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1. The benefit to health care providers resulting from their effective efforts to help minimize reality shock among novice nurses includes: a reduction in staff turnover. a reduction in sentinel events. an increase in patient satisfaction. an increase in advanced degree nurses.
A. Reality shock leads to stress, which can threaten the well-being of new nurses and result in physical illness and mental exhaustion, leading to disillusionment with their career and ultimately to absenteeism and turnover. Although the remaining options are desirable, they are not generally related to reality shock. REF: Page 426
1. During orientation a novice nurse sits and "virtually spends" the first few paychecks, envisioning the money going into a personal bank account. In the dream state, the nurse smiles and knows that the pain of nursing school was worth it. Which phase of reality shock is the nurse experiencing? a. Honeymoon b. Shock or rejection c. Recovery d. Resolution
ANS: A During the honeymoon phase the novice nurse has a positive image of nursing that coincides with the reason for becoming a nurse; this feeling is experienced immediately after the nurse begins work and often while still in orientation. During the shock or rejection phase, the novice nurse is overwhelmed by fear and a sense of incompetence. During the recovery phase, the novice nurse regains some confidence and begins to heal. At the resolution phase, the novice nurse has adjusted to the work environment and can work through change. DIF: Application REF: Pages 499-501
5. Several novice nurses share lunch breaks and have comments such as, "I have insomnia from worrying about what I forgot to do for my patient," and "I have no energy," and "I can't believe I can't do my job correctly." These novice nurses are experiencing: a. burnout. b. self-worth. c. confidence. d. resilience.
ANS: A Symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings, anxiety, poor work quality, depression, and anger. These novice nurses are demonstrating low self-esteem. These novice nurses are uncertain about their abilities as nurses. These novice nurses feel defeated and lack flexibility to overcome feelings of inadequacy. DIF: Application REF: Page 500
12. A certified oncology nurse notices that a novice nurse is unsure of decision making and lacks technical skills. The novice nurse gains confidence by sharing and learning with the experienced nurse. This relationship continues and builds, allowing the novice nurse to become more confident. This relationship is known as: a. mentoring. b. role modeling. c. a preceptorship. d. socialization.
ANS: A The experienced and novice nurses have entered into a mutually agreed upon interactive relationship to ease the transition of the novice nurse into the profession. An interactive relationship is present. A preceptorship is usually a short-term relationship. Socialization is the desired outcome of mentoring but not of actual interactions. DIF: Knowledge REF: Page 509
9. When the novice nurse asks, "What will happen if this task is not completed," which skill is being demonstrated? a. Priority setting b. Delegation c. Organization d. Clinical skills
ANS: A The novice nurse is considering the legal and safety ramifications if the task is not completed. The novice nurse did not ask, "Who else can perform this task?" Prioritization is one part of organization but does not fully operationalize this concept. The novice nurse may be able to perform any required tasks but may be limited by time. DIF: Comprehension REF: Pages 506-507
8. The novice nurse calls a supervisor and requests that a "float nurse" be assigned to help with all "assessments of new admissions and postoperative patients." The supervisor asks, "How many admissions and surgery patients have you received?" The novice nurse becomes flustered because she has not checked the census but simply bases the need on feeling swamped. This situation best indicates a lack of: a. organizational skills. b. communication skills. c. interpersonal skills. d. clinical skills.
ANS: A The novice nurse lacks proficiency, which may be exaggerated by feelings of being overwhelmed by the new environment, causing him or her to not get the facts before asking for help. The novice nurse was able to communicate her need for help but lacked justification. The novice nurse was able to interact with the supervisor and was not required to interact with other members of the health care team. Feeling incompetent or lacking skills may lead to the feeling of being overwhelmed; however, the novice nurse was disorganized and had not accurately assessed the needs of the unit. DIF: Application REF: Page 506
6. Which nurse is more prone to burnout? The nurse who: a. graduated last in the class. b. is industrious and conscientious. c. refuses to work an extra shift even though he or she needs the money. d. volunteers to serve on only one committee and keeps in touch with schoolmates.
ANS: B Burnout is more common among nurses with type A personalities and those who are overachievers. Burnout most often occurs among students who are at the top of the class and have high grades. Long hours and repeated overtime can lead to burnout; thus refusing to work overtime or back-to-back long shifts may help avoid burnout. Prioritizing obligations and retaining friendships outside the work environment can reduce stress, thus reducing the likelihood of burnout. DIF: Comprehension REF: Page 500
2. A novice nurse is assigned a patient who has an order to draw blood for culture and sensitivity from a central line before antibiotic therapy is started. The novice reads and rereads the procedure manual. An hour later he stands at the bedside of the patient and stares at the central line, without knowing how to proceed. This phase of reality shock is termed: a. honeymoon. b. shock or rejection. c. recovery. d. resolution.
ANS: B During the shock or rejection phase, there is inconsistency with what was learned in school and the work environment, and the novice nurse lacks many of the skills needed to be independent in this new role. During the honeymoon phase, the novice nurse has not yet been faced with complicated tasks that he or she feels uncomfortable or incompetent to perform. The novice nurse lacks confidence in himself or herself, and no healing is evident. The novice nurse has not reached the recovery phase, which precedes the resolution phase. DIF: Application REF: Page 499
4. The novice nurse arrives on the nursing unit, is introduced to the staff, is assigned a preceptor, and is asked to participate in the next staff meeting. This introduction into nursing is appropriately termed: a. biculturalism. b. socialization. c. transition. d. "going native."
ANS: B Socialization involves the acceptance and integration of the novice nurse into the profession of nursing, as well as the identification of the novice nurse with the profession of nursing. Biculturalism is the blending of school values with those of the workplace. Transition involves competency when moving from the school to the work environment, and this situation does not require competency on the part of the novice nurse. "Going native" describes an inappropriate attempt to move from the shock phase to the recovery phase in which the novice nurse mimics the unsafe practices of experienced nurses. DIF: Application REF: Page 504
14. A student nurse wants to meet other nursing students from different countries and to learn of employment possibilities. The student nurse should: a. participate in the clinical facility's employee satisfaction task force. b. join the Student Nurses Association. c. take part in self-mentoring. d. postpone taking the licensure examination so he or she can take a tour of foreign countries.
ANS: B Students who participate in preprofessional organizations such as the Student Nurses Association have an opportunity to meet students across the nation and around the world and can network with leaders to gain knowledge about employment possibilities. The clinical facility's employee satisfaction task force is interested only in the population at the place of employment. Self-mentoring can help a novice become more self-sufficient but does not facilitate networking or interacting with individuals from other states or nations. Posting a resume may result in a job offer in another country, but this does not allow interactions with other nurses, or it may limit information acquired about the role of registered nurses in other countries that might be learned through networking. DIF: Comprehension REF: Page 510
15. An experienced nurse working in oncology is shocked to realize that he feels little empathy when a patient explains, "I developed cancer from having to work in the dry cleaning industry since I was only 8 years old to help support my younger siblings during the depression. Now they have all moved away and refuse to help me financially, and it takes everything I have to pay for my chemotherapy medicine." The nurse is experiencing: a. burnout. b. compassion fatigue. c. reality shock. d. Benner's expert stage.
ANS: B The nurse is experiencing a gradual decline in compassion over time as a result of being exposed to events that have distressed his or her patients, such as working at a young age to support a family while inadvertently being exposed to carcinogens. The nurse is experiencing a gradual decline in compassion over time as a result of being exposed to events that have distressed his or her patients, such as working at a young age to support a family while inadvertently being exposed to carcinogens. Burnout refers to feelings of being overwhelmed and distressed, resulting in poor work quality and symptoms such as insomnia and lack of professional pride. Reality shock occurs when a novice nurse enters the workforce after graduating from school and is not prepared to deal with differences between school and workplace values. The expert nurse has intuition, and this scenario does not portray a lack of intuition. DIF: Application REF: Page 500
MULTIPLE RESPONSE 1. In orientation, a new graduate is surprised to learn of workplace violence in healthcare agencies and asks, "What kind of violence is common in hospitals?" The educator describes workplace violence as: (Select all that apply.) a. care of patients admitted who are victims of domestic violence. b. experienced nurses withhold pertinent information from coworkers to portray them as incompetent. c. coworkers participate in employee assistance program (EAP) for support to learn more about anger management for adult children living at home. d. care of persons being held for treatment prior to be jailed incarcerated for committing homicide. e. Statements such as "The new nurse has book sense but can't perform an admission physical without the help of everyone on the unit."
ANS: B, E Withholding information from novices or coworkers to purposely cause them to appear inadequate or unskilled is considered workplace violence due to anxiety and stress it produces. This should not be tolerated and should be reported. Such statements that belittle employees lead to job dissatisfaction, lack of teamwork, and burnout and are considered lateral or workplace violence. This should not be tolerated and should be reported. Employees are not involved in the violence but compassion fatigue may result. The employee is seeking help for issues outside work. Care of the inmate with a history of violent behavior occurred prior to admission to the health care agency. DIF: Application REF: Pages 511-513
3. According to Kramer, nurses in the shock phase should ask themselves: a. "How can I fit in with other staff?" b. "Why can't I perform as everyone expects?" c. "What changes can I make to make me feel good about the choice to become a nurse?" d. "How can I get the rest of the staff to change?"
ANS: C During the shock or rejection phase, novice nurses must ask themselves what they must do to become the type of nurse envisioned and to make a contribution. "Fitting in" comes with gaining confidence, which is the issue faced by the graduate. Although becoming more organized and improving communication is part of resolving the shock phase, the novice should focus on positive accomplishments and should remember that a nurse cannot learn everything in school—many skills are learned after graduation. Expectations of new graduates are often unrealistic. Although being a change agent is beneficial, blaming others is not the best choice. DIF: Comprehension REF: Page 499
11. When comparing mentoring and role modeling, the role of mentoring is represented by: a. the experienced nurse is unaware that the novice nurse is observing him or her gathering supplies needed to start intravenous antibiotics. b. the novice nurse mimics conversations with his or her own patients that were unobtrusively overheard between the experienced nurse and his or her patients. c. the novice nurse receives feedback from the experienced nurse related to the use of a new occlusive dressing product and is told, "I couldn't have done it better myself." d. an experienced nurse is nominated for outstanding employee of the month by the novice nurse.
ANS: C The experienced nurse knowingly enters into a relationship to advocate for and to enhance the self-esteem of the novice nurse. Mentoring requires an interactive process. The novice nurse mimicked the experienced nurse, and the experienced nurse is most likely unaware of this role. The novice nurse is promoting the professional satisfaction of the experienced nurse; however, the experienced nurse is not building the confidence and self-esteem of the novice nurse in an effort to enhance his or her professional confidence. DIF: Application REF: Page 509
13. A novice nurse is unsure how to correctly administer an injection using the Z-track method. What is the best approach for learning this procedure? a. Read the procedure manual and follow the steps exactly. b. Make an appointment at the skills laboratory of the former nursing school to practice. c. Ask to observe the skill as it is being performed, then perform it under direct supervision. d. Try to remember how the task was previously performed during a simulation.
ANS: C The novice nurse can become familiar with the technique, then can perform the skill under the supervision of an experienced nurse, ensuring competency. Although it does allow the novice to follow set steps, there is often more than one correct way to perform a skill, and this approach does not allow competency to be assessed. Once the student has graduated, the staff educator most likely will seek to refine the skills of the novice by demonstrating skills before asking the novice to perform them. Patient safety may be compromised should a critical step be forgotten. DIF: Application REF: Page 505
7. A novice nurse notices the medication nurse hurriedly gathering medications to be administered for the entire day, removing them from the packages, and placing them in a paper cup with the patient's name and room number on the cup. When one of the patients points at a pill and asks, "What is this?" and "What does this do?" the medication nurse is uncertain, because it has long since been removed from the packaging. The novice nurse speaks to the nurse manager about her observations and describes her concerns. The novice nurse has assumed the role of: a. loner. b. "rutter." c. change agent. d. "native."
ANS: C The novice nurse is working to improve the safety and patient environment and is a patient advocate. The novice nurse is interacting with the manager rather than preferring to work alone or in isolation. The novice nurse is taking an interest in her professional and work environment rather than viewing it as just a job. The novice nurse is not mimicking the actions of the experienced nurse but instead is taking action to improve patient care. DIF: Application REF: Page 501
10. In distinguishing between evaluation methods used in school versus those used in the work environment, it is noted that the work environment evaluation includes: a. determining whether steps are logical. b. formulating increments in correct order. c. efficiently organizing stages of the procedure. d. appraising outcomes according to policy.
ANS: D Outcomes are based on meeting existing criteria rather than on knowing how the outcome was achieved. The step "determining whether steps are logical" represents the school environment in which steps are performed on the basis of sound rationales. The step "formulating increments in correct order" represents the school environment evaluation, which stems from the "correct step" aspect. The step "appraising outcomes according to policy" represents the school environment, in which each step is evaluated, rather than indicating the overall outcome. DIF: Application REF: Pages 503-504
16. A recruiter is explaining benefits to a group of nursing externs who are highly sought for employment. The recruiter states, "We are the only hospital in town that offers a residency program." The recruiter further explains that a residency program: a. provides housing for the graduate nurse to decrease expenses until income is established. b. partners a medical resident with a nurse resident to learn interprofessional care. c. allows new graduates to work on a higher degree in nursing while being paid full-time. d. offers extended time for both theory and clinical activities that promote problem solving and clinical decision making.
ANS: D Residency programs offer a longer precepted orientation period (often 12 months) to bridge the gap between the classroom and practice. Housing is not the focus of residency programs but moving expenses may be negotiated as part of the employment process. Interprofessional education may be content for the residency program but partnerships are not included. Residency programs focus on content/activities that help the novice move to a higher level of confidence rather than focusing on higher education. DIF: Comprehension REF: Page 510
5. Nursing educational programs attempt to prepare the novice nurse to enter into clinical practice as a: beginner nurse. advanced beginner nurse. competent nurse. proficient nurse.
B. Advanced beginners are able to perform adequately and make some judgment calls based on experience; most novice nurses enter the workforce during this stage. Beginners are nursing students, while competent and proficient nurses usually emerge after a period of independent nursing practice. REF: Page 431
3. Which nursing care model is most likely to support the novice nurse's familiarity with providing holistic nursing care? Functional Primary Team Task
B. Most novice nurses are more comfortable with the whole-task system because it is more consistent with what they were taught in school. The whole-task system requires complete knowledge and encourages loyalty to the profession. The model of nursing care consistent with the whole-task system is primary nursing, in which the nurse is responsible for all the needs of the patient. The other options tend to fragment the care and divide it among many other providers. REF: Page 429
2. Compassion fatigue is most likely among nurses working with the: elderly. homeless. mentally ill. culturally diverse.
C. Nurses who work in emotionally charged environments, such as hospice, emergency departments, and mental health settings, are likely to experience this reaction. Intensive ongoing losses such as those in oncology care make nurses vulnerable to burnout and compassion fatigue. REF: Page 427
4. In order to best ensure that a novice nurse will transition well into the role of clinical care provider, the emphasis initially should be focused on: time management skills. clinical nursing skills. burnout prevention. socialization.
D. The transition from student to professional nurse is difficult. Socialization of the novice nurse is key to his or her ability to transition or just "survive" at the clinical level. The other options are relevant, but not initially. REF: Page 430