leadership final exam

23. On the scale from 1 to 10, with 1 being no prejudice and 10 being extreme prejudice, the placement of hate on the continuum would be at number _____.

10 Hate is the extreme negative manifestation of prejudice, followed by contempt, then tolerance, which is more neutral. DIF: Application REF: p. 183, Figure 10-1

1. According to the Palliative Performance Scale which patient is considered to possess 70% of normal function? a. 40 year old diagnosed with AIDS whose condition makes it impossible to hold a job. b. 70 year old diagnosed with end stage renal failure who spends most of the day in bed. c. 50 year old diagnosed with emphysema whose disease has begun to impact normal ambulate. d. 30 year old diagnosed with muscular dystrophy who is bed bound.

A 70% function implies that the patient has a reduction in ambulation and the disease process affect ability to hold a job. DIF: Application REF: p. 225, Table 12-3

3. The use of research to guide nursing practice is called: a. utilization. b. dissemination. c. generalizability. d. analysis.

A Utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process. DIF: Comprehension REF: pp. 95-96

6. The first field of nursing to certify advanced practitioners was the field of: A. adult nurse practitioners. B. nurse-midwifery. C. clinical nurse specialist. D. nurse anesthesia.

ANS: D In 1946, nurse anesthesia became the first field of nursing practice to certify advanced practitioners. pp. 71-72

9. Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to as a(n): a. benchmark. b. critical pathway. c. algorithm. d. case management.

B A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis. DIF: Knowledge REF: pp. 388-389

3. The statement, "Nursing is a caring profession that focuses on helping people be as healthy as possible," is an example of a: a. concept. b. construct. c. philosophy. d. model.

C A philosophy is the values and beliefs of the discipline. DIF: Comprehension REF: p. 79, Table 5-1

21. Six cultural phenomena that vary among cultural groups are known to affect health care. The influence of the consequences of these phenomena can be seen in which of the following? (select all that apply) a. Asians and American Indians tend to be nonadherent with medications because they believe that the environment has no control over their fate. b. Some cancers such as stomach cancer occur less frequently among blacks. c. Blacks and American Indians often resist direct eye contact. d. Mexican Americans are more likely to stand close and touch health care providers. e. Whites are often late for health care appointments.

C, D The use of eye contact is a cultural communication phenomenon. Cultures such as black and American Indian may view direct eye contact as rude behavior. Space and touch are cultural phenomena factors. In some cultures, touching strangers is inappropriate. On the other hand, Mexican Americans tend to be comfortable with less space because they like to touch persons with whom they are talking. DIF: Analysis REF: pp. 191-192

24. The largest single payer of hospital charges in the United States is ___________.

Medicare Medicare is the largest health insurance program; it covers the disabled persons with end-stage renal disease, and persons 65 years of age and older who qualify for Social Security. Since enactment of this program in 1965, the population covered by Medicare has doubled. DIF: Knowledge REF: p. 113

10. The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph? a. Time plot b. Pareto chart c. Flowchart d. Cause-and-effect diagram

A A run plot, or time plot, graphs data in time order to identify any changes that occur over time. DIF: Comprehension REF: p. 388

5. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. A nurse is approached to sign a union authorization card. If signed, the card: a. authorizes the union to serve as his or her legal representative. b. indicates that the person is requesting additional information about collective bargaining. c. indicates the nurse desires to share information about grievances. d. gives permission for union dues to be deducted from pay.

A A signature on a union authorization card indicates that the nurse gives the union the right to serve as legal representation. DIF: Comprehension REF: pp. 259-260

15. The surgical team arrives in the operating room and one member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is known as: a. time-out. b. a critical pathway. c. special cause variation. d. lean methodology.

A A time-out occurs in the operating room to ensure the entire surgical team identifies the patient, operative site, and possible concerns or questions about the procedure. DIF: Comprehension REF: p. 391, Box 22-2

9. The nurse who admits making a medication error and immediately files an incident report is demonstrating: a. accountability. b. individuality. c. an injustice. d. values clarification.

A Accountability is an ethical duty that states that one should be answerable legally, morally, ethically, or socially for one's actions. DIF: Comprehension REF: p. 162 |pp. 176-177

7. When first diagnosed with Parkinson disease, how can the patient and family best avoid future ethical dilemmas concerning the patient's care? a. Work with the patient and family to create an advanced plan of care. b. Explain to the family that the patient's cognitive function will deteriorate as time passes. c. Discuss the patient's religious and spiritual concerns to identify potential problems. d. Identify which family members will be in control of decision making for the patient.

A Advance care planning is a process for eliciting a patient's values and preferences concerning current and future health care decisions. This plan is used to establish a patient's goals of care during serious illness. Having such a plan in place will help minimize ethical issues regarding how care will be determined and delivered. DIF: Application REF: p. 220

17. A nurse is assigned to a unit where 95% of all patients required total care. Most days the assistive personnel are able to complete their assignments and provide high-quality care. A patient returning from a procedure was somehow "skipped" when daily baths were performed and requests that her care now be provided. The nurse discovers the bed is rumpled and damp. The RN joins with some other staff to bathe the patient, change the bed, and help make the patient comfortable. These staff members are demonstrating: a. altruism. b. veracity. c. autonomy. d. whistle-blowing.

A Altruism is concern for the welfare of others, including willingness to help others when they are unable to get their assignments completed to ensure that the patient receives high-quality care. DIF: Comprehension REF: pp. 168-169, Table 9-1

8. An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect

A An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue. DIF: Application REF: p. 336

19. In the preparedness phase for disasters, the community plans for a possible terrorist attack using anthrax as the weapon of destruction. What treatments and/or preparations would be needed? a. Vaccines and Level B Personal Protection Equipment (PPE) b. Treatment for burns, decontamination, and Level A PPE c. Social distance determination, decontamination for radioactive fallout d. Identify and detect incendiary devices, treatment for burns and propellants

A Anthrax is a biologic weapon and requires Level B protection since it is a known agent and can be carried in wind or surfaces. Timing of treatment is critical and vaccines are available. DIF: Analysis REF: pp. 282-284, Table 16-1

10. A nurse is preparing a presentation using different websites to collect information. The nurse is concerned that contact information and the author's credentials are not listed for one of the websites reviewed. Which criterion required to establish a reputable website is missing? a. Authority b. Objectivity c. Usability d. Currency

A Authority is the criterion that is related to the credentials and background that have prepared an author to publish on the subject. DIF: Comprehension REF: p. 276

9. According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement? a. Authoritative b. Closed systems c. Open systems d. Trait

A Autocratic/authoritative management style revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place. Represents the systems theory of the organization. DIF: Application REF: p. 300, Box 17-3

12. During a seminar on ethics, the educator realizes that more information is needed when a participant describes which situation as a violation of the ethical principle of autonomy? a. An older person with advanced stages of Alzheimer's disease is denied the right to ambulate in the hallway. b. A mentally competent adult refuses medical treatment for the autoimmune disease lupus erythematosus, stating that this condition reflects the will of a higher power. c. A mentally competent visitor fell during visiting hours but refused to be examined by the physician on call. d. A mentally competent adult with a broken wrist refuses to be given a local anesthetic prior to a procedure.

A Autonomy is defined as personal freedom, the right to make choices. However, in this case, the patient is not able to be fully informed so they can clearly understand the choices being offered. DIF: Application REF: p. 170

7. A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were associated with a survey of college sophomores. The researcher was applying the principles of: a. beneficence. b. human dignity. c. justice. d. human rights.

A Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their good. DIF: Comprehension REF: p. 170

1. Consumers are concerned with security issues related to their confidential health information being placed in an electronic health record (EHR). However, when the security of the EHR is compared with that of paper-and-pencil records, the EHR is: a. more secure. b. less secure. c. equivalent. d. not comparable with the paper-and-pencil record.

A Computer-based patient record systems, such as EHRs, provide better protection than paper-based systems. The EHR allows only authorized users to view data, and access to records can be audited for inappropriate use. DIF: Comprehension REF: p. 271

5. A consumer is learning about electronic health records at a local health fair and states, "I am worried that someone can read my health information and I really don't understand the difference between privacy and confidentiality." The nurse explains that an example of confidentiality would be: a. a pledge that states, "I will hold matters pertaining to my patients in strict intimacy." b. a patient who does not tell the physician that he has been treated for a sexually transmitted disease. c. a teenager who sustains a broken arm and in the emergency department and withholds information about her use of recreational drugs. d. locking medical records in cabinets to prevent unauthorized users from accessing patient information.

A Confidentiality is keeping private the personal information that was given to a health care provider, unless others have a legitimate need to know. DIF: Application REF: p. 271

10. While completing a nursing degree in Virginia, a student who is interested in teaching in Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of Mexican-Americans live there. This nursing student values: a. cultural competence. b. ethnocentrism. c. prejudice. d. stereotyping.

A Cultural competence is the responsibility of all nurses to become knowledgeable about the values, beliefs, and health care practices of the culturally diverse groups that are dominant in the nurse's particular practice area. DIF: Application REF: p. 188

1. An older adult client was admitted to the hospital with the condition classified as "pneumonia." Reimbursement was based on a predetermined fixed price. This classification system is referred to as: a. diagnosis-related groups (DRGs). b. subjective symptom management. c. acuity classification system. d. organized managed care.

A DRGs are used in reimbursement for health care services based on a predetermined fixed price per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a diagnostic grouping on the basis of his or her primary diagnosis at hospital admission. Medicare limits total payment to the hospital to the amount pre-established for that DRG. DIF: Comprehension REF: p. 3 |pp. 9-10 |p. 106 | pp. 108-109

9. An advanced practice nurse inputs into a computer software program the following clinical manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of consciousness. The computer diagnosis of fat emboli is generated by a system known as: a. decision support. b. telehealth. c. robotic technology. d. biometric technology.

A Decision support systems are computer-based information systems that include knowledge-based systems designed to support clinical decision making. DIF: Comprehension REF: pp. 268-269

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

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. DIF: Comprehension REF: pp. 416-417

5. During the relief response phase of a disaster resulting from a "dirty bomb": a. treatment for burns and poisoning is provided for victims. b. emergency plans are coordinated between agencies. c. reconstruction of destroyed facilities and homes begins. d. food stores are collected for potential victims.

A During the relief response phase of a disaster, emergency responders provide assistance to victims and stabilize the scene; with a dirty bomb, radioactive material causes burns and poisoning. DIF: Analysis REF: p. 288

11. A client who is reading a newspaper asks, "This article about health care states that many providers of health care lack effectiveness. What is the difference between effectiveness and efficiency?" The nurse explains that: a. effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome. b. effective refers to competence in clinical practice and efficiency describes quick completion of the task. c. efficiency means wasting and meeting a minimum standard and effectiveness refers to taking all the time needed to exceed expectations. d. efficiency refers to speed and effectiveness refers to the usefulness of the implementation.

A Efficiency means using the right combination of resources—energy, time, and money—to accomplish a task, and effectiveness means doing the right thing right in health care. DIF: Comprehension REF: p. 115

19. A nurse is interested in studying the rituals of a tribe living in remote areas of Africa. The researcher is accepted into the tribe and observes firsthand the rituals practiced. Themes were analyzed to arrive at a description of the culture including rituals. The nurse is practicing which type of research? a. Qualitative, Ethnography b. Qualitative, Phenomenology c. Quantitative, Quasi-experimental d. Quantitative, Secondary data analysis

A Ethnography is a method used to study phenomena from a cultural perspective. Ethnographers spend time in the cultural setting with the research participants to observe and better understand their experience. DIF: Comprehension REF: p. 89 |p. 95, Table 6-2

1. Nurses and community officials are working together to ensure that churches and schools have needed supplies to provide shelter for large numbers of individuals in the event of a natural or manmade disaster. These activities represent which phase of a disaster continuum? a. Preparedness b. Relief response c. Recovery d. Crisis intervention

A Every disaster response begins as a local event known as the preparedness phase, which consists of planning, preparedness, prevention, and warning. DIF: Comprehension REF: p. 285

18. A nurse is reading an abstract about a study related to Rocky Mountain Spotted Fever. The purpose is stated as follows: "To examine the generalizability of two randomized placebo-controlled clinical trials in patients with Rocky Mountain Spotted Fever to determine whether steroid therapy resulted in the positive outcomes." The nurse knows generalizability refers to the: a. conclusion that findings can be generalized from the sample to the entire population. b. fact that the group of steroids used are from the same organic compounds. c. possibility that the subjects were carefully selected and that outside influence is thus suspected. d. fact that the type of bacteria carried by ticks is universal.

A Generalizability is the deduction that findings from one study can be applied to other populations not involved in the actual research. DIF: Comprehension REF: p. 89

18. A nurse is assigned to a unit other than the one she is normally assigned due to increased census on the alternate unit. She is assigned to care for seven patients and participates in walking rounds where the patient's condition and needs are discussed between oncoming and off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall from her pocket, which contain the above information that contains patient sensitive data. The liabilities arising from this incident would be covered under: a. the Health Insurance Portability and Accountability Act. b. the ANA Scope and Practice Act. c. affirmative duty failing to question order. d. personal liability with floating and cross-training.

A HIPAA protects patient information and ensures confidentiality of data. DIF: Analysis REF: p. 125

18. A patient is eligible to change health care providers and insurance and asks, "I am interested in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would support these activities rather than just pay for services when I am sick"? Which, if any, health insurance plan would best meet the needs of this patient? a. Health Maintenance Organization (HMO). b. Fee for Service. c. Preferred Provider Organization (PPO). d. None, because health insurance plans currently cover only disease management, not preventive care.

A HMOs encourage preventive care. DIF: Comprehension REF: p. 110, Table 7-2

1. When planning health care, the nurse should be mindful that members of the Asian culture tend to: a. miss appointments because they are present oriented and time is viewed as flexible. b. look to their ancestors for guidance. c. plan ahead and be future oriented. d. arrive early because they have no concept of time.

A In Asian culture, individuals tend to be present oriented and time is viewed as being more flexible than in the Western culture; being on time for appointments is not seen as a priority. DIF: Comprehension REF: p. 194

13. A nurse who has practiced on an orthopedic unit for 10 years unexpectedly becomes pregnant. At delivery the physician informs the mother, "Your baby has Alport syndrome, but then I don't have to explain what that means with your medical background." The mother is unfamiliar with this disease and withdraws as a coping mechanism. Which nursing theory would provide a framework to guide nursing care for this mother? a. Mishel's uncertainty of illness b. Orem's self-care deficit model c. Nightingale's canons of nursing d. Levine's conservation model

A In Mishel's uncertainty of illness theory, the core position is that uncertainty in illness must be addressed. When uncertainties are not addressed, clients' negative perceptions will escalate and they will suffer. Nursing responsibility based on this theory consists of reframing the client's perceived loss of control, or uncertainty, and helping the client develop new skills of assimilation and accommodation. DIF: Comprehension REF: p. 86

5. A community health nurse has been visiting a postpartum client who suffered domestic violence throughout the pregnancy, and now the infant may be at risk. The nurse assisted the client in finding shelter and legal protection. The nurse's role and the conceptual framework involved are: a. change agent, according to Roy's adaptation model. b. translator, according to Leininger's theory of cultural care diversity and universality. c. case manager, according to Peplau's interpersonal relations model. d. caregiver, according to Rogers' science of unitary human beings.

A In Roy's adaptation model, when the client incurs an insult that renders him or her in need of environmental modification, the nurse will be the change agent in assisting the individual with this adaptation. DIF: Application REF: p. 79, Table 5-1 |p. 85

6. The nurse is preparing a plan of care for an black patient who has had a change of bowel habits from being constipated and having only two firm stools weekly to having three or more loose stools daily. Which comment is related to cultural variation for health information? a. The individual states, "I will need to discuss health care options with my grandmother." b. The eldest male member of the family will make all health care decisions. c. The patient has high respect for the nurse and nods approvingly, although she has no intention of complying with instructions or plan of care. d. The individual speaks very quietly and gently reaches to hold the nurse's hand for support.

A In the African-American culture, women, especially "Granny," play a key role in health care decisions. DIF: Application REF: p. 189 |p. 191, Table 10-1

11. A young child is having abdominal pain, and the doctor informs the parents that a computed tomography (CT or CAT) scan of the abdomen will be ordered. The doctor tells the child, "This CAT scan won't hurt you." The child is visibly upset because of a fear of cats. According to Mishel's uncertainty in illness theory, which stage of the framework is represented? a. Stimuli frame b. Appraisal stage c. Initiation of coping mechanisms d. Adaptation

A In the stimuli frame, the client reacts to some stimulus in a negative manner. The nurse at this stage should listen carefully and then initiate, seek, and clarify concerns and questions. DIF: Comprehension REF: p. 81, Case Study 5-1

3. rNurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system? a. Total patient care b. Partnership nursing c. Team nursing d. Functional nursing

A In total patient care nurses provide all aspects of patient care. DIF: Comprehension REF: p. 370

18. A nurse is evaluating Levin's Theory of Conservation to determine if it can be applied to patients in the initial phases of chemotherapy treatment. During this phase of theory acceptance, the nurse wants to determine if all the concepts of energy, structural integrity, personal integrity, and social integrity are included in the care of cancer treatment. The nurse is applying which criteria of theory acceptance? a. Inclusiveness b. Consistency c. Accuracy d. Fruitfulness

A Inclusiveness asks the question, "Does the theory include all concepts related to the area of interest?" DIF: Application REF: p. 77, Box 5-2

7. Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory? a. Trait b. Chaos c. Bureaucracy d. Organizational

A Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery. DIF: Comprehension REF: p. 298

5. When differentiating between slander and libel, the nurse knows that libel: a. results from defamation caused by subjective comments written in the nurse's notes. b. results from negative subjective comments made to those who are not providing care. c. occurs when the nurse verbally describes to the oncoming nurse assigned to the client objective data that place the client in a negative light. d. consists of repeating prejudiced comments made by the primary caregiver to a neighbor at the local supermarket.

A Libel is defined as comments that are written about a person that are defaming. Nurses may be subject to a charge of libel for subjective comments meant to denigrate the client that are placed in the medical record or in other written materials read by others. DIF: Comprehension REF: p. 149

18. A nurse caring for a Hispanic child admitted with diarrhea notices the child is wearing red yarn around the wrist. The nurse compliments the child's "jewelry," knowing it is believed to prevent: a. mal ojo. b. susto. c. bilis. d. empacho.

A Mal ojo is due to "admiration" from a stranger resulting in diarrhea. DIF: Application REF: p. 198

15. A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit's representative on the ethics committee, and coaching her daughter's soft ball team. Many of the staff observes how she manages time and provides care. This nurse's power comes from which type of power? a. Referent b. Legitimate c. Information d. Connection

A Referent power comes from the followers' identification with the leader. Referent leaders are admired and respected and able to influence other nurses because of their desire to emulate her. DIF: Comprehension REF: p. 297

13. A nurse works on a unit where electronic health records (EHR) are being initiated and asks, "What is meant by 'meaningful use' standards that are in our education packet?" The best answer is that "meaningful use": a. identifies a set of EHR proficiencies and benchmarks that EHR systems must meet to be certain that they are functioning to their maximum capacity and meeting this standard allows companies/organizations to qualify for funds to defray cost of the EHR from Medicare. b. refers to training competencies that all users must achieve to be able to access and transfer patient data/information. c. refers to a requirement that at least 50% plus one of all patients have data entered into the EHR. d. the requirement that rigorous confidentiality security is in place to protect all patient information from sources which have no right to the data.

A Meaningful use is "A defined set of EHR capabilities and standards that EHR systems must meet to ensure their full capacity is realized and for the users (hospitals and physician practices) to qualify for financial incentives from Medicare." DIF: Application REF: p. 271

2. A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with: a. negligence. b. assault. c. defamation of character. d. tort.

A Negligence is defined as failure to act in a reasonable and prudent manner. The most frequent allegations of nursing negligence include failure to ensure client safety, improper treatment, failure to monitor the client and report significant findings, medication errors, and failure to follow the agency's policies and procedures. DIF: Comprehension REF: p. 120|p. 132

5. A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of his or her own values as they relate to this issue. The nurse must: a. know his or her own values and how these values relate to beliefs and the philosophy of nursing. b. rid the impurities in his or her value system. c. ignore his or her own values. d. realize that values do not change and that they cannot be influenced by others.

A Nurses must make a deliberate effort to recognize their own values and must learn to consider and respect the values of others. Health care decisions are seldom made independently of other people. Decisions are made with the client, the family, other nurses, and other health care providers. DIF: Application REF: p. 167

13. A new nurse researcher is interested in tracing the history of nursing research. The researcher learns that nursing research began with: a. the work of Florence Nightingale during the Crimean War. b. studies between 1900 and 1940 following Nightingale's work. c. studies to improve patient care by doctorally prepared nurses. d. studies based on the naturalistic paradigm.

A Nursing research began with the Nightingale during the Crimean War—more can be read in Chapter 1 of this text. DIF: Comprehension REF: p. 91

7. Physical therapists are represented by a union, nurses are represented by a separate union, and pharmacists have yet another union within a single agency. This type of union representation is known as: a. occupational unionism. b. industrial unionisms. c. union shop. d. power sharing.

A Occupational unionism indicates separate unions for each occupation in an agency. DIF: Comprehension REF: p. 257

1. The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to: a. the registered nurse (RN). b. the licensed practical/vocational nurse (LPN/LVN). c. unlicensed assistive personnel (UAP). d. all levels of staff, because the information is about the past and cannot change.

A Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated. DIF: Comprehension REF: p. 357

16. A nurse groups patients with criteria such as "high risk for falls," "infection protocols," and "special communication needs" to determine the mix and number of staff needed on a telemetry unit. The nurse is using: a. a patient classification system to determine safe staffing levels. b. diagnostic-related groups for Medicare billing. c. case management to coordinate care. d. clinical pathways to determine care.

A Patient classification systems group patients according to care needs to determine safe staffing levels. DIF: Comprehension REF: p. 367

14. A group of nurses are assembling outside a hospital protesting the use of foreign nurses after several nurses were terminated due to what the hospital called recurring "decreased census." The nurses carry signs with messages asking potential patients to seek care elsewhere. The local newspaper picked up the story, and the hospital is receiving negative press. The nurses are participating in: a. picketing. b. collective bargaining. c. a strike. d. arbitration.

A Picketing is a form of protest in which people (called picketers) congregate outside a place of work or location where an event is taking place. Often this is done in an attempt to dissuade others from going in ("crossing the picket line"), but it can also be done to draw public attention to a cause. DIF: Comprehension REF: p. 257

16. A nurse is newly employed by a state-owned hospital that provides health care insurance requiring a deductible paid by the employee with the majority of the premium cost covered by the employer. The insurance provided to the nurse is: a. private health insurance. b. a federal insurances program known as PPACA. c. state-subsidized Medicaid insurance. d. single-payer system coverage.

A Private health insurance is a method for individuals to maintain insurance coverage for health care costs through a contract with a health insurance company that agrees to pay all or a portion of the cost of a set of defined health care services and is typically provided through an individual's employer with a portion of the cost paid by the employer and a portion paid by the employee. DIF: Comprehension REF: p. 106 |p. 113

12. According to the Quality Chasm report: a. health care providers should be proactive rather than reactive to patient needs. b. common needs rather than individual preferences should be the priority. c. medical information should be confined to the primary care provider. d. specialized providers or case managers should control health care decisions.

A Quality is based on predicting patient needs rather than reacting to needs. DIF: Comprehension REF: pp. 381-382

22. A nurse involved in researching the leading causes of death for minorities considers the federally defined minority groups, which include: (select all that apply) a. Blacks b. Russians c. Hispanics d. Asians or Pacific Islanders e. Scandinavians

A, C, D The Federally defined minority groups include blacks, Hispanics, American Indians, and Asians or Pacific Islanders. DIF: Comprehension REF: pp. 181-182

2. A nurse has been asked to serve as the charge nurse on the evening shift. The agency where the nurse is employed is considering unionization. If the charge nurse position is accepted, this nurse: a. can be represented by the union because charge nurses are not considered part of the management team. b. is part of the management team, so union participation would be a conflict of interest. c. can file a grievance that will be arbitrated automatically by the union. d. is ineligible for collective bargaining activities that deal with unfair labor practices.

A Serving as charge nurse is part of a nurse's professional role and not a management function. DIF: Comprehension REF: pp. 263-264

15. A nurse working in a privately owned hospital is charged with a negligent act after failing to check laboratory reports prior to giving a dose of digoxin (Lanoxin) resulting in the patient's condition becoming critical due to decreased cardiac output and falling leading to a broken hip and concussion. A nurse is brought in who testifies that a professional with the knowledge and skill of an RN should understand that, before administering this drug, potassium level and pulse level is always checked to prevent such an occurrence. The nurse's testimony as to what constitutes reasonable care is based on: a. the legal definition of standard of care. b. the legal definition of the informed consent process. c. the doctrine of res ipsa loquitur. d. governmental immunity.

A Standard of care is the legal criteria against which the nurse's (and physician's) conduct is compared to determine whether a negligent act or malpractice occurred. Nurses are specialists in hospital care who, in the final analysis, hold the well-being—in some instances, the very lives—of patients in their hands. DIF: Comprehension REF: p. 120

7. A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency? a. Safety b. Timely c. Equitable d. Patient-centered care

A Standardization contributes to safety and improves individual performance of care providers. DIF: Application REF: p. 381

3. A Mexican-American patient is attacked and beaten. This patient is at risk for "fright disease," which is known as: a. susto. b. empacho. c. bilis. d. mal ojo.

A Susto is an emotion-based illness common among Mexicans. An unexpected fall, a barking dog, or a car accident could cause susto. Symptoms include colic, diarrhea, high temperature, and vomiting. DIF: Comprehension REF: p. 198

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 each experiencing different symptoms of: a. burnout. b. low self-esteem. c. lack of confidence. d. resilience.

A Symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings, anxiety, poor work quality, depression, and anger. DIF: Comprehension REF: pp. 417-418

17. A state is devastated by a tornado killing many people, destroying communication systems, utility services, homes, and medical facilities. The state requests immediate assistance from the U.S. Congress and from surrounding states. The affected state should first contact the: a. Emergency Management Assistance Compact (EMAC). b. Institute of Medicine (IOM). c. Red Cross. d. Strategic National Stockpile.

A The EMAC is an organization authorized by the U.S. Congress through which a state impacted by a disaster can request and receive assistance from other member states quickly and efficiently. DIF: Comprehension REF: p. 280

1. A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client is an immigrant and is uninsured. Which act would prevent the client from being transferred to another facility? a. Emergency Medical Treatment and Active Labor Law b. Health Insurance Portability and Accountability Act c. Patient Self-Determination Act d. The Patient Safety and Quality Improvement Act

A The Emergency Medical Treatment and Active Labor Law is a federal statute that was enacted in 1986 to prohibit the transfer of unstable clients, including women in labor, from one facility to another. This law also prohibits refusal of care for indigent and uninsured clients who seek medical assistance in the emergency department. DIF: Comprehension REF: p. 123

13. A group of local volunteers respond to a tornado. Volunteers have completed an emergency response course and are able to assist with triage of injured citizens. They also participate in local health fairs to teach residents how to react during tornadoes. The responders are members of the: a. Medical Reserve Corps (MRC). b. Metropolitan Medical Response System (MMRS). c. National Disaster Medical System (NDMS). d. Commissioned Corps Readiness Force (CCRF).

A The MRC are local volunteers trained to respond to local emergencies. DIF: Comprehension REF: p. 285

14. Troops from the United States participating in a peace mission in a foreign country were the victims of suicide bombers and many soldiers were evacuated back home to receive specialized medical care. The nation's medical responses will be augmented by: a. the federally coordinated National Disaster Medical System. b. local homeland communities where troops receive care. c. the Medical Reserve Corps, which organizes and utilizes public health, nursing, medical, and other volunteers. d. the National Incident Management System, which guides government, nongovernmental organizations, and the private sector to work seamlessly during disaster situations.

A The National Disaster Medical System supplements care for casualties evacuated back to the United States from overseas and federally declared disasters including national disasters, major transportation accidents, technologic disasters, and acts of terrorism. DIF: Comprehension REF: pp. 286-287

5. Which organization provides federal funding for research? a. National Institute of Nursing Research b. Robert Wood Johnson Foundation c. W. K. Kellogg Foundation d. Sigma Theta Tau International

A The National Institute of Nursing Research is a federal agency that provides federal funding for health care research. DIF: Knowledge REF: p. 92

15. The Institute of Medicine (IOM) (2003) recommends that EHR systems offer eight functionalities. A patient has a severe allergy to eggs and penicillin. Which of the eight functions of the EHR would address sharing this information? a. Health information and data capture b. Results/data management c. Provider order entry management d. Clinical decision support

A The health information and data capture function includes information such as medical history, laboratory tests, allergies, current medications, and consent forms. DIF: Comprehension REF: p. 269, Table 15-1

15. Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act (PPACA) based on religious beliefs that prohibit circumcision and blood transfusions. These individuals believe the PPACA is unconstitutional because it: a. mandates that all U.S. and legal residents must secure health insurance. b. replaces current Medicare and Medicaid plans. c. requires all citizens to participate in offered preventive services. d. prohibits use of health practices outside of Western medicine.

A The PPACA is a type of national health insurance program to provide funding for U.S. citizens and legal residents to secure health insurance beyond the current programs such as Medicare and Medicaid. DIF: Comprehension REF: p. 106 |p. 110, Table 7-2

3. Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established? a. Administer an enema for an elective surgery patient. b. Administer an antiarrhythmic medication IV while interpreting the patient's rhythm on the cardiac monitor. c. Develop a plan of care for a stable patient admitted for observation after a head injury. d. Teach a patient how to instill eye drops for glaucoma.

A The RN who is delegating must consider the following: (1) the delegatee's current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task. DIF: Analysis REF: pp. 357-358, Box 20-3

19. A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee? a. Actually observe the delegatee perform the assigned task. b. Ask the delegatee how many times he/she has performed the task. c. Ask the patient if the care provided was satisfactory. d. Ask other nurses if they feel the delegatee is competent.

A The best way for the nurse to determine the competency of LPNs or UAPs is to observe them perform the task. DIF: Application REF: p. 361

2. A nurse is admitting a Mexican-American child, and the mother comments that the child was exposed to mal ojo. The nurse should expect to find which symptom associated with this exposure? a. Fever b. Nervous tension c. Bruising d. Somnolence

A The child has what is referred to as mal ojo or "evil eye," which can lead to diarrhea, fever, and even death. DIF: Comprehension REF: p. 198

14. A nurse is charged with battery after helping an invalid patient back to bed and not calling for help due to a reduced staffing level. The patient sustained excessive bruising, sore joints, and extended stay. In this case, the: a. patient is the plaintiff. b. nurse can be charged with forcefully restraining the patient without orders. c. nurse is accountable due to the decreased level of staffing. d. charge of invasion of privacy may be withheld.

A The complaining person in a lawsuit is the plaintiff. DIF: Application REF: p. 120

16. A nurse practicing on a unit where domestic violence is common wants to learn how to apply nursing theory to practice on this unit. She considers the interrelatedness of the constructs of Watson's Theory of Caring and designs (5 C's : Compassion, Commitment, Conscience, Confidence, Competence): a. conceptual model of caring. b. hypothesis of the impact of caring on domestic violence. c. proposition of how caring is conceptualized. d. theory of scientific inquiry.

A The conceptual model demonstrate how the concepts of compassion, commitment, conscience, confidence, and competence form a theme of caring (Watson). DIF: Comprehension REF: p. 85

6. Regardless of the term used to describe high-quality health care, the focus of quality is: a. what the consumer needs and wants. b. economical care. c. having the greatest technologic advancement. d. services equally distributed among populations.

A The customer determines quality on the basis of his or her unique perception of high-quality care. DIF: Knowledge REF: p. 382

16. The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of: a. direction and communication. b. task. c. person. d. circumstances.

A The directions were not clear. The RN did not specify which type of enema to give and what outcome to expect. And the RN gave no instructions related to reporting back. DIF: Application REF: p. 360

4. An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Referent

A The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency. DIF: Comprehension REF: p. 300, Box 17-3

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.

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. DIF: Comprehension REF: p. 425

6. When assessing an ethical issue, the nurse must first: a. ask, "What is the issue?" b. identify all possible alternatives. c. select the best option from a list of alternatives. d. justify the choice of action or inaction.

A The first step in the situational assessment procedure is to find out the technical and scientific facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and opinions. Assessment can be applied to all areas of patient care, including ethics. Trying to understand the full picture of a situation is time consuming and requires examination from many different perspectives, but it is worth the time and effort. DIF: Comprehension REF: p. 172, Box 9-3

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

A The novice nurse is considering the legal and safety ramifications if the task is not completed. DIF: Comprehension REF: pp. 423-424

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 overwhelmed. This situation best indicates a lack of _____ skills. a. organizational b. communication c. interpersonal d. clinical

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. DIF: Comprehension REF: pp. 422-423

10. The nurse manager is planning staffing levels and realizes that the first step is to: a. know the intensity of care needed by patients according to physical and psychosocial factors. b. examine the educational level of the staff. c. assess the skill level of caregivers. d. review the budget to determine the financial consequences of past staffing patterns.

A The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients. DIF: Application REF: p. 367

4. A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? a. RN b. LPN/LVN c. Unlicensed assistive personnel (UAP) d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.

A The patient's condition is not stable; therefore, the skills of an RN are required. DIF: Application REF: pp. 357-358, Box 20-3

18. A nurse is interested in learning the phases of the disaster continuum and realizes it has many similarities to the nursing process. To better understand the phases of a disaster, which is true when comparing the phases of the disaster continuum to the nursing process? a. The preparedness phase of the disaster continuum is consistent with the assessment and planning steps of the nursing process. b. The recovery phase of the disaster continuum is consistent with the planning step of the nursing process. c. The recovery phase of the disaster continuum is consistent with the implementation step of the nursing process. d. The response relief phase of the disaster continuum is consistent with the evaluation step of the nursing process.

A The preparedness phase requires assessing possible needs of the community and planning appropriate interventions and is consistent with the assessment and planning steps of the nursing process. DIF: Comprehension REF: p. 285

11. A daughter tells the nurse that, "Mom will be as good as new when we get this advanced cancer cured." How can the nurse best help the daughter in the role of caregiver? a. Working toward setting realistic goals for both her mother and herself b. Finding the daughter in home help to assist with her mother's care c. Discuss with the patient the role her daughter will play in her care d. Encourage the daughter to regularly share her feelings with her mother

A The setting of realistic goals is vital to the physical and emotional well-being of the caregiver. DIF: Application REF: p. 229

8. A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? a. Transactional b. Situational c. Transformational d. Contemporary

A The transactional leader is concerned with the day-to-day operations of the facility. DIF: Comprehension REF: p. 298, Box 17-1

6. What are general explanations that scholars use to explain, predict, control, and understand commonly occurring events? a. Theories b. Constructs c. Systems d. Propositions

A Theories are a group of related concepts that explain existing phenomena and predict events. Theories provide us with a frame of reference, the ability to choose concepts to study, or ideas that are within one's practice. DIF: Comprehension REF: p. 79, Table 5-1

19. A novice nurse is in the "rejection phase" of stress and wonders if she made the right decision when deciding nursing was her chosen career. Which strategy would help the novice nurse cope with transition into practice and reduce stress? a. When asked by the charge nurse to accept the new admission even though she had no discharges, the novice nurse stops and considers if this request is acceptable and safe, then accepts the assignment based on two patients having a low acuity level. b. Refusing to eat anywhere but the hospital cafeteria to ensure a balanced diet and time to socialize with other staff and visitors. c. Avoid wasting time by listening to coworkers' problems or ideas on how to staff the unit during the upcoming holiday since the novice nurse's time is valuable and better spent getting her own work completed. d. Make an effort to "win over" hostile or angry coworkers who find fault with the novice nurse's work performance.

A To reduce stress and cope with the rejection phase of transition, the novice nurse should think before answering—take a few minutes before answering and deciding what is best course of action. DIF: Analysis REF: pp. 416-417

17. A nurse manager wants his nursing unit to be a place where all nurses want to work, where patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged to chair taskforces to improve quality of care and he counsels staff in areas of measuring patient outcomes. Other managers want to mimic this manager's approach to improve their own units. This nurse is which type of leader? a. Transformational b. Transactional c. Laissez-faire d. Authoritative

A Transformational leaders mentor followers through a vision and are admired and emulated. DIF: Comprehension REF: p. 298

1 . In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance

A Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider change. DIF: Comprehension REF: p. 311

20. A patient wants to reduce health care costs by being a model for making wise decisions that both promote health and reduce cost. Which statement by the patient would indicate a need for further teaching? a. "I will ask for the brand name drug Tylenol rather than acetaminophen since it works better and I won't be sick as long." b. "I looked up urinary tract infection prevention on the Internet." c. "I had my weight, body fat, and blood sugar measured at a local health fair." d. "My allergies are really bothering me. I spoke to the pharmacist, who recommended an over-the-counter antihistamine."

A Ways to reduce health care costs as a consumer include choosing generic drugs whenever possible. DIF: Analysis REF: pp. 115-116

20. Health care professionals have been activated to respond to a disaster, and the registered nurse who is coordinating the effort realizes that: (select all that apply) a. in the event of a mass casualty incident, care is prioritized to those who have the greatest chance of surviving. b. communities should use their own resources first to attempt to stabilize and organize the response. c. state assistance occurs any time a disaster occurs, regardless of the community's resources. d. the emergency operating plan developed by one central agency rather than individual facilities should be put into operation. e. strict protocols regarding the use of resources must be followed.

A, B Care is shifted to doing the most good for the most people. Efforts begin at the local level. DIF: Comprehension REF: pp. 283-284

23. Medicare would be responsible for: (select all that apply) a. a hospital stay following a total knee replacement for a 70-year-old client. b. nursing home cost for a 67-year-old adult receiving hemodialysis. c. rehabilitation care costs for a 24-year-old client with a broken femur resulting from a fall at work. d. prescription cost for a young mother who meets eligibility for Aid to Families with Dependent Children (AFDC). e. home health services to administer heparin to a 27-year-old truck driver following a thrombus.

A, B Medicare coverage is based on age and Part A covers inpatient hospital services. Medicare eligibility is based on age and disability with hemodialysis resulting from chronic renal failure classified as a disability. DIF: Comprehension REF: p. 110, Table 7-2

25. An interdisciplinary team is evaluating the hospital's care of patients admitted with a myocardial infarction (heart attack) compared to national standards. The team analyzes the hospital's clinical indicator, which would be: (select all that apply) a. aspirin order within 24 hours of discharge. b. patient teaching related to stopping smoking completed prior to discharge. c. beta blocker administered upon arrival. d. support of employer to modify stress in workplace. e. patient's willingness to adhere to a strict cardiac diet after discharge.

A, B, C Clinical indicators are measurable items that reflect the quality of care provided and demonstrate the degree to which desired clinical outcomes are accomplished. National benchmarks are established according to guidelines related to quality care for patients admitted with heart attack and include: aspirin within 24 hours of admission, angiotensin receptor blocker at discharge, stop smoking instruction given, and beta blocker administered upon arrival and discharge. These are all measurable. DIF: Application REF: p. 385

22. A novice nurse notices a patient is pacing the floor and twisting his hands. When the nurse enters the room, the patient stares at her and mumbles, "Can't anyone understand what I want?" while smiling and reaching out to shake the nurse's hand. The nurse recognizes a risk for violence based on which clinical findings? (select all that apply) a. Glaring at the nurse b. Nervousness, twisting of hands c. Murmuring when talking d. Diagnosis of a terminal illness e. Isolation, desire to be alone

A, B, C Nurses can recognize a risk for workplace violence by using the acronym STAMPEDAR (staring, tone of voice, anxiety, mumbling, pacing, emotions, disease process, assertive/nonassertive behavior, and resources). DIF: Application REF: pp. 428-429

21. Which statement made by an RN regarding delegation indicates the need for additional teaching? (select all that apply) a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely. b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for the purpose of increasing renal perfusion. d. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency. e. Responsibility can be delegated to the UAP, but the delegator retains accountability.

A, B, C The statement "UAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely" indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus the assessment skills of an RN are required. The statement "an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD" indicates the need for further teaching because administration of intradermal medication requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on a patient's blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN. DIF: Analysis REF: pp. 357-358, Box 20-3

19. Throughout their careers, nurses are in an ongoing state of acculturation, gaining experience from formal nursing school classes, clinical experiences, and the ethical issues they encounter in their clinical practice. The ideal outcomes of these ongoing experiences with cultural decision making include: (select all that apply) a. increased trustworthiness. b. enhanced ability to take into consideration many aspects of ethical situations. c. confidence to make decisions based on experience and ethical intelligence. d. improved clinical decision making and advocacy for patient autonomy. e. authority to make ethical decisions independently that meet personal moral beliefs.

A, B, C, D The desired outcomes of ethics acculturation across the years are integrity, personal growth, practical wisdom, and effective problem solving on behalf of patients and their families (Weaver et al, 2008). These are the qualities that are characteristics of an ethically sensitive and morally mature person. Trustworthiness is a characteristic of integrity. The ability to take into consideration many aspects of ethical situations is due in part to personal growth and practical wisdom. The confidence to make ethically sensitive decisions comes from experience founded on personal growth and personal wisdom. The ability to be the patient's advocate in ethical decision making is one test of cultural acculturation. DIF: Application REF: pp. 168-169

23. A nurse responsible for staffing a medical-surgical unit must consider: (select all that apply) a. the patient census. b. physical layout of the unit. c. complexity of care required. d. educational level of all staff. e. task preferences of the nurses.

A, B, C, D The primary considerations for staffing a specific nursing unit are the number of patients; the level of intensity of care required by those patients (commonly referred to as patient acuity); contextual issues, such as architecture, geography of the environment, and available technology; level of preparation and experience of the staff members providing the care; and the quality of the nurses' work life. DIF: Application REF: pp. 367-368

23. Which functions can be delegated only to another RN with appropriate experience and training? (select all that apply) a. Assessment of skin integrity on third day of hospitalization b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises c. Nursing judgment related to withholding medication based on vital signs d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed assistive personnel e. Formulation of nursing diagnosis "potential for fall"

A, B, C, E Activities like assessing skin integrity—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like evaluating patient teaching—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like deciding to withhold medication based on vital signs—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like formulating a nursing diagnosis—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. DIF: Application REF: pp. 361-362

21. Which of the following are concepts related to nursing theory? (select all that apply) a. Environment b. Health c. Nursing d. Relevance e. Comfort

A, B, C, E Environment is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. Health is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. Nursing is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. Comfort is a concept, which is a label given to ideas, objects, or events; concepts become the "pieces" that make up a conceptual model or theory. DIF: Comprehension REF: p. 83, Table 5-2

18. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. During the pre-election period, what actions by management are prohibited? (select all that apply) a. Seek individuals to spy on coworkers who are possible union supporters. b. Photograph employees participating in information sessions about unionization. c. Visit managers outside work to gain their perception of popularity of unionization. d. Threaten that, should the union win, the company will relocate when there is no intention to relocate. e. Require employees to declare their position on unionization prior to pick up paychecks.

A, B, D, E During the pre-election period, management may not solicit spying. During the pre-election period, management may not photograph employees engaged in union activities. During the pre-election period, management may not lie about what will happen if the union is the victor in an election. During the pre-election period, management may not question employees about their preferences regarding union activity. DIF: Comprehension REF: p. 261

13. Which statements are true regarding palliative care services? (select all that apply) a. Begins at the time of that a diagnosis of a serious illness occurs b. Care can be delivered in most settings. c. Expenses are paid for by Medicare. d. Is appropriate for all patients regardless of age. e. Providers are skilled in symptom management.

A, B, D, E Palliative care does begin with a diagnosis of a serious illness and can be delivered in a wide variety of care settings. The care is appropriate and available to patients of any age and is provided by skilled professionals. DIF: Comprehension REF: p. 224, Table 12-2

16. A hospital refused to purchase a better grade of utility gloves, even after learning that the cheaper utility gloves are easily punctured during routine use. This unsafe situation led nurses to seek unionization. During the pre-election phase for unionization, which actions by union representatives are prohibited by the National Labor Relations Board? (select all that apply) a. Scheduling a meeting in the agency's cafeteria to determine employees' interest in unionization b. Distributing nondocumented information that female nurses receive lower annual performance evaluations than do male nurses c. Distributing information about the benefits of unionization and grievances in a public parking garage located across from the hospital d. Suggesting to workers the likelihood of job loss should the union not win the election e. Signing authorization cards for employees who are on leave

A, B, D, E Union representatives must meet in nonwork areas. Union representatives must not spread rumors of prejudices. Neither the union nor employers can spread falsehood about potential job loss or repercussion in the event of unionization. Union representatives cannot sign cards for employees. DIF: Application REF: p. 259

22. Which factors would be considered in the first steps in developing an effective patient classification system? (select all that apply) a. Planned procedures b. Ethnic diversity of patients c. Clinical competency of staff d. Educational level of nurses e. Age of patients

A, B, E The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements. DIF: Comprehension REF: p. 368

24. A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2012 National Patient Safety Goals by implementing which protocols? (select all that apply) a. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed. b. Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family. c. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient. d. Mark the procedure site with "X" and again ask the patient to verify correct site. e. After arrival in the operating room, perform a "time-out" for final identification of patient and operative site along with agreement of what procedure is scheduled.

A, C, D, E The 2012 National Patient Safety Goal includes universal precautions to ensure patient safety and prevent sentinel events. Methods to identify patient and surgical procedure are required. DIF: Application REF: p. 391, Box 22-2

20. Registered nurses who are entering the workforce will have expanded leadership responsibilities that include: (select all that apply) a. serving on interdisciplinary care teams. b. being competent to work in several areas independently when dictated by patient census. c. attending a meeting to plan advanced training for unlicensed assistive personnel. d. evaluating outcomes of care that are reported to a standing committee. e. managing units with higher acuity, shorter length of stay, and more diverse patients and staff.

A, C, D, E The new nurses will be placed in many situations that require leadership and management skills: for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. Diverse patients have comorbidities and require complex interventions delivered during shorter stays with an ever-increasing diverse staff. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. DIF: Application REF: pp. 296-297

20. The informed consent documents must include: (select all that apply) a. an explanation of potential risks and benefits to participants in the study. b. medical terminology rather than lay terms to prevent misunderstanding of the study. c. a statement on how the anonymity and confidentiality of participants are protected. d. explanation of the cost of the study. e. details on how to contact the investigator.

A, C, E Informed consent explains the study to the participants and assures them of their rights, including their right to refuse to participate or to withdraw from the study. The informed consent must include protection of anonymity and confidentiality, voluntary participation, compensation, and alternative treatment. The informed consent must include specific information on how to contact the investigator. DIF: Comprehension REF: p. 102

21. While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that dramatic changes will occur as a result of: (select all that apply.) a. the increase in the number of minimally invasive procedures being performed for disease treatment. b. care provided for patients over an extended period in acute care settings. c. the reduction in the number of nurses and other health care professionals who are available to provide care. d. the widespread illiteracy and decreased self-efficacy of the aging patient population. e. the need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient. f. the devaluing of nursing as a means of improving patient outcomes.

A, C, E Invasive surgical procedures are being replaced by laparoscopic procedures. The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population. Care will focus on the unique lifestyles and values of a diverse population. DIF: Comprehension REF: p. 376

22. A researcher seeks funding from an agency that limits studies to quantitative research. The researcher can select from which of the following study designs? (select all that apply) a. Survey b. Grounded theory c. Phenomenology d. Needs assessment e. Experimental

A, D, E Surveys collect demographics, social characteristics, behavioral patterns, and information bases. Needs assessments are used to determine what is most beneficial to aggregates. The experimental method establishes cause-and-effect relationships while also testing relationships. DIF: Comprehension REF: p. 61, Table 6-1

16. A new nurse asks, "Since Electronic Medical Records can improve quality care by having seamless data available for a patient, why doesn't everyone just replace paper and pencil charts"? Barriers to a universal health information infrastructure include the fact that: (select all that apply) a. competition from individual companies to build EMR prevent a universal infrastructure. b. cost is prohibitive even with federal funding for larger health care systems. c. preventive health reminders for immunizations and yearly screenings such as mammograms are used in clinical decision making. d. insurance companies have halted sharing of some patient data due to fear of law suits. e. the full capacity of EHRs has not been realized with only Stage 1 of 3 nearing completion.

A, E It has been recommended that only a federal-based EMR would provide an infrastructure that allows access to comprehensive patient information. The first stage, years 2011 and 2012, forms the foundation for electronic data capture and information sharing. DIF: Comprehension REF: p. 271

16. A nurse is completing the degree requirements for an advanced practice role as a nurse practitioner and is concerned about certification requirements. Which statement concerning certification for advanced practice is true? A. All states require certification for all specialty roles that are identified as advanced practice. B. Nurse anesthetists and nurse-midwives are the only advanced practice role that require certification in the state nurse practice acts. C. Scope of practice remains unclear in state nurse practice acts due to the increasing number of new advanced practice roles. D. Certification is automatic when the nurse applies for an advanced practice license.

ANS: A All states require evidence of certification in the specialty area, and many require periods of practice in the specialty prior to awarding certification status. p. 68

8. A nurse who is licensed in Georgia and moves to Oregon: A. just check Oregon's nurse practice act related to licensure for endorsement. B. will automatically be grandfathered in as a licensed registered nurse. C. may request certification in Oregon rather than licensure, so as not to have to retake the NCLEX-RN®. D. should contact the American Nurses Credentialing Center to determine whether he or she is eligible to practice in an another state.

ANS: A Endorsement refers to the original program whereby a nurse who is licensed in one state can apply and seek licensure in another without undergoing repeat examination, in accordance with the nurse practice act of that state. p. 68

3. Nurse practice acts: A. are written and passed by legislators. B. cannot be influenced by special interest groups. C. reflect only the concerns of RNs. D. are affected by the practice of dentists.

ANS: A Just as other sections of state codes are written and passed by legislators, so is the nurse practice act of each state. p. 69

12. A nurse holds a license in one state but wishes to practice in a second state that is not participating in a nurse licensure compact agreement. The nurse is granted licensure on payment of a fee but does not retake the licensure examination. The nurse obtains licensure in the second state: A. by licensure and by endorsement. B. through mandatory continuing education. C. by the statutory process known as being grandfathered. D. through sunset legislation.

ANS: A Licensure by endorsement allows a nurse licensed in one state to obtain licensure to practice in a second state without examination. p. 68

15. Who establishes the "rules" for nursing practice? A. Individual state boards of nursing B. Employer, based on area of practice C. United States Department of Health and Human Services D. Local health officials

ANS: A The State Practice Act of each state establishes the rules for practice within that state. pp. 68-69

10. When participating in a nurse licensure compact, the nurse: A. is held responsible for complying with the nursing practice laws in the state where practicing at the time care is rendered. B. must purchase a license in each state but does not retake the licensure examination. C. determines residency based on the state where educated as registered nurse. D. may practice using one license in any state or territory in the United States that recognizes the NCLEX as the source of licensure.

ANS: A The nurse is accountable for practicing according to the state practice laws where patient care was provided, although disciplinary action is the responsibility of the state of the nurse's residency. pp. 70-71

13. A nurse practicing in the early 1900s was awarded a permissive license. These licenses: A. were voluntary; however, a nurse who failed the examination could not use the title RN. B. required a maximum of 1 year of formalized nurse training. C. allowed nurses who did not pass the licensure examination to still practice. D. allowed nurses the choice of taking a written or oral licensure examination.

ANS: A These permissive licenses permitted but did not require nurses to become registered. p. 65

21. A nursing student is in the final term of an Associate Science of Nursing (ASN) program and is preparing for licensure. Prior to licensure the candidate must provide evidence of: (select all that apply) A. Graduation from a nursing program. B. Graduation from high school or high school equivalency. C. Evidence of current malpractice insurance. D. Evidence of plan to continue study to obtain a minimum of a BSN within 2 years. E. Validation of skills competence provided by a certifying agency.

ANS: A, B Candidates for licensure must provide evidence of graduation through transcripts of course work or letter from the Dean/Director of the nursing program. All candidates must show evidence of graduating from high school or earning a GED. pp. 67-68

20. A group of graduates were just notified that they had successfully passed the licensure examination. During the orientation process at the hospital, one asks, "I am looking at my license, but I don't really know the duties performed by the board of nursing." The staff development nurse explains that the board of nursing: *(select all that apply)* A. Grants nursing licensure. B. Constructs the licensure examination. C. Assigns disciplinary action when the nurse acts in a manner that results in harm to a patient. D. Members are appointed. E. Conducts certification examinations for advanced practice nurses.

ANS: A, C, D The board of nursing ensures that nursing licenses are granted and renewed. The board of nursing assigns disciplinary action when provisions of the nurse practice act are violated. Members are appointed. pp. 68-69

14. A group of registered nurses with ADN degrees are concerned that the minimum educational standard for licensure as a registered nurse is being raised to the bachelor's (BSN) level. After contacting the American Nurses Association, they learn they will be "grandfathered" in. Under the "grandfather clause," nurses with associate degrees will: A. Be required to complete a bridge program to earn a BSN and then be tested only on material that was not part of the ASN curriculum. B. Continue to use the title "registered nurse." C. Have 10 years to obtain a BSN or the license will be revoked. D. Use whatever title is established for associate degree nurses.

ANS: B All ASNs licensed before the change would be "grandfathered" in, allowing them to use the title of RN. p. 63

17. Nurses in Tennessee, Mississippi, and Arkansas gather for a conference related to improving quality and safety in practice and nursing education. They are awarded continuing education (CE) credit for participation and evaluation of the conference. One nurse from California states, "I need these CEs to renew my license." The nurse from Mississippi replies, "You do not need CEs for license renewal or advance practice certification renewal." Which statement about CEs would help these nurses? A. All states require proof of continuing education for renewal of license with the number of hours varying. B. The purpose of continuing education is to ensure competence of the workforce after graduation, but each state determines if CEs are required. C. Continuing education is required if nurses work across state lines. D. Initial licensure provides evidence of a minimum safety and competence, so it is illegal for states to require continuing education for renewal of license.

ANS: B CE is important to ensure continued competency, and each state determines if CEs are mandatory for renewal and how many units are needed. p. 68

9. When practicing in a compact state: A. the nurse must abide solely by the practice act of the largest state. B. patients' rights in relation to the nurse practice act are protected by the mutual recognition model. C. the nurse must pay for a license in all states that participate in the mutual recognition model. D. the nurse must refer to the nurse practice act for the list of skills that can be performed.

ANS: B Nurses who practice in a compact state are responsible for following the laws and regulations of each state in which they practice. pp. 70-71

4. To ensure that nursing legislation is current and is reviewed by specific dates, if a nurse practice act fails to be reviewed, it is automatically rescinded under which law? A. Nurse review act B. Sunset legislation C. Mandatory revocation D. Grandfathering

ANS: B Sunset legislation may be included in a state's nurse practice act, and this means that the act must be reviewed by a specific date; if not, it is automatically rescinded. p. 70

5. Current trends in telecommunications and increased mobility of nurses have led to the approval of a mutual recognition model of nursing regulation, in which nurses are allowed to practice in states that are compact states without obtaining a license in each state. On which website would a nurse find a list of current compact states? A. National League for Nursing (NLN) B. National Council of State Boards of Nursing (NCSBN) C. American Association of Colleges of Nursing (AACN) D. Commission on Collegiate Nursing Education (CCNE)

ANS: B The NCSBN website contains this information. pp. 70-71

18. A nurse who wishes to practice in another state: *(select all that apply)* A. Must retake the NCLEX-RN for that state. B. Should determine whether the state is a compact state. C. May obtain licensure by endorsement. D. Must revoke licensure in the current state because nurses cannot be licensed in more than one state concurrently.

ANS: B, C If the state is a member of a compact state, that state has established an agreement with other states under which nurses are permitted to practice within the state without additional licensure. Licensure by endorsement refers to the original program whereby nurses who are licensed in one state seek licensure in another state without repeat examination. p. 68

2. The primary purpose of licensure for RNs is to: A. prevent others from using the title nurse. B. demonstrate a specialized body of knowledge. C. protect the public. D. enhance recognition for the profession.

ANS: C Protecting the public is one of the essential purposes of the state board of nursing, which regulates licensure. p. 65

1. The advanced practice nurse who is seeking information about requirements for practice in a specialized area should contact the: a. American Nurses Association (ANA). b. National League for Nursing (NLN). c. American Nurses Credentialing Center (ANCC). d. National Council of State Boards of Nursing (NCSBN).

ANS: C The nurse should contact the ANCC to determine the education, experience, and examination requirements that must be met if one is to become certified. p. 63 |p. 71

19. Which statements concerning licensure as a registered nurse are correct? *(select all that apply)* A. Nurses who graduate from different types of nursing education programs are granted different types of licenses, those with a baccalaureate degree having the most expanded role. B. A nursing license cannot be revoked, only suspended. C. Each nurse practice act describes requirements for initial licensure. D. It is illegal for states to ask about the mental or physical status of an applicant. E. Students who graduate in the top 10% of their class are exempt from taking the NCLEX-RN for licensure. F. Candidates for licensure must present proof of graduation as required by the state.

ANS: C, F A section of each nurse practice act describes requirements and procedures that are necessary for initial licensure. Candidates for licensure must submit evidence of graduation as defined by each state. pp. 67-68

7. A graduate of a nursing school in the United States plans to practice nursing in Paris, France. To request licensure to practice in Paris, the nurse: A. must contact the Graduates of Foreign Nursing Schools to complete a special examination. B. realizes that education in the United States is so generalized that he or she is eligible to practice in other countries without additional licensure. C. is required to take a language proficiency examination for the primary language of that particular country, as well as a cultural assessment test, prior to licensure. D. should contact the International Council of Nurses or the nursing regulatory board of that country.

ANS: D A nurse who is interested in practicing internationally may contact the International Council of Nurses or the nursing regulatory board of the country in which he or she wishes to practice. p. 69

11. A new graduate from a master's entry program in nursing announces, "I just passed my clinical nurse leader certification examination." Certification as a clinical nurse leader: A. is granted by the state board of nursing. B. denotes minimum level of knowledge and skills to practice safely. C. allows independent nursing practice, often in primary care. D. recognizes achievement of advanced skills and knowledge.

ANS: D Certification provides validation of achievement of advanced education and competence. p. 71

22. The primary purpose of licensure is protection of the ___________.

ANS: public p. 65

7. A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to as a: a. patient classification system. b. clinical pathway. c. patient-centered plan of care. d. diagnosis-related group (DRG).

B A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition. DIF: Application REF: pp. 374-375

2. When reading Peplau's theory, a nurse was unable to determine the relationships among concepts. The nurse listed each concept and drew lines denoting relationships to be able to understand the effect of each element. The nurse created a: a. hypothesis. b. model. c. construct. d. variable.

B A model is a group of concepts that are associated because of their relevance to a common theme. DIF: Application REF: p. 78

6. A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement? a. Health maintenance organization b. Preferred provider organization c. Fee-for-service arrangement d. Philanthropic agency

B A preferred provider organization is an arrangement by which the member pays a premium for a fixed percentage of expense coverage. This method includes a required deductible and a copayment. The member may select a physician but pays less for physicians and facilities on the plan's preferred list. DIF: Comprehension REF: p. 110, Table 7-2

10. A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is known as: a. straw man. b. red herring. c. slippery slope. d. confusing cause and effect.

B A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue. DIF: Application REF: pp. 336-337

8. A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a _____ payment system. a. prospective b. retrospective c. diagnosis-related group d. capitated

B A retrospective payment system is a method of reimbursing health care providers (such as physicians and hospitals) in which professional services are rendered and charges are billed on the basis of each service provided; this is also known as a fee-for-service payment system. DIF: Comprehension REF: p. 107| p. 110, Table 7-2

4. A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are performing a(n): a. standardization of care. b. root cause analysis. c. process variation. d. analysis of a deployment flowchart.

B A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences. DIF: Application REF: p. 380

3. A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified as a: a. root cause. b. sentinel event. c. variation in performance. d. causal factor.

B A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay. DIF: Comprehension REF: p. 380

1. A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is called a: a. deployment flowchart. b. top-down flowchart. c. Pareto chart. d. control plot.

B A top-down flowchart shows the sequence of steps in a job or process such as medication administration. DIF: Comprehension REF: p. 379 |p. 388

6. A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patient's oxygen saturation decreased drastically as a result of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation represents a: a. patient outcome. b. variance. c. goal. d. standard.

B A variance is a deviation from the planned path. DIF: Comprehension REF: p. 375

7. An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for: a. delegating the task to another UAP if he or she does not have the time or skill to complete the task. b. keeping the RN informed of any abnormal blood pressure readings. c. calling the physician when the patient's vital signs are not within established parameters. d. informing the dietary department to initiate a low-sodium diet for patients who are hypertensive.

B After accepting the assignment, the UAP is responsible for completing the task and reporting any patient concerns to the RN. DIF: Application REF: p. 354

7. A nurse gives Dilantin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "Everyone just pushes the medicine slowly. No one checks for compatibility. There isn't even a compatibility chart on the unit." Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Appeal to emotion d. Appeal to tradition

B An appeal to common practice occurs when the argument is made that something is okay because most people do it. DIF: Application REF: p. 336

9. The new director of nurses has instituted "walking rounds" on all nursing units, rather than the usual taped shift reports. A veteran nurse exclaims, "She doesn't know how we do things here!" The nurse is demonstrating: a. appeal to emotion. b. appeal to tradition. c. red herring. d. straw man.

B An appeal to tradition is the argument that doing things a particular way is best because they've always been done that way. DIF: Application REF: p. 336

6. A group of RNs wish to seek union representation that would protect all workers in the agency including nonlicensed assistive personnel and non-nursing employees such as nutritionists and dietary workers. The type of union being sought is the strongest collective group and is known as a(n): a. occupational union. b. industrial union. c. union shop. d. right-to-work bargaining organization.

B An industrial unionism is a single union for all workers in the agency. DIF: Comprehension REF: p. 257

2. A family requests that no additional heroic measures be instituted for their terminally ill mother who has advance directives in place. The nurse respects this decision in keeping with the principle of: a. accountability. b. autonomy. c. nonmaleficence. d. veracity.

B Autonomy is the principle of respect for the individual person. Within the concept of autonomy, people are free to form their own judgments and perform whatever actions they choose. They are self-determining agents who are entitled to decide their own destiny. DIF: Comprehension REF: p. 4 |pp. 169-170, Table 9-1

10. A concern that nurses were being asked to perform tasks that went beyond the state's nurse practice act was brought to the union's attention. Nurses were informed that either mediation or binding arbitration will be used to resolve the issue. A novice nurse asks about the difference between these techniques and is informed that: a. mediation is sanctioned by the National Labor Relations Board (NLRB) to formally discuss concerns with management and labor. b. binding arbitration is a formal discussion between labor and management in which the arbitrator's recommendations are compulsory. c. mediation uses a trained person to negotiate a legally binding plan. d. binding arbitration requires both labor and management to participate in discussions on the least destructive approach to allow self-governance by employees.

B Binding arbitration requires that both parties meet in formal talks, and all parties must obey the arbitrator's recommendations. DIF: Comprehension REF: p. 257

12. A cultural phenomenon that is based on biologic variation would include: a. belief that exposure of a pregnant woman to an eclipse can result in cleft lip. b. denser bones in blacks result in less morbidity associated with osteoporosis. c. the grandmother who determines that her grandchild has scoliosis and should seek treatment, then informs the parents of her decision. d. a family that participates in feasts prepared to celebrate and make decisions.

B Biologic variations include denser bones in blacks. Biologic variations such as body build and structure, genetic variations, skin characteristics, susceptibility to disease, and nutritional variations exist among different cultures. Other common variations include skin color, eye shape, hair texture, and adipose tissue deposits. DIF: Analysis REF: p. 191

7. A nurse walks up to a computer in the hallway and presses the index finger to the sensor, thereby gaining access to patient data. A few moments later another nurse performs the same steps and is granted access. A visitor who is watching from a room walks over and places the index finger on the sensor, only to receive an "error and access denied" message. Security is being maintained by: a. robot technology. b. biometric technology. c. telehealth. d. ubiquitous computing.

B Biometric fingerprint identification uses personal characteristics to allow access to health information. DIF: Comprehension REF: p. 277

15. A nurse is preparing to teach a class related to risk factors for cancer to a diverse ethnic group attending a health fair. The nurse should be aware: a. that Hispanic women overestimate the prevalence of cancer and strictly following breast self-examination guidelines. b. of the importance of risk factors such as smoking and alcohol consumption that increase esophageal cancer when speaking with black. c. that American-Indian women have a higher rate of ovarian cancer than the general population. d. that cancer as well as heart disease and stroke are lower in ethnic groups.

B Black men have a higher risk for esophageal cancer than the general population so teaching risk factors is needed. DIF: Comprehension REF: p. 191

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.

B Burnout is more common among nurses with type A personalities and those who are overachievers. DIF: Application REF: pp. 417-418

17. During height and weight assessments at a school's health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, "Drinking coffee stunts a child's growth." This logical fallacy is referred to as: a. appeal to common practice. b. confusing cause and effect. c. ad hominem abusive. d. red herring.

B Cause and effect are confused when one assumes that a particular event must cause another just because the two events often occur together. DIF: Application REF: p. 336

19. A nurse plans care knowing when specific recovery milestones are expected. The nurse is providing care via: a. patient classification systems. b. clinical pathways. c. functional nursing. d. case management.

B Clinical pathways plans patient care activities and interprofessional interventions and desired patient outcomes within a specified time period for a particular diagnosis or health condition. DIF: Comprehension REF: p. 366

5. Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as: a. charity. b. cost shifting. c. price sharing. d. governmental reimbursement.

B Cost shifting occurs when providers increase their charges against households and public and private insurers who pay for their own care while making some contribution to the care of the uninsured population. DIF: Comprehension REF: p. 111

12. A nurse providing care at the bedside receives an "alert" that a patient's stat potassium level is 2.5 and digoxin (Lanoxin) is scheduled. The nurse holds the medication and prevents a possible complication. This feature of the Electronic Health Record is available through which core function of EHR? a. Order entry/order management b. Decision support c. Patient support d. Administrative support

B Decision support provides reminders about preventive practices, such as immunizations, drug alerts for dosing and interactions, and clinical decision making. DIF: Comprehension REF: pp. 268-269

4. Which patient's decision-making capacity should be a concern for the palliative care nurse? a. The one who asks, "Why do I need palliative care?" b. The patient with a diagnosis of moderate Alzheimer's disease c. The one whose family is used to being consult about decisions affecting the patient d. The patient who has expressed concerns about "all the decisions I have to make."

B Decision-making capacity focuses on one's ability to make decisions about their health care. They must be able to understand the facts, appreciate the alternatives that may exist, and to communicate these decisions to the health care team. Moderate Alzheimer's disease is likely to have an affect the patient's cognitive abilities. DIF: Analysis REF: p. 220

12. The disaster medical assistance team works quickly to contain contaminants from a chemical plant explosion. Afterward, personnel undergo a special process to remove harmful chemicals from equipment and supplies. This removal process is known as: a. containment. b. decontamination. c. triage. d. scene assessment.

B Decontamination is the physical process of removing harmful substances from personnel, equipment, and supplies. DIF: Knowledge REF: p. 280

10. Three illegal immigrants with no health insurance or money sustained life-threatening injuries during an automobile accident. Two of these individuals had head trauma and lacerated internal organs. The decision was made to provide extended care in the trauma center after emergency surgery was performed to save their lives. The third individual received only minor injuries, which were treated in the emergency department. The care of the two critical clients was based on the ethical principle of: a. utilitarianism. b. deontology. c. autonomy. d. veracity.

B Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and that compel them to do what is right. Deontological theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. DIF: Comprehension REF: p. 162 |p. 170

9. When the client is unable to make medical decisions for himself or herself, authorization that allows another person to make these decisions is called: a. living will. b. durable power of attorney. c. informed consent. d. immunity.

B Durable power of attorney involves preselection by the client of a person who has been authorized legally to make health care decisions once the client becomes incompetent to do so. Several states have enacted a Uniform Durable Power of Attorney Act, which sanctions a durable power of attorney for health care. DIF: Knowledge REF: p. 152

20. A group of nurses are interested in the how to improve teaching effectiveness for patients who have a hearing impairment and lack family involvement while hospitalized. They believe "hearing loss decreases the teaching effectiveness while hospitalized." The group plans to evaluate teaching effectiveness using a 10-point Likert scale pre-post teaching, perform a hearing test to determine degree of hearing loss on admission, and have social work evaluate the impact of hearing impairment on patient's ability to safely live alone prior to discharge. The group is working in which step of the scientific process? a. Hypothesis b. Method c. Results d. Evaluation

B During the method step, the group decides what data will be collected to answer the question and identifies step-by-step procedures that will be used to collect these data. DIF: Application REF: p. 77, Box 5-1

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.

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. DIF: Comprehension REF: pp. 416-417

8. During a community health fair the disaster medical assistance team (DMAT) informs participants that every community must be ready to provide disaster care. A participant asks, "In a disaster, the local community cannot possibly be effective, so why not have a plan to call federal agencies immediately to provide relief?" The correct response by the DMAT is: a. "Unless known terrorist activities involving mass destruction occur, the federal government does not become involved." b. "The community is essentially the 'first responder' to any disaster." c. "The preparedness phase of a disaster is the responsibility of the community, the relief response phase is assigned to state agencies, and the recovery phase is the responsibility of federal agencies." d. "Unless local health care facilities are incapacitated, state and federal agencies will withhold assistance."

B Each disaster begins locally, and each community responds first and receives assistance from state and federal agencies when local resources are not adequate for the situation. DIF: Comprehension REF: p. 285

5. A nurse is caring for a recent Asian immigrant client and is overheard making the following comment, "These rituals you believe in are false. You live in America now and must believe in realistic health practices, like Americans do." The nurse is exhibiting: a. stereotyping. b. ethnocentrism. c. cultural accommodation. d. empathy.

B Ethnocentrism is the belief that one's own ethnic group, culture, or nation is best. DIF: Comprehension REF: p. 180

2. A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations? a. Blocking b. Filtration c. Empathy d. False assurance

B Filtration is the unconscious exclusion of extraneous stimuli in communication. DIF: Comprehension REF: p. 331

4. Einstein's theory of relativity laid the groundwork for theories of mathematics, and Freud and Jung provided the basis for a philosophy of man. Which nursing theory served as the foundation for nursing science? a. Rogers' science of unitary human beings b. Nightingale's theory of practice c. Watson's theory of human caring d. King's theory of goal attainment

B Florence Nightingale investigated the effect of the environment on healing, and this serves as the foundation for nursing science. DIF: Comprehension REF: pp. 81-82

10. A qualitative researcher reviews data collected with a grief support group to develop a theory of how widows and widowers mourn. The researcher is using which qualitative research design? a. Phenomenology b. Grounded theory c. Case study d. Hypothesis generation

B Grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose. DIF: Comprehension REF: p. 95, Table 6-2

19. A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women's health specialist because the primary care physician did not order the referral or the mammogram. Which type of insurance plan adheres to this type of payment system? a. Fee for Service b. Health Maintenance Organization (HMO) c. Preferred Provider Organization (PPO) d. Point of Service (POS)

B HMOs require patients to select a primary care physician approved by the HMO who then must refer or order any test/diagnostic procedures before payment is approved or preapproval must be sought. DIF: Comprehension REF: p. 110, Table 7-2

8. A client is hypertensive, and the doctor prescribes weight reduction. The client is excited about beginning the diet, but on arriving home the spouse states, "You have always been fat, and I am not going to starve because you can't control yourself." The client becomes anxious and is unable to participate in the diet plan, resulting in a weight gain of 5 pounds in 2 weeks. Which theorist could best be referred to for guidance regarding interventions in this situation? a. Martha E. Rogers b. Hildegard E. Peplau c. Florence Nightingale d. Myra Estrin Levine

B Hildegard Peplau's theory describes interpersonal relations as a nursing process. Nursing intervention in Peplau's model focuses on reducing related incapacitating stressors through therapeutic interpersonal interaction. DIF: Application REF: pp. 83-84, Table 5-2

3. Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing: a. hospital admission rates. b. length of hospital stay. c. outpatient services. d. specialty groups.

B Hospitals face a strong financial incentive from the DRG reimbursement system to reduce the client's length of stay and minimize procedures performed. If hospital costs exceed the DRG payment for a client's treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. DIF: Comprehension REF: p. 109

12. During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting: a. assertive communication. b. active listening. c. empathy. d. passive communication.

B In active listening a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak. DIF: Comprehension REF: p. 337

4. A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. This type of delivery system is: a. total patient care. b. functional nursing. c. team nursing. d. primary nursing.

B In functional nursing members of the team are assigned specific tasks such as assessment or medication administration. DIF: Comprehension REF: pp. 370-371

9. The research hypothesis is that aromatherapy reduces stress more effectively than does acupuncture. The researcher does not identify a control group. This study would be a(n) _________ design. a. experimental b. quasi-experimental c. survey d. meta-analysis

B In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing. DIF: Comprehension REF: p. 94, Table 6-1

16. The emergency response team responded to a terrorist attack where hundreds of people died following symptoms of chest tightness, palpations, seizures, and finally paralysis. A colorless odorless liquid known as Sarin (GB) was the agent, which is primarily inhaled with limited exposure through the skin. The concentration of Sarin has not been measured. What level is the minimum level of personal protection and safety equipment (PPE) that would be needed? a. A b. B c. C d. D

B Level B requires a high level of respiratory protection, but less skin protection, providing a chemical splash-resistant suit with hood and self-contained breathing apparatus (SCBA). It provides maximum respiratory protection but less skin protection than level A equipment. DIF: Analysis REF: p. 289

8. A nurse is given a referral to make a home visit to a Russian immigrant. The nurse knows very little about the health beliefs of this ethnic group. To research this group, she can use an Internet search engine and enter the term "Russian cultures" or "Russian health beliefs." To obtain more generalized information, she could also search under: a. federally recognized minorities. b. marginalized populations. c. Asian/Pacific Islander cultures. d. Latino cultures.

B Marginalized populations include recently arrived immigrants. Their lives and health care needs are often kept secret and are understood only by them. DIF: Comprehension REF: p. 182

7. Which type of theory most often guides present nursing practice? a. Grand theory b. Middle range theory c. Developmental theory d. Values theory

B Middle range theory is a nursing theory that refers to a specific population or to a specific situation, thereby making the theory easy to understand. An example is the theory of unpleasant symptoms (Lenz and Pugh), which examines symptoms that are influenced by physiologic, psychological, and situational factors as they relate to performance. DIF: Knowledge REF: p. 79

9. Which statement is true regarding health care for minorities? a. Federal legislation that provides free health insurance for minorities has resulted in fewer minorities than members of the general population who lack health insurance. b. Higher costs of health care coupled with lower wages for minorities have prevented most minorities from seeking health care. c. Because many Mexican Americans are highly skilled workers with comparable wages, they have the lowest uninsured rate. d. Asians, because of their quiet demeanor and unwillingness to challenge the health care system, have the highest rate of uninsured people.

B Most families with racially or ethnically diverse backgrounds have a lower socioeconomic status than is observed in the population at large. Dramatic changes in technology and specialization in the health care field have caused health care costs to skyrocket. Therefore, not everyone can afford health care services. DIF: Comprehension REF: p. 182

17. A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation? a. Run chart b. Pareto chart c. Flowcharts d. Cause-and-effect diagrams

B Pareto charts are used to prioritize areas to reduce medication errors. Eighty percent of all errors were caused by interruptions, so this should be the area of priority. DIF: Comprehension REF: pp. 385-386

9. A nurse manager is mentoring a novice nurse manager in determining staffing needs. The mentor explains, "We must determine the acuity level of the patient by: a. assessing patient satisfaction with nursing care." b. quantifying the amount and intensity of care required." c. examining the skill mix and educational preparation of the staff." d. determining the number of hospital days required by the patients."

B Patient acuity is measured by determining the amount and intensity of care required. DIF: Comprehension REF: p. 367

18. A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is termed: a. partnership. b. patient-centered. c. case management. d. total patient care.

B Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients' wants, needs, and preferences are the priority while allowing the patient and family to participate in decisions and educational needs. DIF: Comprehension REF: p. 373

14. Nurses on a busy medical schedule want to reduce documentation time and improve order entry. Additionally, patient records from previous visits are often incomplete or do not include care from other providers. To improve patient care, a taskforce suggests using an Electronic Medical Record for 1 month to determine whether this provides the desired outcomes. This unit is participating in which type of study? a. Ethnography b. Pilot c. Secondary data analysis d. Phenomenology

B Pilot studies are small-scale studies often referred to as feasibility studies to determine if a larger more sophisticated research study is needed. DIF: Comprehension REF: p. 89 |p. 95

14. A nurse is preparing discharge teaching for an Asian-American woman with a fractured hip. The nurse reviews the client's diet history while hospitalized and is concerned that the patient refused milk and yogurt, placing her at risk for osteoporosis. What cultural variation is the nurse overlooking? Asian Americans: a. have denser bones than other ethnic groups. b. consume diets rich in pork bone and shells, reducing the risk of osteoporosis. c. would participate in the practice of burning to compensate for this injury. d. would consult a curandero for dietary consultation.

B Pork bones and shells are rich in calcium, reducing the risk of osteoporosis. DIF: Comprehension REF: p. 197

12. Although a hospital reversed all charges when a client was the victim of wrong site surgery, the court awarded the client $1.5 million. The client was able to return to work in 6 weeks and had no permanent damages. This monetary compensation is termed: a. res ipsa loquitur. b. punitive damages. c. vicarious liability. d. immunity.

B Punitive damages are monetary compensation to an injured client that is greater than amount of loss. DIF: Application REF: p. 120 |p. 135

15. A researcher is interested in learning if elderly persons perceive their health to be satisfactory even with comorbidities and chronic illness. A large multisite assistive living facility will be the site. The researcher lists residents in alphabetical order and chooses every third person on the list. To ensure improved generalizability, the researcher is using: a. triangulation. b. randomization. c. informed consent. d. a meta-analysis approach.

B Randomization is a method of choosing subjects based on chance alone. DIF: Comprehension REF: p. 89

8. What is the initial step when addressing an ethically challenging situation? a. Identify all those who are involved in the situation. b. Review the overall situation to identify the core issues. c. Gather all the relevant facts about the situations. d. Determine what the ethical dilemma is.

B Reviewing the overall situation in order to identify what is going on in this particular situation is the initial step in addressing an ethically challenging situation. DIF: Application REF: p. 221, Table 12-1

9. A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting. The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis: a. the cost of caring for this client was $5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company. b. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee. c. the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease. d. the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.

B Since 1983, if hospital costs exceed the DRG payment for a client's treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Hospitals face strong financial incentives to reduce the client's length of stay and minimize procedures performed. DIF: Comprehension REF: p. 106| pp. 108-109

11. A nurse is interested in locating reliable information concerning noninvasive blood glucose monitoring. Information is located, and the author is a scientist who conducted studies within the last year on the effectiveness of a particular noninvasive blood glucose monitor. The scientist received funding from a pharmaceutical company to support the studies. The URL indicates the pharmaceutical company site.com. The nurse is concerned about this information's: a. authority. b. objectivity. c. accuracy. d. currency.

B Sites sponsored by organizations such as pharmaceutical companies may influence the content. DIF: Comprehension REF: p. 276

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."

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. DIF: Comprehension REF: p. 414

8. The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed assistive personnel (UAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with: a. assignments. b. staffing. c. output. d. productivity.

B Staffing is the activity of determining that an adequate number and mix of health care team members are available to provide safe, high-quality patient care. DIF: Comprehension REF: p. 367

17. An Asian teenager is admitted with an eating disorder which she contributes to by not meeting the academic expectations of her parents. The nurse is overheard saying, "That isn't the reason; all Asians are really smart." This nurse is demonstrating: a. cultural humility. b. stereotyping. c. cultural assimilation. d. acculturation.

B Stereotyping is associating certain behavior or competencies with an ethnic group without considering the individual. DIF: Comprehension REF: p. 180

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.

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. DIF: Comprehension REF: pp. 426-427

4. A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. This type of research design is: a. quasi-experimental. b. survey. c. case study. d. ethnography.

B Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. DIF: Application REF: p. 94, Table 6-1

23. Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies? a. Patient-centered care b. Informatics c. Teamwork d. Quality improvement

B Technology (PDA) is used to aid decision making and reduce errors. DIF: Comprehension REF: p. 393

14. A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association's (ANA) recommendations? a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe, high-quality care. b. Staffing should allow time for the RN to apply the nursing process so decisions result in high-quality, safe patient outcomes. c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix. d. RN staffing is not cost-effective; thus is it important for staffing models to limit the number of RNs assigned per shift.

B The ANA recommends that nurses have time to exercise professional judgment. DIF: Analysis REF: p. 367

2. A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the: a. Institute for Safe Medication Practices. b. Institute of Medicine. c. National Committee for Quality Assurance. d. The Joint Commission.

B The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health. DIF: Comprehension REF: pp. 379-380

2. The Karnofsky prognostication scale is most appropriately used to screen patients with which medical diagnoses? a. Respiratory diseases b. Cancers c. Cardiac diseases d. AIDS

B The Karnofsky scale is more appropriate for the patient with a cancer diagnosis. DIF: Comprehension REF: p. 225

11. An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to: a. check the patient's drug packages to ensure that the correct drugs were given. b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. c. contact the nurse manager and ask that the LPN/LVN's license be suspended. d. call the pharmacy and ask for replacement medications for the patients.

B The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's responsibility requires that he or she intervene and identify concerns with the LPN/LVN. DIF: Analysis REF: p. 363

10. Following a terrorist attack, victims are exhibiting posttraumatic stress syndrome, and care providers are exhibiting compassion fatigue. Which federal response system should be initiated? a. Strategic National Stockpile b. Metropolitan Medical Response System (MMRS) c. Commissioned Corps Readiness Force d. National Disaster Medical System

B The MMRS is concerned with deploying trained responders who are able to provide mental health care for victims and health care providers. DIF: Comprehension REF: p. 286

3. The Metropolitan Medical Response System (MMRS): a. is totally financed by the federal government national disaster fund. b. consists of responders who have obtained specialized training and equipment to deal with mass casualty events. c. has a storehouse of medications and antidotes to be used during response in times of national emergencies. d. arranges for patient admissions to federal hospitals.

B The MMRS responds to disaster with trained individuals who have expertise in this type of situation and who have the equipment required to be effective. DIF: Comprehension REF: p. 286

20. The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse: a. is showing empathy and as long as she lets the patient know the money is not from her, she is not violating any social media guidelines. b. is at risk for HIPAA violations. c. has properly followed policy and protected the patient by not using her name. d. is demonstrating the logical fallacy of slippery slope.

B The National Council State Board of Nursing's policy on social media prohibits posting of patient information on social media sites. This patient could be identified by knowing where she works and the fact that she was seen in the ED the day before. DIF: Application REF: p. 344

15. A nursing unit is comparing team nursing to the partnership model and finds that: a. with the partnership model, an RN does not have to be part of the mix. b. leadership abilities of the RN is a major determinant of effectiveness of care for both models. c. the RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to apply the nursing process in team nursing. d. with team nursing the RN cares for the patient while the team members work with the family or significant others.

B The RN leads regardless of whether partnership model or team nursing is practiced. DIF: Comprehension REF: p. 371 |p. 372

4. A community in the New Madrid fault zone experiences an earthquake resulting in injuries from propelled objects and abrasions for many victims. The local supply of antibiotics is quickly exhausted. Local authorities would contact the: a. Commissioned Corps Readiness Force. b. Strategic National Stockpile. c. Department of Homeland Security. d. local Young Men's Christian Association (YMCA).

B The Strategic National Stockpile provides antibiotics, antidotes, and medical and surgical items when local and state supplies have been exhausted. DIF: Comprehension REF: p. 287

6. A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to: a. supplement the staffing pattern when an RN is not available. b. aid the RN by performing appropriately delegated care tasks. c. replace the RN when the health care facility provides long-term care. d. provide patient teaching, allowing more direct care to be provided by the RN.

B The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice. DIF: Comprehension REF: p. 353

13. The nurse is demonstrating active listening when: a. while assessing the patient's vital signs, the nurse records the data and states, "You are improving, your vital signs are normal." b. eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. c. he or she states, "I know how you feel, I recently lost my father and I am still hurting." d. cultural values are in opposition to the patient but shares that "I agree with your decision to use herbs rather than the prescribed medications."

B The behavior demonstrates active listening. A number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak. DIF: Application REF: p. 337

2. A nurse at a school notices that several students have "blisters" on their bodies. Further investigation reveals that a terrorist incident has occurred, causing smallpox. If the chemical, biologic, radiologic, nuclear, and explosive (CBRNE) agent categories are used, this incident would be classified as: a. chemical. b. biologic. c. radiologic. d. nuclear.

B The biologic category refers to diseases such as plague or smallpox. DIF: Comprehension REF: p. 284, Table 16-1

5. The nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers is called a: a. nurse manager. b. case manager. c. coordinator of patient-centered care delivery. d. team leader in team nursing care delivery.

B The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness. DIF: Comprehension REF: p. 373

5. Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is: a. Pareto chart. b. control chart. c. deployment chart. d. top-down flowchart.

B The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process. DIF: Comprehension REF: p. 380

4. A priority action for the nurse who works with culturally diverse clients is completion of a: a. sign language course. b. cultural self-assessment. c. cultural client assessment. d. continuing education course on how to speak Spanish.

B The first step to becoming a culturally sensitive and competent health care provider is to conduct a cultural self-assessment. Through identification of health-related attitudes, values, beliefs, and practices, the nurse can better understand the cultural aspects of health care from the client's perspective. DIF: Application REF: p. 191

6. A nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at the scene, the nurse knows that: a. the response of local hospitals will be dictated by the federal government. b. the same ground rules practiced in other settings and during smaller crises will be applicable. c. the least experienced nurses will be assigned to triage low-risk victims and victims who have no chance of survival. d. multiple incident commanders ensure a quick, effective response.

B The fundamentals of nursing applied to other settings and situations can be used in a disaster. DIF: Comprehension REF: p. 283

6. Which statement regarding informed consent is correct? Informed consent: a. is mandated by federal but not state law. b. must reveal expected benefits. c. requires concealing any known risks. d. allows the RN to communicate information needed so that informed consent can be provided.

B The information that constitutes informed consent for the client includes the nature of the therapy or procedure, expected benefits and outcomes of the therapy or procedure, potential risks of the therapy or procedure, alternative therapies to the intended procedure and their risks and benefits, and risks of not having the procedure. DIF: Comprehension REF: p. 152

3. In today's world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d. Electronic messaging

B Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking. DIF: Knowledge REF: p. 331

11. A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin (Dilantin) before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? a. The nurse is upset and states, "I am sure I have injected this before without a problem" and the supervisor interprets this to mean the nurse often take shortcuts. b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." c. "The nurse who started the IV didn't get a blood return but determined the IV was the patient's—that is the problem." d. "This drug always occludes the line because it is so viscous."

B The nurse diverts attention away from the issue of not checking compatibility to introduce an irrelevant topic of chemotherapy administration certification which is not related to this situation. DIF: Application REF: pp. 336-337

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. horizontal hostility.

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. DIF: Comprehension REF: pp. 417-418

18. A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad. How can you get cancer without smoking?" Which statement by the nurse represents empathy? a. "Research is identifying many risk factors for cancer besides smoking." b. "I understand how you could feel angry about the diagnosis." c. "He is still a good husband." d. "Why do you think he got cancer?"

B The nurse is placing herself in the wife's position and sharing her emotions. DIF: Application REF: p. 334

3. The first step in the nursing process and in the problem-solving process is to: a. identify the problem. b. gather information. c. consider the consequences. d. implement interventions.

B The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision making and problem-solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation. DIF: Comprehension REF: pp. 309-310

12. A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery? a. Modular b. Primary c. Team d. Functional

B The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present. DIF: Comprehension REF: p. 372

7. A nurse researcher who is seeking funding for a study should identify _____ of funding agencies. a. board members b. priorities c. budgets d. accreditation

B The priorities of funding agencies indicate their preferences for funding; these are more likely to be funded than are studies that are not aligned with funding preferences. DIF: Comprehension REF: pp. 91-92

13. A nurse is interested in working in a large trauma center that is unionized but does not want to join the union or pay fees. She accepts the position but is not required to join or pay fees to the union based on which law? a. National Labor Relations Act b. Right-to-work law c. National Labor Relations Act d. Taft-Hartley Act

B The right-to-work law prohibits membership or payment of union dues or "fees" a condition of employment, either before or after hiring. DIF: Comprehension REF: p. 257 | p. 260

16. A researcher conducts a survey to determine the perceived health status of elderly persons living independently at home. The same subjects participate in a telephone call in which they describe the lived experience of living with chronic illness. When writing up the research study, the nurse would describe using: a. a control group. b. triangulation. c. a pilot study. d. secondary data analysis.

B Triangulation is the use of a variety of methods to collect data on the same concept—in this situation, quantitative research through survey and qualitative research through phenomenology. DIF: Comprehension REF: p. 89|p. 95

14. A nurse is caring for a patient who is to receive an antibiotic drug that causes severe skin damage when infiltrated. The order reads, "infuse over 1 hour by portacath." The nurse accesses the Personal Digital Assistant for software that lists the steps to access a portacath. The nurse is using: a. electronic health records. b. point-of-care technology. c. data management. d. telehealth.

B Using a Personal Digital Assist device to access information at the bedside is considered point-of-care technology. The nurse was able to retrieve the steps for accessing a portacath electronically while remaining at the bedside. DIF: Comprehension REF: p. 273

11. A 13-year-old female is brought to the family planning clinic by her enraged father, who has just learned that she is pregnant. The pregnant client states, "I want to have this baby and give it up for adoption." However, the father is adamant that she will disgrace the family and demands that the health care providers tell his daughter that she has a physical condition that would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a conflict that involves the ethical principle of: a. deontology. b. veracity. c. autonomy. d. beneficence.

B Veracity is telling the truth in personal communication as a moral and ethical requirement. DIF: Comprehension REF: p. 170

3. An older adult client is comatose and had one electroencephalogram that indicated no activity. The daughter is very distraught and notices her mother's hand moves when she is talking to her. The daughter asks the nurse, "Is mother responding to my voice?" The nurse, attempting to console the daughter, knows the movement was involuntary but states, "It does appear she did." The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Deontology

B Veracity is the principle of telling the truth in a given situation. DIF: Comprehension REF: p. 171

17. Which of the following situations would be appropriate for the supervisory level of initial direction and/or periodic inspection? a. Experienced RNs work together to provide care for a group of patients newly diagnosed with meningitis. b. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly. c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the patient status every 15 to 30 minutes and asks the graduate to explain "next steps." d. No supervision is necessary since both are registered nurses.

B When a working relationship is established and competencies of the delegate established, the delegator may check in during intermittently during the shift. DIF: Application REF: p. 361

18. In which case does the nurse act as "whistle-blower"? a. One staff member on the unit covers for another nurse, who leaves the premises to purchase illegal substances and signals her friend when she must return. b. The nurse reports that another nurse is taking medications out of stock medicine for herself or himself. c. A nurse informs respiratory therapy that a patient is now due a treatment. d. The nurse delegating care to unlicensed assistive personnel makes rounds to ensure all care was rendered properly.

B Whistle-blowing is the reporting of acts or situations that violate the principle of beneficence such as a chemical impairment, negligence, abusiveness, incompetence, or cruelty. DIF: Application REF: pp. 176-177

16. The Health Care Reform Act provides insurance for all U.S. citizens and legal residents presenting far-reaching ethical considerations related to diverse individual patient health care beliefs for those delivering nursing care. Nurses must consider their civil rights under the rights of conscience and how new health care agendas such as the Patient Protection and Affordable Care Act (PPACA) could affect their practice in situations that may conflict with their own belief system. Today's practicing nurse must: a. remember it is one's professional duty to render patient-centered care—even when it is in direct conflict with the nurse's own beliefs—or be held liable for withholding treatment. b. consider whether the right to act according to one's inner beliefs will continue to be permissible when federal health insurance becomes fully enacted. c. discuss with the patient and family different options in hopes they will accept the nurse's health care beliefs. d. suggest to the hospital administration that they not accept federal funding to prevent controversial health practices.

B With federal funding, many controversial health care services will be covered and provided as part of patient care when desired by the patient; therefore, whether a nurse has autonomy to refuse to provide care may not be as clear even when one might request another patient. DIF: Application REF: pp. 168-169

6. A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? a. Personal perception b. Past experiences c. Filtration d. Preconceived idea

B With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated. DIF: Application REF: p. 331

20. A patient asks, "What is an advance directive?" The nurse explains that examples of advance directives are: (select all that apply) a. preserving cord blood for possible future needs of a child. b. providing instructions that life-sustaining medical procedures should be withheld in the event of a terminal situation. c. giving someone the legal right to act on one's behalf when one becomes incapacitated. d. completing hospital admission paperwork before being admitted to the hospital.

B, C Advance directives document an individual's desires regarding end-of-life care. These wishes are generally stated through the execution of a formal document known as the living will. Right-to-die statutes vary from state to state; therefore, nurses must become familiar with their state-specific statute. DIF: Analysis REF: p. 120|p. 151

21. When teaching community preparedness for a community group, the nurse explains that components of the National Disaster Medical System (NDMS) provide for: (select all that apply) a. a nationwide bomb disposal squad team for the rapid removal of explosive devices. b. teams of health care providers who are experts and have specialized supplies and equipment. c. structures for patient evacuation from the disaster area to an unaffected area. d. arrangements for hospitalization in federal and volunteer nonfederal acute care hospitals. e. providing mental health care for the community, for victims, and for health care providers.

B, C, D The NDMS provides specially trained teams of people along with equipment designed for disaster relief. The NDMS is responsible for removing patients from unsafe to safe areas. The NDMS coordinates efforts to evacuate victims to federal or nonfederal volunteer hospitals that can care for disaster victims. DIF: Comprehension REF: p. 286

21. A nurse learns in orientation that an incident report does not "blame" anyone but concisely documents the events leading up to an occurrence. Which events would warrant completion of an incident report? (select all that apply) a. The client is crying and distraught when he learns of a diagnosis of cancer. b. An intravenous antibiotic given preoperatively does not infuse because of a faulty pump. c. The nurse is unable to carry out orders written by the specialist because of illegibility. d. A client falls while in the shower, although she was told not to get up alone. e. The registered nurse is not available to complete the preoperative checklist.

B, C, D, E Nurses are legally bound to report critical incidents to their nurse managers, agency administration, and risk manager through a formal intra-agency document generally titled the "incident report." Circumstances under which an incident report should be filed include malfunction or failure of medical equipment. DIF: Analysis REF: p. 146

22. A nurse who speaks at a health fair states that current attempts to increase efficiency of health care include: (select all that apply) a. an increase in acute care, so that specialized care can be provided. b. the growing use of outpatient services. c. shifting toward health promotion and prevention. d. allowing physicians to control health care decision making. e. the use of technology to educate the public about cost-effective measures.

B, C, E Economic forces are motivating the shift toward providing more services and procedures in outpatient settings. Economic forces are motivating the shift toward a model of health promotion and preventive. The Internet can inform and educate consumers (or clients) about how to access health care educational resources more effectively. DIF: Analysis REF: p. 106 |p. 115

15. A hospital is seeking a 2.5% wage reduction for all nurses as part of a new balanced budget plan; however, the plan provides for raises for upper-level management. This plan resulted in a call for a union to protect the nurses. When the union representative arrives, what questions should the nurses ask? (select all that apply) a. Will the dues be used to support charity care when clients are unable to pay? b. How effective has the union been in representing nurses' best interest? c. What percent of dues pays union personnel salaries? d. Are dues used to promote research for terminally ill clients? e. If arbitration is unsuccessful and a strike occurs, will nurses receive compensation during the strike?

B, C, E Laborers (staff nurses) want a union with a successful track record of improving wages and benefits. Union dues are used to support union personnel, and the amount varies among different union groups; the higher the percentage of money that goes to pay union personnel salaries, the less money will be available to support members. Employers are not obligated to pay laborers during a strike, and unions may choose to pay employees while striking. DIF: Application REF: p. 263, Box 14-1

21. Faculty comes to class to present information about joining the Student Nurses Association (SNA). A student is heard saying, "Why join this organization? It is just a bunch of students like us. I'll wait and join the real nursing organization after graduation." This student is not aware of which benefits of SNA? (select all that apply) a. Members are eligible to sit for the licensure examination at a reduced rate. b. Leadership skills can be refined by working with other schools of nursing. c. The National SNA provides discounted rates for study abroad opportunities. d. A global view of nursing can be obtained through networking internationally. e. Lobbying efforts are a major benefit of belonging to SNA.

B, D Leadership opportunities are available as officers and through conferences. SNA members work with other nursing students across the nation and internationally. DIF: Comprehension REF: pp. 426-427

19. Which types of abuse are the nurse required to report or be subject to fines and imprisonment for not reporting? (select all that apply) a. Animal b. Child c. Alcohol d. Infant e. Emotional

B, D State laws have been created as a result of the 1973 Child Abuse Prevention and Treatment Act. These laws dictate that health professionals must report infant and child abuse and specified communicable diseases. Failure by the nurse to comply can result in fines and/or imprisonment. DIF: Comprehension REF: p. 130

26. A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals. These include: (select all that apply) a. advanced health assessment techniques. b. patient-centered care. c. prescriptive pharmacology content. d. quality improvement. e. safety.

B, D, E Patient-centered care is a recommended competency, along with teamwork and collaboration, evidence-based practice, and informatics. Quality improvement is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. Safety is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. DIF: Comprehension REF: p. 393

20. In orientation, a new graduate is surprised to learn of workplace violence in health care 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 withholding pertinent information from coworkers to portray them as incompetent. c. coworkers participating in an employee assistance program (EAP) to learn more about anger management for adult children living at home. d. care of persons being held for treatment prior to be 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."

B, E Withholding information from novices or coworkers to purposely cause them to appear inadequate or unskilled is considered workplace violence because of the anxiety and stress it produces. This should not be tolerated and should be reported. Such statements, which 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. DIF: Application REF: p. 424

2. The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a _____ nurse. a. case management b. quality assurance c. utilization review d. cost-control

C Hospital-based utilization review nurses review medical records to determine the most appropriate DRG for clients. Financial gains can be made through careful diagnosis of clients according to their highest potential DRG classification. DIF: Knowledge REF: p. 109

15. A nurse is informed that the Federal Bureau of Investigation has determined that a bomb has been detected and is in the possession of a known terrorist group. The government buildings in the local community are the target. This situation is termed a(n): a. all-hazards approach. b. biologic event. c. credible threat. d. natural disaster.

C A credible threat is a situation in which the Federal Bureau of Investigation (FBI) determines that a terrorist threat is probable and verifies the involvement of a weapon of mass destruction in the developing terrorist incident. DIF: Comprehension REF: p. 280

8. A nurse studied a community to determine if there were clients who would benefit from a hospice program if one were developed. This type of research is: a. a survey. b. quasi-experimental. c. a needs assessment method. d. a pilot study.

C A needs assessment method is a study in which the researcher collects data for the purpose of estimating the needs of a group; the method is commonly used to prioritize the needs of an organization or community. DIF: Comprehension REF: p. 94, Table 6-1

6. Which type of data analysis results in the non-numerical organization of data? a. Descriptive b. Inferential c. Qualitative d. Quantitative

C Qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line in an effort to group common conceptual meanings. DIF: Comprehension REF: p. 95

11. A large corporation employs nurses all over the United States. Nurses in one agency learned that fellow nurses in another agency are striking because they are required to work 16-hour shifts to cover for nurses who have left due to unsafe staffing practices. The union of the nonstriking agency nurses decides to stop work to support the nurses who are striking; thus, this union: a. is placing nurses at risk for a lawsuit because their direct employer did not cause the strike. b. must be an industry union representing both parties. c. is participating in a sympathy strike, which, if done correctly, is legal. d. must pay for any losses incurred by the agency during the strike.

C A sympathy strike occurs when a union stops work to support the strike of another union. DIF: Comprehension REF: p. 257

12. The principle of autonomy is best supported by what intervention made available to palliative care patients? a. Arranging for in-home health care b. Addressing the patient's specific pain management needs c. Helping the patient decide on the details of their advanced plan of care d. Conducting a thorough performance status screening on the patient

C Advance directives, if present, can speak for the patient and their wishes thus assuring their autonomy in making the end of life decisions they are in agreement with. DIF: Application REF: p. 230

21. Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of expertise but also recognize other members' strengths. Which of the QSEN competencies are being demonstrated? a. Quality improvement b. Evidence-based practice c. Teamwork and collaboration d. Patient-centered care

C An interdisciplinary team is working to prevent hand-off errors on discharge. DIF: Application REF: p. 393

19. Which of the following occurrences would be classified as a sentinel event? a. A postpartum patient who elects to breastfeed only twice daily develops mastitis. b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator. c. A nurse assisting with the delivery of twins places the "Twin 1" name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin. d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin subcutaneously, resulting in a drop in the patient's serum glucose from 160 to 100 mg.

C Any procedure performed on a wrong person or organ constitutes a sentinel event. DIF: Application REF: p. 380 |p. 391

10. When working with the family of a patient receiving palliative care, what is the nurse's initial intervention? a. Determining who will be the patient's durable power of attorney b. Identifying what types of help the family will need to care for the patient c. Completely an assessment of the family's strengths and weaknesses d. Discuss the dynamics of the family with the patient

C Any strategy to meet the needs of a patient's family begins with a comprehensive family assessment including an assessment of family strengths and weaknesses. DIF: Analysis REF: p. 229

15. A client is in extreme pain after he was involved in a motor vehicle accident, and morphine has been ordered every hour for pain. The nurse injects saline into the client's IV line and takes the morphine for herself. The nurse is violating which principle of ethics? a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas

C Beneficence is providing benefit to others by promoting their good. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the client's pain medication and substituting saline, the nurse did harm, not good, for this client. DIF: Comprehension REF: p. 170

1. A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating: a. open communication. b. filtration. c. blocking. d. false assurance.

C Blocking occurs when the nurse responds with noncommittal or generalized answers. DIF: Comprehension REF: p. 335

17. A nurse interested in quality improvement tools performed a search for cause and effect diagrams using www.ishikawa.com. A page opened that provided images and templates for performing fishbone diagrams. Which type of search did the nurse conduct? a. Quick and dirty b. Advanced c. Brute force d. Link searching

C Brute force is a method of searching where you type in what you think might logically be a web address and see what happens. DIF: Comprehension REF: p. 275

16. Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." When explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism, the instructor states: a. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization. b. D stand for deviation, which is an alteration in the expected drugs ordered. c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process. d. A stands for algorithm, which includes all steps of the process.

C C stands for check if the change improved the process and what was learned. DIF: Analysis REF: p. 397, Figure 22-7

21. A nurse is very interested in learning more about health care economics and how she can use that knowledge to become a better patient advocate. She comments, "Nurses should not only deliver care one day at a time in one facility but should coordinate patient care as they move from acute care to rehabilitation to home care." This nurse would be a candidate for which nursing role? a. Disease management program (DMP) for chronic illnesses b. A hospital-based utilization management nurse who reviews medical records to determine the most appropriate DRG for patients c. Case management d. Reviewer for Managed Care Organization

C Case management offers nurses the opportunity to demonstrate cost-effectiveness by coordinating patient care at the appropriate level of care across the continuum of care. Patient advocacy and understanding current health care economics are critical to this role. DIF: Comprehension REF: pp. 108-109

20. A patient is ordered a low-protein, low-calorie diet but the patient's family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. This situation would represent: a. a sentinel event. b. an adverse event. c. patient-centered care. d. the communication technique of "call-out."

C The nurse and dietitian are respecting patient values, preferences, and expressed needs. DIF: Comprehension REF: pp. 381-382

17. A nurse in a rehabilitation unit plans activities of daily living to prevent excessive fatigue, helps the patient dress before the family visits, assists with range of motion, and allows the patient to decide which clothes to wear during the visit. This nurse is best applying which theory to practice? a. Watson's Theory of Caring b. Rogers' Theory of Unitary Humans c. Levine's Theory of Conservation d. Leininger's Theory of Transcultural Nursing

C Certain parts of all the theories can be applied; however, all the constructs of Levine's Model of Conservation are applied, including energy conservation, structural integrity, personal integrity, and social integrity. In this situation, the nurse conserved energy by planning ADLs, conserved structural integrity through ROMs, conserved social integrity by helping patient with appearance during family visits thus improving the milieu for social visits. DIF: Application REF: p. 83, Table 5-2

16. A staff nurse states, "I really enjoyed having dinner with the Chief of Medical Staff and the President of the hospital. We hope to meet again soon." Which source of power does this nurse possess? a. Expert b. Legitimate c. Connection d. Reward

C Connection power results from knowing or associating with power people such as the upper administration. DIF: Comprehension REF: pp. 297-298

17. A physician shares with the patient's family that, while a central line was being inserted, the patient's lungs were inadvertently punctured, which required oxygen administration. The physician also explains that a chest x-ray indicated the lung remained intact and no additional treatment was required. The physician's role in this instance is based on the legal principle of: a. comparative negligence. b. gross negligence. c. disclosure. d. the Emergency Medical Treatment and Active Labor Act (EMTALA).

C Disclosure is a process in which the patient's primary provider (physician or advanced practice nurse) gives the patient, and when applicable, family members, complete information about unanticipated adverse outcomes of treatment and care. DIF: Comprehension REF: p. 120| p. 139

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?"

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. DIF: Application REF: pp. 416-417

14. An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? a. "You are just too late for that. Where were you when he needed you?" b. "Did you ever consider purchasing a cell phone for your dad to prevent this from happening?" c. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." d. "I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."

C Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person. DIF: Application REF: p. 334

10. A young mother has detected a lump in her breast, and because she lives at the poverty level, she is covered under Medicaid. This individual: a. is more likely to participate in mammography screening than are individuals covered by private insurance. b. has designated primary care and a specialist as sources of care. c. will more likely wait to seek care and will require hospitalization for a mastectomy, which could have been avoided if care had been sought earlier. d. has decreased access to health care when compared with the uninsured.

C Even with improved access as compared with the uninsured, Medicaid recipients are not as likely to obtain needed health services. The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor. DIF: Comprehension REF: pp. 110-111

4. A nursing student planning to apply for licensure knows that being charged with which offense would result in a minor criminal offense? a. Solicitation of illegal drugs b. Stealing a car c. Failing to report elder abuse d. Billing Medicare for services not rendered

C Failing to report elder abuse can lead to penalty of fine or imprisonment. DIF: Comprehension REF: p. 150

23. A nurse is overhead saying, "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly I don't trust any politicians anyway. I plan to take a few weeks off next month." She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, "Let's think the suggestions over and come back together next week." This nurse's communication style is consistent with which generation? a. Baby Boomers b. Traditionalist c. Generation X d. Millenniums

C Generation X individuals grew up in when there was a high rate of divorces; they tend to be more cynical and value work-life balance and teamwork. Holidays are often associated with family gatherings which may have been absent in this generation's family; belief that ALL politicians are untrustworthy may be viewed as cynical. The need to take time to form suggestions to save time and come together to reach team decision are reflective of this generation. DIF: Comprehension REF: p. 343

13. When deciding which staffing option to use on a nursing unit that will open soon, the manager realizes that: a. continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on 3 consecutive days per week. b. the use of part-time nurses provides the variability needed to meet diverse patient needs. c. satisfaction of the staff equates to satisfaction of patients. d. nurses provide the same level of care, regardless of the work environment.

C High nurse satisfaction is generally equated with high patient satisfaction and positive patient outcomes. DIF: Comprehension REF: p. 368

16. A nurse performing a history and physical on a newly admitted Hispanic patient learns the patient has just used the services of a savador to: a. determine which herbs would best reduce hot flashes in a menopausal woman. b. communicate with a family member who recently died. c. receive treatments to reduce lower back pain. d. receive acupuncture to stop smoking.

C Hispanic patients may want the support and care of a savador, which is similar to that offered by a chiropractor. DIF: Comprehension REF: p. 195

14. A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should: a. query the state nursing association to determine their stance on the role of LPNs. b. ask the LPNs on the unit to list what tasks they routinely performed. c. contact the state board of nursing to determine legal scope of practice for LPNs. d. refer to California's nurse practice act because the scope of LPNs/LVNs is consistent across the United States.

C If the nurse practice act lacks clarity, the state board of nursing can provide guidance. DIF: Application REF: pp. 354-355

12. A group of nurses interested in unionizing decides to contact the largest union in the United States representing registered nurses, which is the: a. American Nurses Association. b. United American Nurses. c. National Nurses United. d. National Labor Relations Board.

C In 2009, the National Nurses United became the largest union representing nurses RNs as a result of a merger between the United American Nurses, California Nurses Association, National Nurses Organizing Committee, and Massachusetts Nurses Association. DIF: Comprehension REF: p. 259

10. A client involved in a motor vehicle accident is blinded. The nurse helps the client obtain a guide dog so the client may continue grocery shopping and visiting friends and family. This enables the client to cope with the handicap and perform activities of daily living. Which nursing theory can be applied to this scenario? a. Watson's philosophy and science of caring and humanistic nursing b. Mishel's uncertainty in illness c. Orem's self-care deficit d. Rogers' science of unitary human beings

C In Orem's self-care deficit theory, the nurse implements measures to help clients meet self-care needs by matching them with an appropriate supportive intervention. DIF: Application REF: pp. 83-84, Table 5-2

11. A Southeast Asian woman brings her baby into the clinic because the baby is lethargic. The nurse determines that the baby has had diarrhea and vomiting for several days, resulting in dehydration. Physical examination reveals small, round burns on the abdomen. These burns probably are the result of cigarettes or burning cotton used to: a. try to quiet the child and is considered child abuse. b. bring out toxic wind from the body. c. balance heat loss from the body. d. brush the body with ruda to allow spirits to return.

C In the Southeast Asian culture, touching a burning cigarette or piece of cotton to the skin, usually the abdomen, is done to compensate for "heat" lost through diarrhea. This type of burning is a common part of self-care. DIF: Comprehension REF: pp. 196-197

18. A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform "huddles to update the team" as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. This stage of Lewin's change is: a. unfreeze. b. moving. c. refreeze. d. resistance.

C In the refreezing stage, change becomes status quo and the agent reinforces until the change is part of the daily process as in the above situation. DIF: Comprehension REF: p. 311

16. On a nursing unit all assigned breaks including lunch/dinner breaks are assigned at the beginning of the shift. A nurse caring for a patient with anemia and heart failure prepares to hang a unit of packed red blood cells and realizes her break is in 5 minutes. She decides it is not necessary to have another nurse check the blood against the patient's information since the patient's blood type is O+ which she incorrectly remembered to be the universal donor. She hangs the blood, noting the patient is "reading and vital signs normal." She leaves the floor for her break and does not report leaving or ask anyone to perform required vital signs. Upon returning she meets a family friend who is visiting and time "just flies." She returns to the patient's room after admitting a new patient. The patient is hypotensive and color is cyanotic and anxious. She reports the findings to the charge nurse, who then contacts the physician. A blood reaction occurrence is noted. The nurse providing care is charged: a. with comparative negligence. b. with a preventable adverse event. c. with criminal negligence. d. under the doctrine of res ipsa loquitur.

C In this case, criminal negligence charges would be based on "reckless and wanton" disregard for the safety, well-being, or life of an individual; behavior that demonstrates a complete disregard for another, such that death is likely in the transfusion reaction. Type "O" is the universal donor rather than universal recipient; however, regardless of blood type, policy and procedures for assessing vital signs and patient status during blood transfusion must be followed. DIF: Comprehension REF: p. 120|p. 136

2. Customer satisfaction is primarily based on: a. access to modern, up-to-date facilities. b. availability of an extensive menu selection. c. personal interactions with employees. d. having to undergo fewer invasive procedures.

C Interactions between employees and patients/families actually affect clinical outcomes, functional status, and even physiologic measures of health. DIF: Knowledge REF: p. 369

20. A nurse is seeking to become culturally competent in regard to obtaining information during health history and when performing physical diagnosis. The nurse is aware that which biologic variation is found in all of the following ethnicities: blacks, Asians, Hispanics, and American Indians? a. Mongolian spots b. Sickle cell anemia c. Lactose intolerance d. Thalassemia

C Lactose intolerance is found in all four of the noted ethnicities. DIF: Application REF: p. 193, Table 10-2

1. Nurses in a unionized hospital are paid "compensatory pay" when working holidays equal to the number of hours worked with no extra compensation. Although they have suggested changes during the annual survey of employee satisfaction, management refuses to consider another system for compensatory pay. A trained member listened to both nurses and management to make recommendations that were not legally binding. This type of settlement is termed: a. picketing. b. binding arbitration. c. mediation. d. grievance.

C Mediation enlists the help of a trained person to listen to both sides; however, recommendations are not legally binding. DIF: Comprehension REF: p. 257

14. An elderly person, age 80, is finding it difficult to live alone and the family is considering long-term care. The elderly person is reasonably healthy, with only normal aging declines, and maintains a healthy appetite. All medications are administered orally and require only minimal assistance. She is financially secure with an income based on retirement from both the military and factory from her deceased husband and herself. The family contacts long-term care and is told that, based on this patient's information: a. Medicare will cover the cost of stay since skilled services are required. b. Medicaid is only for families with dependent children. c. Medicare will pay for home health services should these additional services meet the needs of the individual. d. Medicare will pay regardless of household income or financial status for nursing home care.

C Medicare does cover home health care. DIF: Comprehension REF: p. 113

12. A nurse interested in life satisfaction among patients receiving hemodialysis reviews databases and identifies relevant studies which are then statistically analyzed providing generalization through multiple studies. The nurse researcher is using which type of research? a. Quasi-experimental b. Secondary analysis c. Meta-analysis d. Survey

C Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization. DIF: Comprehension REF: p. 94, Table 6-1

13. A nurse who is infected with human immunodeficiency virus (HIV) while working in the operating room seeks revenge by deliberately placing clients at risk by not adhering to universal precautions. This nurse is violating the ethical principle of: a. veracity. b. beneficence. c. nonmaleficence. d. autonomy.

C Nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. The nurse is definitely violating this principle through her actions. DIF: Comprehension REF: p. 170

9. In recent Gallop Polls, nurses were voted as the most honest with the highest ethical standards of all professions. How does this degree of professionalism affect nurses' desire to participate in organized strikes? a. Nurses most often turn to collective bargaining strategies such as strikes to emphasize client safety initiatives. b. Nurses use evidence-based studies that reflect both management and labor views to support participation in unionization. c. Nurses often find union activities such as strikes in conflict with the need to serve and protect clients and their profession. d. Nurses who strike can be legally punished for abandonment and negligence, considered to be professional misconduct.

C Nurses are client advocates and promotion of professionalism is valued as evidenced by the public's opinion related to honesty and professionalism. DIF: Application REF: p. 262

1. Ethics applied to nursing can best be defined as: a. doing what is best for the client. b. making good decisions about care. c. care based on what should be done in keeping with the values of the client. d. rules for providing competent care that is based on scientific principles.

C Nursing ethics is a system of principles intended to guide the actions of the nurse in his or her relationships with clients, clients' family members, other health care providers, policymakers, and society as a whole. A nurse must make an attempt to understand what values are inherent in the situation. DIF: Knowledge REF: p. 164

10. An RN is counseled by the nurse manager regarding inappropriate delegation when the: a. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their rooms. b. nursing assistant informs the RN that she has not been trained to collect a sputum specimen and the RN states, "I will show you this time and you can show me the next time." c. RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube. d. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a patient before she is discharged home.

C Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation. DIF: Application REF: p. 357

5. What is the primary factor that characterizes a patient receiving palliative care a. A diagnosis of a serious, life-threatening disease b. Ability to make sound health care decisions c. An interest in exploring available life sustaining treatment options d. A life expectancy of less than 12 months

C Palliative care is appropriate for the patient diagnosed with a life-threatening disorder who wishes to take advantage of any life sustaining treatments available. DIF: Application REF: p. 222

14. The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is a: a. cause-and-effect diagram. b. run chart. c. Pareto chart. d. flowchart.

C Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized. DIF: Comprehension REF: pp. 385-386

17. Health care is one of the major stories in newspaper and television and a group of nurses are interested in how the economy impacts their nursing practice. The group critiques the relationship between contemporary economic trends and professional nursing practice and finds: a. the implementation of the DRG system led to the nursing shortage since cost of nursing care is not billed. b. nursing care is focused on technologically advanced acute care rather than preventive, patient-centered care. c. with pay for performance, nurses have a significant effect on the quality of patient outcomes by reducing errors and providing care based on best practices. d. economic issues have little or no impact on nursing practice.

C Pay for performance, where providers are reimbursed based on the quality of care, gives nurses an opportunity to reduce costs and adopt practices that improve quality of care. DIF: Comprehension REF: pp. 113-114

2. A nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes in order to understand the "lived experience." These characteristics are consistent with the qualitative research method known as: a. grounded theory. b. ethnography. c. phenomenology. d. case study.

C Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. DIF: Comprehension REF: p. 89 | p. 95, Table 6-2

3. When paper-and-pencil medical records are compared with computer-based records: a. paper-and-pencil records provide controls to determine who has viewed the health information. b. information contained in a paper-and-pencil record has the capability of being more in-depth than that found in computer-based records. c. patients have the right to know that the confidentiality of their records is strictly maintained, regardless of the type of medical record used. d. patients must sign for each item of information released on the computer record.

C Regardless of the type of record used, the Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality of the patient's medical information and imposes legal consequences for those who breech confidentiality. DIF: Comprehension REF: p. 271

15. An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation? a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin. b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound. c. An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway. d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3.

C Risk of falling is great in later stages of Huntington's disease due to chorea movements. DIF: Application REF: pp. 359-360

6. A physician has installed a computer-based patient records system. An outside care provider who requests medical information must obtain the patient's signed consent and then is assigned a password to gain access to the medical information. A monthly audit is conducted to determine for whom and for what purpose patient records have been accessed. This protection is referred to as: a. privacy. b. confidentiality. c. security. d. data capture.

C Security is the limitation of access to health care information through passwords and other precautions. DIF: Comprehension REF: p. 271

6. Managers who exhibit an authoritative behavioral style are most likely to use which source of power? a. Informal b. Expert c. Coercive d. Reward

C Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished. DIF: Application REF: p. 300, Box 17-3

5. An RN with excellent assessment and psychomotor skills would derive power on the basis of which source? a. Rewards b. Coercion c. Expert d. Legitimate

C Seven primary sources of power are known. Expert power is based on knowledge, skills, and information. DIF: Comprehension REF: p. 297

11. A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To enhance employee satisfaction related to staffing, the management team: a. negotiates for additional agency nurses. b. hires more part-time employees. c. includes participatory management into staffing decisions. d. uses "float" nurses to cover vacancies.

C Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction. DIF: Application REF: p. 368

9. Which statement correctly applies to a person's suffering? a. Pain is the cause of suffering. b. Suffering and pain are experienced separately. c. Suffering can exist without the experience of pain. d. Pain is the focus of all nursing assessments.

C Suffering is the experience of a person while pain and other symptoms are the result of physical body or organ changes. Suffering and pain can coexist together, although one can be present without the other. DIF: Comprehension REF: pp. 228-229

21. A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through: a. empathy. b. positiveness. c. supportiveness. d. accommodation.

C Supportive communication occurs when each person's opinion/position is valued and each participant has the freedom to express a position but is willing to change that opinion/position. DIF: Comprehension REF: p. 346

8. Historically, what movement most influenced unionization in American health care agencies/hospitals? a. Immigration laws protected foreign employees from discrimination in hiring or discharge on the basis of national origin and citizenship status. b. Women entered the workforce, gaining voice to support unions. c. The Industrial Revolution led to poor working conditions and the need to protect workers. d. Nurses were exposed to communicable diseases, which led to death and disability.

C The Industrial Revolution led to people working in factories where poor and unsafe working conditions were widespread. DIF: Comprehension REF: pp. 258-259

13. A physician orders a drug for a patient with a known allergy resulting in anaphylactic shock. The nurse: a. realizes that disclosure of the error will result in more severe ramifications for the agency than if the negligence is discovered by the patient or family. b. should disclose the occurrence before speaking with the physician who ordered the drug or with hospital management. c. recognizes disclosure as an essential component of the national patient safety movement. d. should report the occurrence to the patient's insurance company to decrease patient costs.

C The National Quality Forum identified the process of disclosure as a key element of the national patient safety movement. DIF: Application REF: p. 139

18. A nurse is asked to "float" to a telemetry floor and is to place a patient on telemetry monitor. The nurse is unfamiliar with placement of EKG leads and would consult which type of chart to learn the correct placement? a. b. c. d.

C The Pareto chart is used to prioritize interventions that caused the majority of the problems. DIF: Application REF: p. 387, Figure 22-3

20. Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria? a. The RN administers all medications to all patients. b. The LPN performs sterile dressings and IV tubing changes on all central lines. c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor. d. The RN administers an enema to a stable patient who has an order "administer fleet enema PRN when no bowel movement in 2 days."

C The UAP, when properly trained, can place patients on telemetry. This meets quality and cost containment goals because the LPN and RN have higher salaries. DIF: Application REF: pp. 353-354

10. All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a living will or a durable power of attorney. This act is known as the: a. Emergency Treatment and Active Labor Law. b. Americans with Disabilities Act. c. Uniform Health Care Decisions Act. d. doctrine of res ipsa loquitur.

C The Uniform Health Care Decisions Act of 1993 is a federal statute that was established to support individuals in expressing their preferences about medical treatment and making decisions about end-of-life care. DIF: Comprehension REF: p. 152

15. A nurse develops a new nursing theory related to stress and viability. The nurse determines the theory accounts for historical events in which soldiers suffering from the stress of inadequate clothing to protect them from the cold and lack of correspondence from home had an increased mortality related to gunshot wounds. The theory will predict gunshot victims' need for proper clothing and letters from significant others as they serve in Iraq. Which criterion for theory acceptance is being validated? a. Inclusiveness b. Consistency c. Accuracy d. Simplicity

C The accuracy of a theory is its ability to explain past occurrences while being useful in determining future outcomes. DIF: Application REF: p. 77, Box 5-2

11. The crisis communication officer may first inform the public or health care facility of a disaster or an act of terrorism. This representative has the responsibility to: a. contain the facts to within the administration group. b. incite the public to quickly take cover and obtain emergency supplies. c. provide understandable and straightforward facts about the event within the facility and possibly to the news media. d. inform the public that no information can be released until it has been confirmed by state and federal agencies.

C The crisis communication officer is the first contact for patients, families, and employees within the facility or news media, so they may better understand the situation and know how to react and protect themselves. DIF: Comprehension REF: p. 289

2. During a search for the term informatics, when the nurse finds the domain ".edu," the site is affiliated with a(n): a. government agency. b. commercial site. c. educational institution d. Internet service provider.

C The domain of an educational institution is .edu. DIF: Knowledge REF: p. 276

11. When comparing mentoring and role modeling, the role of mentoring is represented by which of the following situations? 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.

C The experienced nurse knowingly enters into a relationship to advocate for and to enhance the self-esteem of the novice nurse. DIF: Analysis REF: p. 425

1. Institutional review boards determine whether research studies involving human subjects will: a. be published. b. add to the body of nursing knowledge. c. cause harm. d. receive funding.

C The institutional review board (also called the human subjects committee) examines research proposals to ensure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected. DIF: Knowledge REF: p. 102

14. A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet its goal to "provide quality patient care with attention to compassion and excellence." An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management? a. Transactional b. Clinical consultant c. Corporate supporter d. Autocratic

C The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement. DIF: Comprehension REF: p. 311

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.

C The novice nurse can become familiar with the technique, then can perform the skill under the supervision of an experienced nurse, ensuring competency. DIF: Application REF: p. 429

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."

C The novice nurse is working to improve the safety and patient environment and is a patient advocate. DIF: Comprehension REF: p. 418

18. A novice nurse is placed in charge just after orientation ends. Which statement by the novice nurse would ensure a smooth delegation experience when delegating to an experienced staff member? a. "You have the patients in rooms 1 to 7. These patients require little skill so you will be fine." b. "Your assignments are posted in writing by the nurses' station. Be certain all your tasks are completed so the next shift is not behind." c. "You have patients in rooms 5 through 10 and I will administer all IV medications. I will let you know if I have to adjust. If you see you need help let me know." d. "Everyone is capable of providing the best care, so please sign up for the patients you would like to be assigned to."

C The nurse is clearly stating the assignments, allowing for a need to adjust both to needs of the unit and the delegate's needs. DIF: Application REF: pp. 422-423

7. A client states, "I am leaving. No one here knows what they are doing." The nurse completing the Against Medical Advice form must: a. defer notifying the provider until the client has had ample time to leave. b. state in medical terms the risks of leaving. c. inform the client that leaving could result in complications and impairment. d. detain the person with the use of soft restraints until security arrives.

C The nurse must articulate to the client the dangers associated with leaving the facility if the primary provider is not present. The nurse's notes on this form should reflect the specific advice given to the client, which should include the fact that leaving the facility could aggravate the current condition and complicate future care, result in permanent physical or mental impairment or disability, or result in complications that can cause death. DIF: Application REF: p. 93

19. A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is?

C The patient must be able to name the day of the week rather than use answer yes or no. DIF: Application REF: p. 334

4. When reviewing the literature on the effects of Medicaid on health care for the poor, the nurse researcher found that the poor: a. have less access than even the uninsured. b. receive many unnecessary treatments. c. lack consistent providers. d. abuse preventive services.

C The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor. DIF: Comprehension REF: p. 111

2. An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that: a. the role of the LPN/LVN is the same from state to state. b. the LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided. c. he or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN. d. The Joint Commission has certified and established roles for the LPN/LVN.

C The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN. DIF: Comprehension REF: p. 354

2. One difference between a leader and a manager is that a: a. leader has legitimate authority. b. manager motivates and inspires others. c. manager focuses on coordinating resources. d. leader focuses on accomplishing goals of the organization.

C The terms leadership and management are often used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes. DIF: Comprehension REF: p. 296

7. In the triad of health care, which would be considered the third-party payer? a. Client b. Health care provider c. Insurance company d. Government agency that sets reimbursement rules for services

C The third-party payer is an organization other than the client and the supplier (hospital or physician), such as an insurance company, that assumes responsibility for payment of health care charges. DIF: Knowledge REF: p. 107 |p. 113

4. Nurses in a nonprofit hospital have expressed an interest in forming a union to secure fair wages and ensure client safety. To form a core support group of nurses, the union organizer can conduct meetings to gather initial information: a. away from the worksite with a group of managers to learn both sides of the situation. b. at the worksite with staff nurses who are respected leaders. c. in homes or local businesses with staff nurses. d. after photographing management meeting to discuss their strategies to decrease interest in unionization.

C The union representative meets with laborers (staff nurses) at a nonwork setting to gather information about grievances. DIF: Application REF: p. 260

9. An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision? a. There is no supervision, because at times the LPN/LVN is not with the RN. b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care. c. Continual supervision is being provided until the RN determines competency. d. Initial supervision is being provided because this is the LPN/LVN's first day on the unit.

C This level of supervision is required when the working relationship is new, the task is complex, or the delegatee is inexperienced or has not demonstrated an acceptable level of competence. DIF: Comprehension REF: p. 362

4. In attempting to decide which services should be offered to a community, the public health nurse decides to implement hypertension screening and treatment because most of the residents are hypertensive. This decision is based on the principle of: a. veracity. b. values. c. utilitarianism. d. autonomy.

C Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. On the basis of this principle, an attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the situation. DIF: Application REF: p. 162 |p. 169

21. A researcher is interested in quality of life and after an extensive literature review quantitatively integrates data from identified studies and describes the findings. This researcher is using which approach? (select all that apply) a. Survey b. Triangulation c. Meta-analysis d. State of the science summary e. Quasi-experimental design

C, D Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. State of the science summary is a merging of findings from several studies that explored the same topic. DIF: Comprehension REF: p. 94, Table 6-1

22. A nursing administrator who is considering the feasibility of an all-RN staff reviews the report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) and determines that RNs: (select all that apply) a. are more costly and less efficient than LPNs. b. have little or no effect by being proactive but instead are reactive to patient care errors. c. have a positive effect on patient outcomes when managing patient care. d. are effective overseers of patients' overall health condition. e. lack the training to be effective delegators.

C, D RNs are effective at coordinating care that results in improved patient outcomes. RNs are valuable monitors of a patient's health status—a practice that results in improved patient outcomes. DIF: Comprehension REF: p. 353

21. A nurse asks, "What is meant by 'internal' customers?" The correct response is: (select all that apply) a. insurance companies b. accreditors such as The Joint Commission c. X-ray technicians d. clinical pharmacist e. chief financial officer

C, D, E Internal customers are employees of an organization at all levels. An x-ray technician is an example of an internal customer. Internal customers are employees of an organization at all levels. A clinical pharmacist is an example of an internal customer. Internal customers are employees of an organization at all levels. A chief financial officer is an example of an internal customer. DIF: Comprehension REF: p. 308

17. It is important to realize that nurses may seek unionization if: (select all that apply) a. physicians rotate on-call coverage among group members for complicated long-term clients. b. scheduling is presented that provides adequate staffing on holidays by rotation of time off for holidays among nurses. c. incident report trends indicate medication errors are caused by shift reports being taped and heard after nurses from the prior shift have left the unit. d. physicians, nurses, nutritionists, and physical therapists visit concurrently with clients to plan care. e. staff development activities are planned daily at 8 AM for 2 consecutive days to educate staff on new cardiac monitoring procedures while following normal staffing patterns.

C, E Policies where shift reports are taped and heard after a prior shift has left have proved to lead to errors and unsafe care. Staff development activities should be scheduled to allow nurses to attend, and normal staffing patterns or time of training must coincide with nurses' availability and ability to listen to and retain information (such as at the beginning or end of the shift while others provide coverage). DIF: Comprehension REF: p. 262

15. A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. "Do you exercise?" b. "Do you like to exercise?" c. "When do you exercise?" d. "What exercise practices do you participate in?"

D "What exercise practices do you participate in?" is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances. DIF: Analysis REF: p. 334

17. A nurse is interested in learning how reminiscence therapy can improve memory in cognitively intact persons over the age of 65 years. Findings from three groups are compared. Group 1 receives music therapy, Group 2 receives life review therapy, and Group 3 does not receive therapy, but data are collected from all three groups and compared. Group 3 is known as the: a. pilot study. b. survey. c. needs assessment. d. control group.

D A control group is a set subject in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. DIF: Comprehension REF: p. 89

13. A nurse plans to move to an area that is rich in immigrants from several countries and is concerned about respecting others' cultural beliefs. The nurse's first step to ensure cultural competence and sensitivity is to: a. enroll in a nursing theories course to increase knowledge about transcultural practices. b. become immersed in nursing literature about culturally diverse clients. c. participate in continuing education that focuses on health assessment variations among cultural groups. d. conduct a cultural self-assessment.

D A cultural self-assessment allows the nurse to identify attitudes about individuals from different cultures. DIF: Application REF: p. 196

8. An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to as a: a. Pareto chart. b. control chart. c. top-down flowchart. d. deployment chart.

D A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety. DIF: Comprehension REF: p. 385

3. A peaceful death is best characterized by which terminally ill patient? a. One who is surrounded by family b. One who uses meditation to help manage pain c. One who has advanced directives in place d. One who has drifted from lethargy to coma

D A peaceful death is generally described as being peaceful and comfortable with the patient drifting though the various stages of alertness to finally being comatose. DIF: Application REF: pp. 224-225

19. A nurse is heard making this comment, "I believe human dignity is based on perceived self-worth while caring is based on perceived role in society that forms the basis of nursing practice." This nurse is: a. demonstrating a model of human dignity. b. evaluating the relevance of Leininger's Theory. c. applying Mishel's Theory of Disease Uncertainty. d. making a proposition concerning the constructs of nursing practice.

D A proposition is a statement that proposes the relationship between and among concepts. DIF: Application REF: p. 76 |p. 78

13. During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter's wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation? a. Failure to take time to put on shoes due to urgency b. Unsteady gait due to narcotic administration c. Poor lighting that led to decreased vision d. Improper construction that caused the leak and towel placement

D A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project. DIF: Application REF: p. 383

11. Which action represents the key management function of strategic planning? a. Determining that all nurses on the unit understand the current organizational philosophy b. Evaluating the communication process between the pharmacy and the nursing departments c. Monitoring data from the quality management initiative related to the last three orientation programs d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units

D A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future. DIF: Application REF: pp. 301-302

8. When can a nurse detain a client by using restraints? a. Staffing resources are insufficient to monitor a patient with hemiplegia. b. The client is confused. c. The family requests the restraints to prevent the client from leaving the facility. d. There are current physician orders following a medical evaluation.

D A written physician's order that is timed and dated is required for the use of restraints. Renewal of orders must be accompanied by evidence of medical evaluation and nursing reassessment. DIF: Comprehension REF: p. 155

12. Which statement related to delegation is correct? a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act. b. Nursing practice can be delegated only when the LPN/LVN and UAP have received adequate training. c. Supervision is not required when routine tasks are delegated to a competent individual. d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.

D Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice. DIF: Knowledge REF: p. 354

1. Accrediting agencies such as The Joint Commission address staffing by: a. imposing maximum staffing levels. b. requiring a specific staff mix. c. stipulating nurse-patient ratios. d. looking for evidence that patients receive satisfactory care.

D Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing. DIF: Comprehension REF: p. 369

14. A client and her husband used in vitro fertilization to become pregnant. The unused sperm was frozen so the couple could have more children later. The husband is killed while in combat, and the client journals her choices and the possible ramifications. She comes to the fertility clinic after looking at the situation from many perspectives and after considering many alternatives. She asks that the sperm be destroyed because her husband's faith prohibited remarrying, and allowing another person to use the sperm would conflict with her late husband's beliefs. The nurse realizes that: a. the client is in the second step of ethical decision making and that the client's value system is influencing her choices of alternative actions. b. a logical line of reasoning has led to validation of the decision to destroy the husband's sperm. c. the client has not been able to navigate the complicated issues inherent in this situation. d. a rational decision was reached that was based on reflection and on the value systems of the wife and the husband.

D After completing all steps in the situation assessment procedure, the client is now ready to justify her selection. In this phase, the person will specify reasons for the action, will clearly present the ethical basis for these reasons, will understand the shortcomings of the justification, and will anticipate objections to the justification. DIF: Analysis REF: p. 172

7. A nurse is submitting a grant application to improve access to health care and mortality for minority groups. The grant focuses on the six causes of death that are identified as priorities for minorities, which include: a. chronic obstructive pulmonary disease. b. malnutrition. c. cirrhosis of the liver. d. cancer.

D Cancer is identified as a leading cause of excessive death among minority group members. The six leading causes are cancer, cardiovascular disease and stroke, chemical dependency, diabetes, homicides/accidents, and infant mortality. DIF: Comprehension REF: p. 182

12. A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services? a. Prospective payment system b. Retrospective payment system c. Single-payer system d. Capitation

D Capitation is a method of reimbursing providers (usually, primary care providers such as physicians or nurse practitioners) in which the insurance company pays the provider a set amount of money each month to provide a defined set of health care services under this plan. Payment is generally received as a per-member-per-month payment. Defined health care services generally include preventive, diagnostic, and treatment services. DIF: Comprehension REF: p. 106

7. Nurses caring for the victims of a mass casualty incident: a. determine the common terminology to be used by hospitals and participating agencies. b. take charge of communicating with the news media. c. determine whether there is a credible threat of a terrorist attack. d. give priority for care to those with the greatest chance of survival rather than those most critically ill.

D Care is shifted from categorizing patients at low, intermediate, and critical risk to using resources to serve those with the greatest likelihood of survival. DIF: Comprehension REF: p. 283

4. Which statement accurately describes communication? a. The components of communication are mutually exclusive. b. Communication is linear. c. Communication involves only the sender and the receiver; everything else is superficial. d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.

D Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes. DIF: Comprehension REF: p. 330, Figure 19-1

19. A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function? a. Directing b. Planning c. Organizing d. Controlling

D Controlling is the final management function. It includes performance evaluations, financial activities, and tracking outcomes of care to ensure quality. DIF: Comprehension REF: p. 307

11. A nurse who functions in the role of team leader can be held negligent for matters involving: a. inadequate training. b. lack of development of proper policies and procedures. c. failure to discipline unsafe workers. d. delegation of client care tasks.

D Delegation of client care tasks falls within the role of the team leader, and inappropriate delegation of client care tasks could result in negligence. Team leaders, charge nurses, and managers are held to the standard of care of the reasonably prudent nurse employed in that role. DIF: Comprehension REF: p. 144

12. A nurse researcher determines whether findings are substantial by calculating the level of significance. Which aspect of the scientific inquiry is being conducted? a. Hypothesis b. Method c. Data collection d. Evaluation

D During evaluation, results are examined with the goal of determining the relevance of outcome data in answering the hypothesis; the significance of the data and the potential for future research are also explored. DIF: Application REF: p. 77, Box 5-1

19. A Hispanic patient is visited by several family members and the nurse witnessed one visitor who pinches a piece of skin at the waist. The nurse asks the purpose and learns the "provider" is listening for a snap from the abdominal region, which is then repeated several times. The patient most likely suffers from: a. mal ojo. b. susto. c. bilis. d. empacho.

D Empacho is believed to be caused by lodged food particles, causing acute stomach/intestinal pain. DIF: Comprehension REF: p. 198

22. Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct? a. Each competency is mutually exclusive. b. The competencies focus on individual efforts to reduce errors. c. Physicians lead the team to achieve each competency. d. The competencies address both individual and system approaches to transform care.

D Errors and increased health care costs result from both the actions of health care workers and the nature of the system in which they deliver care. DIF: Comprehension REF: p. 381

20. An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery? a. Team b. Partnership c. Primary d. Functional

D Functional care delivery models assign tasks to each provider. In the above visual, the LPN is responsible for oral medication administration, the unlicensed assistive personnel provide hygiene, and the RN is assigned to task that require the nursing process. DIF: Application REF: pp. 370-371

4. A nurse is preparing a scholarly publication on the prevalence of hepatitis A worldwide. The most efficient and effective means of conducting an Internet search to gather information for this publication is to use: a. a search engine such as Google or Yahoo. b. a consumer health website. c. a decision support system. d. MEDLINE database.

D MEDLINE is one of the scientific and research scholarly databases, and it would be the most appropriate for use in gathering information for a scholarly publication. DIF: Comprehension REF: p. 276

1. Which nursing theory might a nurse use as a conceptual framework to determine how to meet the needs of immigrants while ensuring provision of high-quality and culturally sensitive care? a. Martha Rogers' nursing theory b. Dorothea Orem's nursing theory c. Hildegard Peplau's nursing theory d. Madeleine Leininger's nursing theory

D Madeleine Leininger proposed the theory of cultural care diversity and universality. This theory of transcultural nursing comprises concepts involving caring and the components of a cultural care theory: diversity, universality, worldview, and ethnohistory. DIF: Comprehension REF: p. 85

11. A group of nurses is presenting the importance of high-quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that: a. being insured has little effect on a person's longevity and the quality of care received. b. lobbyists for the drug companies are able to gain permission for the use of new drugs within 1 year of their discovery. c. although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS). d. medication-related errors place a tremendous financial burden on the U.S. health care system.

D Medication-related errors for hospitalized patients cost roughly $2 billion annually. DIF: Comprehension REF: pp. 381-382

17. A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms 211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. The care delivery model used in this situation is: a. team. b. primary. c. partnership. d. modular.

D Modular (or geographic) assignments are based on a geographic location in the nursing unit. DIF: Comprehension REF: p. 372

14. If a nurse applies Nightingale's theory to current practice, the nurse's first step will be to evaluate the hospital room's air quality and, second, to: a. make certain that the volume of the television is not too loud. b. consult the dietitian to check that essential nutrients are added to meet requirements noted on MyPyramid. c. ask the client's family to bring family photographs and bright-colored throws for the bed. d. arrange for the client to go outside, weather permitting, while keeping the room's window blinds open.

D Nightingale believed the need for light was second only to the need for fresh air. DIF: Application REF: p. 82

8. Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegatee has had experience and training? a. Evaluate the ability of a patient to swallow ice after a gastroscopy. b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.

D Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation. DIF: Analysis REF: pp. 357-358, Box 20-3

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.

D Outcomes are based on meeting existing criteria rather than on knowing how the outcome was achieved. DIF: Application REF: p. 420

22. A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style? a. Assertive b. Aggressive c. Passive d. Passive-aggressive

D Passive-aggressive communication is represented by incongruent actions—the nurse shows friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the original unit; however, she shows her anger by hitting the wall and muttering. DIF: Comprehension REF: p. 341

8. The physician who insists on providing treatment in spite of the client's wishes because he "knows best" is reflecting: a. autonomy. b. beneficence. c. justice. d. paternalism.

D Paternalism is an action and an attitude wherein the provider tries to act on behalf of the client and believes that his or her actions are justified because of a commitment to act in the best interest of the client. Paternalism is a reflection of the "father knows best" way of thinking. DIF: Comprehension REF: pp. 175-176

5. A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of a(n): a. interpretation. b. context. c. precipitating event. d. preconceived idea.

D Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before having an encounter. Such ideas can dramatically affect the receiver's acceptance and understanding of the message. DIF: Application REF: p. 330

11. Which statement about qualitative research is correct? a. Qualitative research requires less time than quantitative research because complex statistical analysis is not necessary. b. To be statistically significant, qualitative studies must consist of large, randomly selected sample sizes. c. Because qualitative studies deal with human concepts such as suffering and quality of life, results can be generalized. d. Interviews are the primary means of collecting data that enable the researcher to describe unclear phenomena.

D Qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena. DIF: Comprehension REF: p. 95

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.

D Residency programs offer a longer precepted orientation period (often 12 months) to bridge the gap between the classroom and practice. DIF: Comprehension REF: pp. 425-426

9. A nurse who is conducting a staff in-service on the phases of a disaster continuum teaches participants that, during the impact/response stage, activities focus on: a. community awareness in anticipation of a terrorist attack or natural disaster. b. determining the effectiveness of the disaster medical assistance team (DMAT). c. the use of an all-hazards approach. d. initiating response activities.

D Response activities during the relief response phase consist of immediate actions to save lives and meet basic human needs. DIF: Comprehension REF: p. 288

5. A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation? a. Supervision b. Communication c. Person d. Circumstance

D Right circumstance involves the delegation of tasks that do not require independent nursing judgments. DIF: Comprehension REF: p. 360

9. A nurse believes that humans use creativity and critical thinking to balance their connections with their surroundings. The nurse decides to conduct a study on the basis of this belief. Which nursing theory would be best for this study? a. Peplau's interpersonal relations as a nursing process: man as an organism that exists in an unstable equilibrium b. Roy's adaptation model: assistance with the adaptation to stressors to facilitate the integration process of the client c. Orem's self-care deficit model: self-care, self-care deficits, and nursing systems d. Rogers' science of unitary human beings: humans as energy fields that interact constantly with the environment

D Rogers' science of unitary human beings, in which humans are seen as energy fields that interact constantly with the environment, is a theory in which the nurse promotes synchronicity between human beings and their universe/environment. DIF: Comprehension REF: pp. 83-84, Table 5-2

8. A nurse who is teaching a class to introduce telehealth to the staff would include which example? a. A robot performs menial housekeeping chores for an invalid patient. b. A computer software program alerts the nurse or physician who is reviewing orders that an order for a new drug can cause synergy of the theophylline inhaler. c. A physician speaks into a computer, and the admission history is recorded and saved in the patient file. d. While a patient in Wyoming performs peritoneal dialysis, a nurse watches remotely from California to ensure that all steps are being followed correctly.

D Telehealth is the delivery of care to a patient who is at a distance from the health care provider. DIF: Application REF: p. 273

3. A nurse has heard rumors that other nurses are interested in unionizing but knows little about the purpose of unions. The nurse's first action is to: a. contact an arbitrator who has worked with other nurses in unions. b. picket the agency where employed to gain inside information as to why unionization is sought. c. sign the dual-purpose union authorization card. d. review the National Nurses United website for collective bargaining information.

D The National Nurses United website gives information about collective bargaining for nurses. DIF: Application REF: p. 259

12. A hospital's policy requires that all nurse managers must have a minimum of a bachelor's degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, "The new nurse manager has book sense but no leadership abilities." What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit? a. Send memos to all staff except the upset nurse to invite them to a luncheon. b. Ask management to transfer the upset nurse to another unit. c. Assign the upset nurse to committees that do not directly affect that nursing unit. d. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication.

D The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual's clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse's power as an informal leader, should involve him and other staff members in decision-making and change-implementation processes, and should clearly communicate goals and work expectations to all staff members. DIF: Application REF: pp. 297-298

13. A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? a. Coercive b. Transformational c. Laissez-fair d. Legitimate

D The coordinator of the committee has an official position within the organizational committee. DIF: Comprehension REF: p. 297

17. A novice nurse is stressed due to always being behind with her assignments. She is overheard saying, "No one here worries about checking nasogastric tube placement before they give medications and hang feedings. Skipping that step would save me an extra 30 minutes to be used for charting. If they can do it, so can I." This nurse is experiencing which stage of reality shock? a. loner. b. "rutter." c. change agent. d. "native."

D The novice nurse is mimicking the actions of the experienced nurse taking shortcuts that were not taught in school and not following policy and procedure. DIF: Comprehension REF: p. 417

3. A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse completes the following interventions: places the client on the examining table, completes a thorough history and physical, covers the client with a sheet, places the call button within reach, and goes out in the hall to speak with the client's physician. The client tries to get up to speak with his family and falls, sustaining a hematoma on the head and a broken hip. The nurse's actions reflect: a. invasion of privacy. b. libel. c. slander. d. negligence.

D The nurse is failing to ensure client safety after medication administration; this is defined as negligence. DIF: Comprehension REF: p. 120|p. 132

6. As a patient's condition moves toward their impending death, which nursing intervention demonstrates how the focus of palliative care change? a. The patient is encouraged to discuss their spiritual needs. b. The patient is educated concerning the physical changes associated with the dying process. c. The patient's advance care plan is formulated and implemented. d. The patient's comfort needs are identified.

D The palliative care continuum model of begins comfort care at the time of diagnosis when therapies are aggressive but as the disease progresses towards death comfort care increases. DIF: Application REF: pp. 224-225

18. A registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult the state board of nursing to determine scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). She also realizes there are common policies which exist in most state practice acts that include: a. the RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee. b. the RN may only delegate tasks that are not in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task. c. since the LPN is licensed, they practice professional nursing. d. to determine what tasks can be safely delegated, the RN must first assess the patient.

D The stability of the patient must be determined prior to delegation. Even routine tasks such as taking vital signs that are often delegated may need to be performed by the RN when the patient's condition is critical. DIF: Comprehension REF: pp. 354-355, Box 20-1

13. During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that: a. the health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. UAPs cannot be held responsible for their own actions or inactions. d. the nurse practice act and state regulations related to delegation override the organization's policies.

D The state's nurse practice act is the deciding factor regarding what can legally be delegated. DIF: Comprehension REF: p. 355

16. Which component of an e-mail shown below would be both effective and concise? a. Subject: A short concise subject line: Meeting. b. Body: I would like you to answer these questions before the next meeting: Where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582.

D This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication. DIF: Analysis REF: p. 339

10. A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? a. Every morning at shift change, thank each employee for an excellent job. b. Rotate a monthly "employee recognition award" among all employees on the unit. c. Wait until the annual performance review to recognize accomplishments. d. Give spur-of-the-moment recognition to an employee who has accomplished a goal.

D To be effective, positive reinforcement should (1) be specific, with praise given for a particular task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment. DIF: Application REF: p. 306

13. In February 2010, Congress passed legislation to support universal health care for all Americans. At a local health fair, an individual asks about the difference between universal health care and a single payer system. The nurse explains the difference is that: a. with universal health, one universal payer, usually the government, pays all expenses for health care. b. single-payer systems offer health care only to eligible persons based on income. c. single-payer systems rely on insurance companies to pay predetermined fees for services. d. with universal health, one payer is responsible for all health care costs, providing health care to all citizens.

D Universal health has one payer (usually the government) and provides health care for all citizens. DIF: Comprehension REF: p. 107 |p. 113

14. ________________ occurs when a physician predicts the course and outcome of a disease process.

Prognostication Prognostication occurs when a physician creates a prediction about the course and outcome of a disease, often made with consideration of survival, symptoms, function, and quality of life with or without treatment. DIF: Comprehension REF: p. 220

20. Practicing nurses participate in employer-sponsored professional development classes that provide case studies related to ethical situations and decision making. Ethical considerations are debated among teams, and an expert helps the class arrive at the "best practices." The nurses are experiencing ethics ______________.

acculturation Ethics acculturation is the didactic and experiential process of developing ethical reasoning abilities as a part of ongoing professional education. DIF: Knowledge REF: p. 162

24. The healthiest form of communication is the ________ style.

assertive Assertive communicators are honest and direct while valuing and respecting other individuals' views and seeking a win-win solution without the use of manipulation or game-playing. DIF: Knowledge REF: pp. 340-341

22. The basic ingredients of theory are ____________.

concepts A theory is defined as a group of related concepts that explain existing phenomena and predict future events. DIF: Knowledge REF: p. 76

22. The emergency preparedness term that is used to describe the process of limiting the emergency situation within a well-defined area is ___________.

containment Containment is correct because the focus is to prevent the agent that caused the disaster from spreading. DIF: Knowledge REF: p. 280 2. The term used during a pandemic disaster that refers to the attempt to contain germs by limiting socialization and personal interactions is ___________. ANS: social distancing The term social distancing refers to the attempt to keep people as far apart as possible so as to limit the possibility of spreading germs. DIF: Knowledge REF: p. 291

18. Software programs that process data to produce or recommend valid choices are known as ______________.

decision support systems Decision support systems use software programs that process data to produce or recommend decisions by linking with an electronic knowledge base. DIF: Knowledge REF: p. 269

24. Although communication varies among members of different cultures, the greatest obstacle to providing multicultural care is differences in _____.

language Language can be the greatest obstacle to providing multicultural care. If the client does not speak the same language as the nurse, a skilled interpreter is mandatory. DIF: Comprehension REF: p. 191

25. A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer. The surgeon removed the left kidney. Medicare will no longer pay for preventable medical errors known as ____________.

never events Medicare identified 28 medical errors that were preventable and with serious consequences for which they will no longer pay. These errors are called never events. DIF: Knowledge REF: p. 114

27. Quality is defined by the ____________.

patient Quality is based on the perspective of the consumer or, in this instance, the patient. DIF: Knowledge REF: pp. 382-383

26. The type of insurance that shifts the largest percentage of costs for goods and services to employees and consumers is _____________ insurance.

private Private insurance shifts a more costs to employees and consumers than does any other type of insurance. DIF: Knowledge REF: p. 107

23. Development and validation of the body of knowledge and foundation on which practice is based is called ____________.

research Research refines and enhances new and existing knowledge and provides accountability for nursing practice. DIF: Knowledge REF: p. 90

23. It is important for novice nurses to know that "self-esteem = self-confidence + self-______."

respect DIF: Knowledge REF: pp. 426-427

28. While taking a shower, a patient pushes the emergency light. When the nurse arrives, the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient's walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a _______ event.

sentinel A sentinel event is an occurrence that results in death or serious illness and requires immediate investigation. DIF: Comprehension REF: p. 380