Chapter 1, Introduction to Nursing

An oncology nurse with 15 years of experience, certification in the area of oncology nursing, and a master's degree is considered to be an expert in her area of practice and works on an oncology unit in a large teaching hospital. Based upon this description, which of the following career roles best describes this nurse's role, taking into account her qualifications and experience? A) Clinical nurse specialist B) Nurse entrepreneur C) Nurse practitioner D) Nurse educator

Ans: A Feedback: A clinical nurse specialist is a nurse with an advanced degree, education, or experience who is considered to be an expert in a specialized area of nursing. The clinical nurse specialist carries out direct patient care; consultation; teaching of patients, families, and staff; and research. A nurse practitioner has an advanced degree and works in a variety of settings to deliver primary care. A nurse educator usually has an advanced degree and teaches in the educational or clinical setting. A nurse entrepreneur may manage a clinic or health-related business.

A client reports to the emergency department with ankle pain from a minor road accident. The nurse asks the client to fully describe the circumstances of the accident. Which ANA standard of nursing practice is best demonstrated by the nurse's action? A) Assessment B) Diagnosis C) Ethics D) Caring

Ans: A Feedback: According to the ANA Standard I, the registered nurse collects comprehensive data pertinent to the client's health or the situation. Standard 2 - Diagnosis is Standard 2, which occurs when the registered nurse analyzes the assessment data to determine the diagnoses or issues pertaining to the client. Standard 7 - Ethics pertains to the ethical guidelines of nursing practice. Caring, although an essential part of nursing practice, is not considered an ANA Standard.

The Nurse Corps of the United States Army was established by whom? A) Dorothea Dix B) Lillian Wald C) Florence Nightingale D) Isabel Hampton Robb

Ans: A Feedback: Dorothea Dix established the Nurse Corps of the United States Army.

A nurse instructor explains the concept of health to her students. Which of the following statements accurately describes this state of being? A) Health is a state of optimal functioning. B) Health is an absence of illness. C) Health is always an objective state. D) Health is not determined by the patient.

Ans: A Feedback: Health is a state of optimal functioning or well-being. As defined by the World Health Organization, one's health includes physical, social, and mental components and is not merely the absence of disease or infirmity. Health is often a subjective state; a person may be medically diagnosed with an illness but still consider himself or herself healthy.

A nurse receives an x-ray report on a newly admitted patient suspected of having a fractured tibia. The nurse contacts the physician to report the findings. What role is the nurse engaged in? A) Communicator B) Advocate C) Caregiver D) Researcher

Ans: A Feedback: Nurses are communicators when they report findings to the health care team. Advocacy involves actions such as protecting the patient's safety or rights. Administering care measures directly to the patient demonstrates the caregiver role. Research involves collecting and analyzing data.

The client's plan of care is created by the nurse using which guideline for nursing practice? A) Nursing process B) Nursing's Social Policy Statement C) Nurse practice act D) ANA Standards of Nursing Practice

Ans: A Feedback: Nursing process is used by nurses to identify the client's strengths, limitations, and health care needs; to formulate a plan of care to address the health care needs; to plan and implement a plan of care to meet those health care needs; and to evaluate the effectiveness of the plan to achieve established outcomes. The ANA Standards of Nursing Practice defines the activities of nurses that are specific and unique to nursing. Nurse practice acts are laws established by each state to regulate the practice of nursing. Nursing's Social Policy Statement describes the values and social responsibility of nursing, provides a definition and scope of practice for nursing and nursing's knowledge base, including the methods by which nursing is regulated.

A nurse is assigned the care of a client who has been admitted to the health care facility with high fever. Which nursing skill should be put into practice at the first contact with the client? A) Assessment B) Caring C) Comforting D) Counseling

Ans: A Feedback: On admission of the client to a health care facility, the nurse would be required to conduct an initial assessment of the client. Therefore, the nurse would implement his or her nursing skills in this case. This can be done by interviewing, observing, and examining the client. Caring skills are put into practice once the nursing needs are determined. Comforting and counseling skills may not have a major role in assessing client problems.

Which of the following organizations is the best source of information when a nurse wishes to determine whether an action is within the scope of nursing practice? A) American Nurses Association (ANA) B) American Association of Colleges in Nursing (AACN) C) National League for Nursing (NLN) D) International Council of Nurses (ICN)

Ans: A Feedback: The ANA produces the 2003 Nursing: Scope and Standards of Practice, which defines the activities specific and unique to nursing. The AACN addresses educational standards, while the NLN promotes and fosters various aspects of nursing. The ICN provides a venue for national nursing organizations to collaborate, but does not define standards and scope of practice.

A student has completed a nursing program accredited by the Commission on Collegiate Nursing Education. Which of the following is true about the organization? A) It fosters continued improvement in nursing education programs. B) Accreditation is by governmental peer review process. C) It ensures the quality and integrity of diploma nursing programs. D) It uses state-recognized standards to evaluate the programs.

Ans: A Feedback: The Commission on Collegiate Nursing Education fosters continued improvement in nursing education programs. Accreditation is by nongovernmental, peer review process. It ensures the quality and integrity of baccalaureate and graduate nursing programs, not diploma nursing programs. It uses nationally-recognized, not state-recognized, standards to evaluate the programs.

A nurse at a health care facility provides information, assistance, and encouragement to clients during the various phases of nursing care. In which of the following activities does the nurse use counseling skills? A) Educating a group of young girls about AIDS B) Telling a client to localize the pain in his abdomen C) Encouraging a client to walk without support D) Assisting a lactating mother in feeding her child

Ans: A Feedback: The activity of educating a group of young girls about AIDS is based on the nurse using counseling skills. Telling a client to localize his pain is an assessment skill. Encouraging a client to walk without support can be both a comforting skill and a caring skill. Assisting a lactating mother in feeding her baby is an example of a caring skill.

The nurse is administering immunizations to a group of teens in a county health clinic. The nurse correctly identifies this action as: A) Illness prevention B) Restorative care C) Treatment of disease D) Supportive nursing care

Ans: A Feedback: The aim of illness prevention activities is to reduce the risk for illness, to promote good health habits, and to maintain optimal functioning. Immunization administration is an example of illness prevention. Assisting with crutch walking, and teaching medication administration would be examples of health restoration activities. Administering antibiotics to a patient to treat an infection would be an example of treatment of disease. Hospice care is an example of supportive care.

Organize these events in chronological order, beginning with the earliest (1) and ending with the most recent (5). 1) During the Crusades, religious orders provided nursing care to the sick. 2) Florence Nightingale administered care to British soldiers during the Crimean War. 3) Clara Barton organized the American Red Cross. 4) Mary Elizabeth Mahoney graduated from the New England Hospital for Women and Children in 1879 as America's first African American nurse. 5) Margaret Sanger advocated for contraception and family planning in the United States. A) 1, 2, 3, 4, 5 B) 1, 2, 4, 3, 5 C) 1, 2, 4, 5, 3 D) 1, 2, 3, 5, 4 E) 2, 1, 4, 3, 5

Ans: A Feedback: The correct order of these events is (1) during the Crusades, religious orders provided nursing care to the sick; (2) Florence Nightingale administered care to British soldiers during the Crimean War; (3) Clara Barton organized the American Red Cross; (4) Mary Elizabeth Mahoney graduated from the New England Hospital for Women and Children in 1879 as America's first African American nurse; and (5) Margaret Sanger advocated for contraception and family planning in the United States.

What guidelines do nurses follow to identify the patient's health care needs and strengths, to establish and carry out a plan of care to meet those needs, and to evaluate the effectiveness of the plan to meet established outcomes? A) Nursing process B) ANA Standards of Professional Performance C) Evidence-based practice guidelines D) Nurse Practice Acts

Ans: A Feedback: The nursing process is one of the major guidelines for nursing practice. Nurses implement their roles through the nursing process. The nursing process is used by the nurse to identify the patient's health care needs and strengths, to establish and carry out a plan of care to meet those needs, and to evaluate the effectiveness of the plan to meet established outcomes.

A nurse is caring for a client with a hernia. Which of the following statements should the nurse use while counseling the client about his condition? A) "Open hernioplasty is the best surgery for you." B) "Open and laparoscopic hernioplasty are available." C) "You are not a suitable candidate for hernioplasty." D) "I had a bad experience when I underwent hernioplasty."

Ans: B Feedback: A counselor should provide the client with unbiased information from which to choose. Therefore, the statement that "Open and laparoscopic hernioplasty are available" should be used by the nurse when counseling a client with hernia. The nurse should, however, refrain from giving a personal opinion, so it should not be mentioned which surgery is best for the client; likewise, the nurse should not bring up his or her own past experiences. By reserving personal opinions, a nurse promotes the right of every person to make his or her own decisions and choices on matters affecting health and illness care. Telling the client about his suitability to surgery or the best surgery for him may be biased from the experiences of the past.

A nurse is caring for a young victim of a terrorist attack. During the rehabilitative process, the nurse assists the client in bathing and dressing. What role the nurse is engaged in? A) Advocate B) Caregiver C) Counselor D) Educator

Ans: B Feedback: As providers of care, nurses assume responsibility for helping clients promote, restore, and maintain health and wellness. Communicating the client's needs and concerns, and protecting the client's rights are components of the advocacy role of nursing. The nurse is simply assisting in hygiene measures; no education or counseling is being provided.

Which of the following nursing pioneers established the Red Cross in the United States in 1882? A) Florence Nightingale B) Clara Barton C) Dorothea Dix D) Jane Addams

Ans: B Feedback: Clara Barton volunteered to care for wounds and feed union soldiers during the civil war, served as the supervisor of nurses for the Army of the James, organized hospitals and nurses, and established the Red Cross in the United States in 1882.

A licensed practice nurse (LPN) is working as a staff nurse. What role do the LPNs working as staff nurses play? A) Work only in long-term care facilities and at client's homes B) Provide direct nursing care to the clients in the health care facility C) Work only as care providers, team members, and communicators D) Supervise the work of charge nurses working in different units

Ans: B Feedback: LPNs working as staff nurses provide direct nursing care to the clients in the health care facility. Staff nurses may work in hospitals, the community, clinics, long-term care facilities, or homes. They work not only as care providers, team members, and communicators but also as decision makers, client advocates, and educators. They do not supervise the work of charge nurses working in different units. Their work is coordinated by the charge nurse or the team leader.

A nurse incorporates the health promotion guidelines established by the U.S. Department of Health document: Healthy People 2010. Which of the following is a health indicator discussed in this document? A) Cancer B) Obesity C) Diabetes D) Hypertension

Ans: B Feedback: The 10 leading indicators of health established by Healthy People 2010 are: physical activity, excessive weight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunizations, and access to health care.

During the clinical rotation, a nurse documents the vital signs of a client on the bedside chart. What role is the nurse playing in such a situation? A) Decision maker B) Communicator C) Coordinator D) Client advocate

Ans: B Feedback: The nurse is providing, in written form, the client's vital signs to the health care provider checking the bedside chart during his or her clinical rounds, so the nurse acts as a communicator. The nurse is not making any decisions here, so the role is not that of a decision maker. The nurse is not playing the role of a coordinator or a client advocate. When the nurse coordinates services offered by a variety of health care professionals, the nurse acts as a coordinator. As a client advocate, the nurse should protect the client, understanding the client's needs and concerns.

A student wants to join a nursing program that provides flexibility in working at both staff and managerial positions. Which nursing program should the nurse suggest for this student? A) Hospital-based diplomas B) Baccalaureate nursing programs C) Associate degree programs D) Continuing nursing programs

Ans: B Feedback: The student could opt for a baccalaureate nursing program. Baccalaureate-prepared nurses have the greatest flexibility in qualifying for nursing positions at both staff and managerial levels. Hospital-based diploma programs are three-year courses and provide maximum exposure to clinical nursing. Students becoming nurses through the associate degree program would not be expected to work in a management position. Continuing nursing programs are on-the-job educational programs.

A nurse practitioner is caring for a couple who are the parents of an infant diagnosed with Down Syndrome. The nurse makes referrals for a parent support group for the family. This is an example of which nursing role? A) Teacher/Educator B) Leader C) Counselor D) Collaborator

Ans: C Feedback: Counseling skills involve the use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, and facilitate the patient's problem-solving and decision-making skills. The teacher/educator uses communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of clients and their families. A leader displays an assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups. The collaborator uses skills in organization, communication, and advocacy to facilitate the functions of all members of the health care team as they provide patient care.

Who is considered to be the founder of professional nursing? A) Dorothea Dix B) Lillian Wald C) Florence Nightingale D) Clara Barton

Ans: C Feedback: Florence Nightingale is considered to be the founder of professional nursing. She elevated the status of nursing to a respected occupation, improved the quality of nursing care, and founded modern nursing education. Although the other choices are women who were important to the development of nursing, none of them is considered the founder.

After graduation from an accredited program in nursing and successfully passing the NCLEX, what gives the nurse a legal right to practice? A) Enrolling in an advanced degree program B) Filing NCLEX results in the county of residence C) Being licensed by the State Board of Nursing D) Having a signed letter confirming graduation

Ans: C Feedback: The Board of Nursing in each state has the legal authority to allow graduates of approved schools of nursing to take the licensing examination. Those who successfully meet the requirements for licensure are given a license to practice nursing in the state. It is illegal to practice nursing without a license issued by the State Board of Nursing. A nurse does not have the legal right to practice nursing by enrolling in an advanced degree program, filing NCLEX results, or having a letter confirming graduation.

A health care facility determined that a nurse employed on a medical unit was documenting care that was not being given, and subsequently reported the action to the State Board of Nursing. How might this affect the nurse's license to practice nursing? A) It will have no effect on the ability to practice nursing. B) The nurse can practice nursing at a less-skilled level. C) The nurse's license may be revoked or suspended. D) The nurse's license will permanently carry a felony conviction.

Ans: C Feedback: The license and the right to practice nursing can be denied, revoked, or suspended for professional misconduct, such as a crime. Other areas of professional misconduct include incompetence, negligence, and chemical impairment. Committing a felony does affect the legal right to practice nursing, does not allow the nurse to practice at a lower level, and is not attached to the license.

A nurse is caring for a client who is a chronic alcoholic. The nurse educates the client about the harmful effects of alcohol and educates the family on how to cope with the client and his alcohol addiction. Which of the following skills is the nurse using? A) Caring B) Comforting C) Counseling D) Assessment

Ans: C Feedback: The nurse is using counseling skills to educate the client about the harmful effects of alcohol. The nurse can also suggest rehabilitative care for the client. The nurse uses therapeutic communication techniques to encourage verbal expression and to understand the client's perspective. Caring, comforting, and assessment may require active listening, but counseling is based upon the active listening and interaction between the client and the counselor.

A registered nurse assigns the task of tracheostomy suctioning of a client to the LPN. The LPN informs the nurse that she has never done the procedure practically on a client. What should be the most appropriate response from the registered nurse? A) "You are through with your theory class, so you should know." B) "Take the help of the nurse who knows to perform the procedure." C) "Take the help of the procedure manual and act accordingly." D) "I will help you in performing the procedure on the client."

Ans: D Feedback: Although the registered nurse has assigned the task to the LPN, the overall responsibility lies with the registered nurse. The registered nurse is answerable for the client's care, not the LPN. Telling the LPN that she should know the procedure because it is taught in class is inappropriate; putting theory into application would require supervision. Asking the LPN to refer to the manual and perform the procedure is incorrect because the LPN may commit mistakes. The LPN is not confident about the procedure and therefore should not be asked to do the task alone or with another nurse who knows the procedure.

A registered nurse adheres to the American Nurses Association's standard of professional performance by engaging in which of the following? A) Assessment B) Diagnosis C) Evaluation D) Collaboration

Ans: D Feedback: Collaboration is designated in ANA's standard of professional performance. Assessment, diagnosis, and evaluation are not designated in ANA's standard of professional performance. They are professional nursing responsibilities designated in ANA's standard of care list.

Which nursing role is the nurse exhibiting when collecting data about the number of urinary tract infections on the nursing unit? A) Advocate B) Leader C) Counselor D) Researcher

Ans: D Feedback: Data collection is part of the research process. As an advocate, the nurse would implement actions to protect the rights of the client. Counseling involves the use of therapeutic, interpersonal communication skills to provide information, make appropriate referrals, and facilitate client problem-solving and decision-making skills. A nurse leader is assertive and self-confident when providing care, effecting change, and functioning within groups.

While providing care to the diabetic patient the nurse determines that the patient has a knowledge deficit regarding insulin administration. This nursing action is described in which phase of the nursing process? A) evaluation B) implementation C) planning D) nursing diagnosis

Ans: D Feedback: Nursing focuses on human responses to actual or potential health problems. Identifying the problems occur in the nursing diagnosis phase. Mutually establishing expected outcomes with the patient occurs in the planning phase. Implementation of the individualized interventions, and evaluation of outcomes are also phases in the nursing process.

Which of the following is a criteria that defines nursing as profession? A) an undefined body of knowledge B) a dependence on the medical profession C) an ability to diagnose medical problems D) a strong service orientation

Ans: D Feedback: Nursing is recognized increasingly as a profession based on the following defining criteria: well-defined body of specific and unique knowledge; strong service orientation; recognized authority by a professional group; code of ethics; professional organization that sets standards; ongoing research; and autonomy.

The director of nursing (DON) of a major hospital is seeking to hire a nurse with a strong technical background to care for patients on a busy surgical unit. The DON is most likely going to hire a nurse prepared at which level of nursing? A) Doctoral level B) Master's level C) Baccalaureate level D) Associate level

Ans: D Feedback: The ANA's 1965 resolution prompted the 1985 ANA statement adopting the titles of associate nurse (a nurse prepared in an associate degree program with an emphasis on technical practice) and professional nurse (a nurse possessing the baccalaureate degree in nursing) for these two levels. Master's and doctoral prepared nurses possess higher degrees and expertise.

A student is choosing her educational path and desires a nursing degree with a track that contains community nursing and leadership, as well as liberal arts. The student would best be suited in which type of program? A) Licensed practical nursing program B) Certification in a nursing specialty C) Diploma nursing program D) Baccalaureate program

Ans: D Feedback: The baccalaureate degree in nursing offers students a full college or university education with a background in the liberal arts.

A nurse is caring for a client with quadriplegia who is fully conscious and able to communicate. What skills of the nurse would be the most important for this client? A) Comforting B) Assessment C) Counseling D) Caring

Ans: D Feedback: The client needs assistance in performing activities of daily life. This would require implementation of caring skills from the nurse. Comforting, counseling, and assessment skills are also required, but the priority is the caring skill. Comforting skills involve providing safety and security to the client, whereas counseling skills are implemented while providing health education and emotional support. Assessment skills would be required when collecting data from the client.

A nurse is providing nursing care in a neighborhood clinic to single, pregnant teens. Which of the following actions is the best example of using the counselor role as a nurse? A) Discussing the legal aspects of adoption for teens wishing to place their infants with a family B) Searching the Internet for information on child care for the teens who wish to return to school C) Conducting a client interview and documenting the information on the client's chart D) Referring a teen who admits having suicidal thoughts to a mental health care specialist

Ans: D Feedback: The role of the counselor includes making appropriate referrals. Discussing legal issues is the role of the advocate and searching for information on the Internet is the role of a researcher. Conducting a client interview would fall under the role of the caregiver.

Training schools for nurses were established in the United States after the Civil War. The standards of U.S. schools deviated from those of the Nightingale paradigm. Which of the following statements is true about U.S. training schools? A) Training schools were affiliated with a few select hospitals. B) Training of nurses provided no financial advantages to the hospital. C) Training was formal, based on nursing care. D) Training schools eliminated the need to pay employees.

Ans: D Feedback: Training schools in the U.S. profited by eliminating the need to pay employees because students worked without pay in return for training, which usually consisted of chores. U.S. training schools were established by any hospital; there was no formal training. Training was an outcome of work, which eliminated the need to pay employees. Nightingale training schools were affiliated with a few select hospitals, training of nurses provided no financial advantages to the hospital, and the training was formal, based on nursing care.