapy. C) Methods of influence that keep relevant facts from a client should only be used with the consent of the client's significant others. D) Methods that work through the cognitive and affective structure of a person are preferred treatment.

D) Methods that work through the cognitive and affective structure of a person are preferred treatment.

14. A hospital patient has discussed with the nurse her use of visualization, biofeedback, and relaxation exercises in managing the chronic pain that results from her fibromyalgia. The nurse should recognize this patient's use of what category of complementary/alternative medicine (CAM)? A) Biologically-based practices B) Manipulative practices C) Traditional indigenous medicine D) Mind-body medicine

D) Mind-body medicine

14. A nurse is aware that the incidence of medication errors at the hospital is much higher than it should be and that it is possible to reduce this incidence. Which of the following measures carries the greatest potential to reduce medication errors? A) Implementing team nursing, whereby every medication is administered by a pair of nurses B) Attaching physicians' orders to medication administration records (MARs) C) Keeping medication administration records (MARs) at the patients' bedsides D) Taking action to reduce distractions to nurses while they are administering medications

D) Taking action to reduce distractions to nurses while they are administering medications

9. The advent of technology has made it increasingly difficult to define the exact point at which death occurs. Which of the following is currently the most commonly-accepted criterion for death? A) The cessation of blood circulation B) The inability to perform respiration spontaneously C) Persistent lack of interaction with outside stimuli D) The cessation of brain activity

D) The cessation of brain activity

4. A nurse helps a client work through an ethical dilemma by using an ethical decision-making framework. Which of the following statements describes a component of this process? A) The steps of this process are distinctly different from those of the nursing process. B) Most ethical problems have one possible solution. C) The nurse uses the framework of his or her own values to assist the clients to make a decision. D) The facts of a situation make a difference in the options that are possible.

D) The facts of a situation make a difference in the options that are possible.

6. A nursing leader has expressed a desire to foster the characteristics and behaviors associated with transformational leadership. Which of the following actions best demonstrates transformational leadership? A) The leader makes it clear to employees that positive work performance will be rewarded and that sub-standard performance will bring consequences. B) The leader ensures that decisions are based on the consensus of every employee. C) The leader prioritizes the needs of each individual employee over the interests of the larger organization. D) The leader takes action to build trust and relationships between him/her and the employees.

D) The leader takes action to build trust and relationships between him/her and the employees.

3. Which of the following statements accurately reflects one of the primary provisions of the ANA Code for Nurses? A) The administrators of the healthcare facility are responsible and accountable for individual nursing practice. B) The physician determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. C) The nurse's primary commitment is to the employing agency. D) The nurse owes the same duties to self as to others.

D) The nurse owes the same duties to self as to others.

10. Racial and ethnic discrimination has been identified as a reality within healthcare institutions. Which of the following goals for the nursing profession is most appropriate? A) The nursing workforce should transcend racial and ethnic categorization and should not be appraised through this lens. B) The nursing workforce should have fewer Caucasian members and more racial/ethnic minorities. C) The nursing workforce should be made up of members from as many cultures as possible. D) The nursing workforce should reflect the population for whom it provides care

D) The nursing workforce should reflect the population for whom it provides care

3. The movement of a client from acute care to a long-term nursing care facility involves planning to provide continuity of care. What is the term for this type of planning? A) Discharge planning B) Comprehensive planning C) Ongoing planning D) Transition planning

D) Transition planning

1. A mother and a daughter are taken to the emergency room for injuries suffered in a car accident. When the mother is taken to surgery, the nurse tells her that her daughter will be fine, even though she does not know the exact extent of the daughter's injuries. This nurse's actions may have been guided by which of the following ethical theories? A) Social equity and justice B) Natural law C) Deontology D) Utilitarianism

D) Utilitarianism

8. A recent nursing graduate has become overwhelmed with reality shock in recent weeks, despite the fact that he secured a job in the setting that was his first choice. This nurse's best response to his experience with reality shock is to A) confront the manager of the unit with the details of his experience. B) reduce the performance expectations that he places on himself. C) prioritize physical assessments and interventions over patients' psychosocial needs. D) seek input from a trusted nurse who can act as a coach or mentor.

D) seek input from a trusted nurse who can act as a coach or mentor.

13. The practice or organ transplantation is associated with several important bioethical issues. The ethics of transplantation primarily surround the fact that A) organ transplantation does not guarantee positive outcomes. B) only a small number of the organs in the body are amenable to transplantation. C) transplantation is a treatment of last resort. D) the demand for organs greatly exceeds the available supply.

D) the demand for organs greatly exceeds the available supply.