NSG 301 Exam 3

Question 6 The nurse using Westerhoff's stages of faith should place a 13-year-old patient in which stage? 1. Experienced faith 2. New faith 3. Owned faith 4. Affiliative faith

Correct Answer: 1 Rationale: Westerhoff's stage of experienced faith, occurring in infancy and early adolescence, is described as a time when the individual experiences faith through interaction with others who are living a particular faith tradition. Owned faith in middle adulthood and old age puts faith into personal and social action. Affiliative faith in late adolescence is participating in activities that characterize a particular faith tradition. New faith is not one of Westerhoff's stages of faith.

Question 6 A nurse with an associate's degree in nursing and bachelor's degree in social work has been practicing in a holistic healthcare environment for the past two years and wishes to be certified as a holistic nurse. What other requirements will need to be met for certification as a Basic HN-BC? 1. Contact hours 2. Years in nursing 3. Age 4. Location

Correct Answer: 1 Rationale: Certification involves an application and examination and also requires a self-reflective self-assessment. Eligibility criteria include contact hour minimum, active practice requirement, licensure, and graduation specifications. Years in nursing, age, and location are not required for a basic HN-BC certification.

Question 17 A conflict between two groups has gone through the conflict management process, but the groups are still not working well together. Is this a normal situation? 1. Yes; groups often have difficulty letting go of the conflict. 2. Yes; when bargaining is used, the outcome is often unpredictable. 3. No; these groups should go back through the problem-solving process. 4. No; some problems are not amenable to conflict management.

Correct Answer: 1 Rationale: Even though conflict management techniques have been used, groups often have difficulty letting go of the conflict, particularly if the conflict has been a major source of discussion between team members. There is no indication that bargaining makes the outcome unpredictable, that these groups should go back through the process, or that the problem was not amenable to conflict management techniques. In most cases, the groups should be allowed to work through the letting-go process to see whether the situation improves.

Question 20 Herbs, vitamins, and organic whole foods are what complementary and alternative medicine category-based therapies? 1. Biologically-based 2. Energy 3. Manipulative body-based 4. Mind-body

Correct Answer: 1 Rationale: Herbs, vitamins, and organic whole foods are biologically-based complementary and alternative medicine category-based therapies. Mind-body therapies use prayer, guided self-healing, meditation, and art, music, and dance therapy. Manipulative body-based therapies use cranial-sacral therapy, massage therapy, osteopathic manipulation, and chiropractic therapy. Energy therapies use magnet therapy, therapeutic touch, healing touch, Reiki, and Qui Gong.

Question 3 What is the philosophy of health care that encourages healthcare providers to be more comprehensive in their approach to patient care, including physical, emotional, spiritual, and psychological attributes? 1. Holistic health 2. Nursing with a purpose 3. Complete health assessment 4. Contemporary alternative medicine

Correct Answer: 1 Rationale: Holistic health is a concept that evolved in the 1970s and 1980s and is defined as "a comprehensive approach to health care including physical, emotional, psychological, and spiritual attributes of a person." Nursing with a purpose is a goal of delivering nursing care but is not a philosophy of health care. A complete physical health assessment is often performed on patients at an initial health evaluation. Contemporary alternative medicine (CAM) is use of unconventional medicine or healing therapies.

Question 18 What should a nurse consider when planning holistic care for a patient? 1. Spiritual and religious beliefs 2. Only physical needs 3. Patients who are too sick to be spiritual 4. The job of the hospital chaplain to identify any spiritual needs of the patient

Correct Answer: 1 Rationale: In viewing patients holistically, nurses must consider the spiritual and religious beliefs of patients when providing care. Nurses should understand how spiritual beliefs influence the health and decision making of patients. Physical needs are part of holistic care but do not encompass the totality to the patient's needs. The degree of patient illness does not determine the need for holistic nursing care. Hospital chaplains may assist with spiritual needs of the patient but the nurse retains responsibility for spiritual assessment and holistic nursing care.

Question 12 Which are modifiable risk factors? 1. Obesity, blood pressure, smoking, and sedentary lifestyle 2. Gender, smoking, blood pressure 3. Diabetes, obesity, age 4. Smoking, diet, genetics

Correct Answer: 1 Rationale: Modifiable risk factors include those factors that are amenable to modification such as weight, blood pressure, exercise patterns, and smoking. Gender, age, and genetics are non-modifiable risk factors, which are not amenable to intervention

Question 13 A 47-year-old male with a BMI of 32 does not smoke, has a blood pressure of 160/90, and a family history of diabetes and kidney disease. When preparing to perform primary prevention education for this patient, which non-modifiable risk factors should the nurse identify? 1. Age, gender, and genetics 2. Previously diagnosed disease processes 3. Diabetes, hypertension, and kidney disease 4. Gender and family history

Correct Answer: 1 Rationale: Non-modifiable risk factors are defined as those identified risk factors that are not amenable to intervention. These would include age, gender, and genetics. The other options contain modifiable risk factors, which are amenable to modification.

Question 10 School nurses often teach about sun protection and give instruction on healthy eating. What do these actions exemplify? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Preventive care

Correct Answer: 1 Rationale: Primary prevention focuses on health promotion and education as well as the prevention of illness and disease through health-promoting behaviors. Educating clients about promoting healthy behaviors is considered optimal because the costs for primary prevention are minimal and its impact can be significant. Secondary prevention focuses on screening and early detection of disease with the goal of early intervention. This helps to identify clients who are at risk for certain diseases. Tertiary prevention is the care and restoration of a patient after an insult or injury/disease has occurred. Preventive care is not a level of health promotion but a component of all three categories of care delivery.

Question 22 Which statement is true regarding clients and the use of "natural products" such as herbs? 1. Clients do not always reveal their use of natural products. Only one third of clients are providing information regarding complementary therapies. 2. Natural products are always safe because they are biologically based. 3. The Food and Drug Administration monitors herbal remedies, and labeling is always accurate. 4. All clients are aware that natural products may be hazardous to their health.

Correct Answer: 1 Rationale: Regarding clients and their use of natural products, it is noted that clients do not always reveal their use of natural products. Only one third of clients are providing information regarding complementary therapies. In addition, not all biologically-based therapies are safe for all clients. Clients are not always aware that there may be contraindications. The Food and Drug Administration does not monitor herbal remedies, and labeling is usually minimal and may not indicate contraindications. Another challenge is that clients are not aware that natural products may be hazardous to their health, and nurses must always stress the importance of disclosure.

Question 4 Which organization developed standards of nursing practice that define holistic nursing practice as a specialty? 1. AHNA 2. ANA 3. NCCAM 4. ANCC

Correct Answer: 1 Rationale: The American Holistic Nurses Association (AHNA) developed standards of practice that define holistic nursing practice as a specialty practice that draws upon nursing knowledge, theories, expertise, and intuition to guide nurses in becoming therapeutic partners with clients to strengthen the client's ability to heal. The ANA is the American Nurses Association, this organization has not developed standards of nursing practice for the holistic nurse. The NCCAM is the National Center for Complementary and Alternative Medicine; their mission is to explore complementary and alternative healing practices within the context of rigorous science. The ANCC, American Nurses Credentialing Center, has not defined or developed the standards of nursing practice for the holistic nurse.

Question 13 The hospital is a complex organization in which some amount of conflict is always present. How is this level of conflict described? 1. Latent 2. Felt 3. Perceived 4. Overt

Correct Answer: 1 Rationale: The constant level of conflict present in complex organizations is called latent conflict. Perceived conflict is when awareness begins. Felt conflict is when hostilities, anxieties, and stress erupt. Overt conflict results when the conflict is acted out.

Question 9 By volunteering at the local health fair and handing out Women's Heart Disease pamphlets, the nurse is practicing which type of health promotion? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Preventative care

Correct Answer: 1 Rationale: The first level of prevention, known as primary prevention, focuses on health promotion and education as well as the prevention of illness and disease through health-promoting behaviors. Secondary prevention focuses on screening and early detection of disease with the goal of early intervention. This helps to identify clients who are at risk for certain diseases. Tertiary prevention is the care and restoration of a patient after an insult or injury/disease has occurred. Preventive care is not a level of health promotion but a component of all three categories of care delivery.

Question 7 In Westerhoff's stage of affiliative faith, what does an individual do? 1. Participates in activities that characterize a particular faith tradition 2. Puts faith into personal and social action 3. Acquires a cognitive as well as an affective faith 4. Experiences faith through interaction with others who are living a particular faith tradition

Correct Answer: 1 Rationale: Westerhoff's stage of affiliative faith, occurring in late adolescence, is described as a time in which one participates in activities that characterize a particular faith tradition; experiences awe and wonderment; feels a sense of belonging. Experienced faith in infancy and early adolescence means experiencing faith through interaction with others who are living a particular faith tradition. Searching faith in young adulthood lists the behavior development as a process of questioning and doubting one's own faith, acquiring a cognitive as well as an affective faith through this questioning. Owned faith in middle adulthood and old age puts faith into personal and social action.

Question 18 Which statements describe stages of therapeutic touch? 1. Centering oneself physically and psychologically to prepare for the healing session. 2. Preparing the field of energy for therapeutic touch through mind sensitizing to detect subtle energy flow changes. 3. Helping the client to "re-pattern" his or her energy through the use of their excess energy. 4. Utilizing herbal remedies to reach the inner power of one's self. 5. Guiding the patient to empty the mind and focus on a pleasant experience.

Correct Answer: 1, 2, 3 Rationale: In 1972, nurse Dolores Krieger introduced a new modality for healing called therapeutic touch. There are four phases to Krieger's therapeutic touch session: (1) centering oneself physically and psychologically to prepare for the healing session, (2) preparing the field of energy for therapeutic touch through sensitizing the hands to detect subtle changes in energy flow, (3) mobilizing the energy in the client's field that may be stuck or congested by laying on hands, and (4) helping the client to "re-pattern" his or her energy through the use of healer's excess energy. Herbal remedies are not part of Krieger's therapeutic touch modalities. Emptying the mind to focus on a pleasant experience is a part of guided imagery.

Question 25 The nurse preparing a patient care plan utilizes the nursing diagnosis Enhanced Spiritual Well-Being to address which aspects of the patient? (Select all that apply.) 1. Sense of inner peace 2. Sense of meaning 3. Sense of world unity 4. Sense of purpose in life 5. Sense of relationship with others

Correct Answer: 1, 2, 4, 5 Rationale: Enhanced Spiritual Well-Being is defined as "experiencing affirmation of life in a relationship with a higher power (as defined by the person), self, community, and environment that nurtures and celebrates wholeness." It is characterized by having the resources to meet spiritual needs; a sense of inner peace; a sense of meaning and purpose in life; a commitment toward love, hope, meaning, and truth; a sense of a unifying and sacred source; and a sense of relationship with others, including family, friends, community, environment, and a Supreme Being. World unity is not included in the nursing diagnosis of enhanced spiritual well-being.

Question 15 Which are included in Spector's four types of healing that involve spiritual and/or religious belief? (Select all that apply.) 1. Spiritual healing 2. Exorcism 3. Meditation 4. Inner healing 5. Physical healing

Correct Answer: 1, 2, 4, 5 Rationale: Spector identified four types of healing that involve spiritual and/or religious belief: spiritual healing, inner healing, physical healing, and deliverance or exorcism. Meditation is an internal reflection or contemplation, and is not included as a type of healing.

Question 15 What is the mission of the National Center for Complementary and Alternative Medicine (NCCAM)? (Select all that apply.) 1. Train complementary and alternative medicine researchers. 2. Provide certification for holistic nurses 3. Provide authoritative information to the public. 4. Provide authoritative information to professionals concerning CAM. 5. Provide a billing process for patients receiving CAM therapy.

Correct Answer: 1, 3, 4 Rationale: The mission of NCCAM includes exploring complementary and alternative healing practices within the context of rigorous science, training complementary and alternative medicine researchers, and disseminating authoritative information to the public and professionals. The American Holistic Nurses' Certification Corporation offers certification for nurses in holistic nursing. NCCAM does not provide reimbursement and billing strategies for CAM therapy.

Question 24 The staff development trainer has been asked to prepare a program on the latest approach to health care. In which order should the trainer review the identified concepts? 1. Holistic health 2. Integrative medicine 3. Alternative medicine 4. Complementary and alternative medicine

Correct Answer: 1, 3, 4, 2 Rationale: In the 1970s-1980s the term holistic health was commonly used to explain a comprehensive approach to health care including physical, emotional, psychological, and spiritual attributes of a person. In the 1990s-2000 the term alternative medicine was used to describe an area that included a wide array of therapies that were used as an "alternative" to conventional medicine. In 2008 the term complementary and alternative medicine (CAM) was used to describe a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine. Currently the term integrative medicine is being used to describe an approach to medicine that combines treatments from conventional medicine and CAM for which there is some high-quality scientific evidence of safety and effectiveness.

Question 24 Which interventions are appropriate for a patient experiencing impaired religiosity? (Select all that apply.) 1. Provide privacy for religious practices. 2. Assure the patient that they do not need religion while hospitalized. 3. Provide presence of self. 4. Contact the patient's preferred religious leader. 5. Pray with the patient.

Correct Answer: 1, 3, 4, 5 Rationale: For patients experiencing impaired religiosity, the nurse should communicate his or her own understanding of the importance of religious practices and consider the following interventions: provide an environment that assists the patient to fulfill religious obligations; provide privacy and quiet for religious practices; contact the patient's preferred religious leader; inform the patient of available resources that support religious practices; if comfortable, pray with the patient; and be available as a presence. Patient's wishes to practice their religion while in the hospital should be honored.

Question 1 What should the nurse include when assessing a patient's spirituality? (Select all that apply.) 1. Relationship with self 2. Relationship with other cultural groups 3. Relationship with deity 4. Relationship with others 5. Relationship with nature

Correct Answer: 1, 3, 4, 5 Rationale: The characteristics of spirituality include personal connectedness, connectedness to others, the environment, and to a supreme being. A relationship with other cultural groups is not a characteristic of spirituality.

Question 27 The nurse is using the SPIRIT model to assess a patient's spirituality. In which order should the nurse ask the following questions? 1. What gives your life meaning/purpose? 2. Are there any unresolved areas of your life? 3. What are your sources of hope and strength? 4. What lifestyle activities does your religion encourage? 5. Do you belong to any religious or spiritual community? 6. Would you like to discuss religious implications of your health care?

Correct Answer: 1, 3, 5, 4, 6, 2 Rationale: The question "What gives your life meaning/purpose?" assesses the spiritual belief system. The question "What are your sources of hope and strength?" assesses personal spirituality. The question "Do you belong to any religious or spiritual community" assesses integration and involvement with a faith or spiritual community. The question "What lifestyle activities or practices (e.g., diet, worship practices, prayer rituals, holy day observances, medical treatment childbearing/child-rearing practices) does your religion encourage, discourage, or forbid?" assesses ritualized practices and restrictions, behaviors, and lifestyle practices that influence health. The question "Would you like to discuss religious/spiritual implications of your nursing and health care?" assesses implications for health and nursing/medical care. The question "Are there any unresolved areas of your life at this point that you would like us to assist you with addressing?" assesses terminal events planning or end-of-life care.

Question 28 The nurse is using the HOPE tool when assessing a patient's spiritual needs. In which order should the nurse ask the patient the following questions? 1. Identify sources of strength 2. What specific actions conducted? 3. Does religion influence health care? 4. What is the role of religion in your life?

Correct Answer: 1, 4, 2, 3 Rationale: When completing the HOPE tool the nurse should complete the tool in the following order: H: What are the sources of Hope, strength, comfort, meaning, purpose, peace, love and connectedness for the client? O: What is the role of Organized religion for the client? Is the client a practicing member of an organized religion? Does the client identify with a specific religion but is not an active member of a faith congregation? P: What are the Personal practices of spirituality and/or religion for the client? How do those Personal spiritual/religious practices influence health and healing? E: What are the Effects of spiritual/religious beliefs on health and nursing care?

Question 20 Issues such as access to health care can only be solved by using which technique? 1. Technology 2. Collaboration 3. Awareness 4. Legislation

Correct Answer: 2 Rationale: Although technology, awareness, and legislation also have the potential to solve today's healthcare issues, these techniques also depend upon collaboration.

Question 15 The nurse-manager has received several reports of unprofessional behavior regarding a nurse. While discussing these reports with the nurse, the manager remains warm, caring, and respectful. What type of feedback is the manager providing? 1. Negative 2. Positive 3. Neutral 4. Incongruous

Correct Answer: 2 Rationale: Because the nurse-manager is using the positive communication techniques of remaining warm, caring, and respectful, the feedback is considered positive. The determination of negative or positive is based upon communication style, not content of the message. Feedback is categorized as positive or negative, not neutral or incongruous.

Question 3 Which option characterizes effective collaboration? 1. Outcomes are positive for each healthcare provider. 2. Common purpose and goals are identified at the outset. 3. There is interdisciplinary goal setting for the patient. 4. Each provider evaluates own outcomes.

Correct Answer: 2 Rationale: Characteristics of effective collaboration include common purpose and goals identified at the outset, clinical competence of each provider, interpersonal competence, humor, trust, and valuing and respecting diverse and complementary knowledge. The outcomes may not be positive for each healthcare provider, as compromise may be necessary. Interdisciplinary goal setting may be an outcome of collaboration but does not necessarily indicate that the collaboration was effective. Evaluation of own outcomes does not reflect effective collaboration.

Question 10 What must nurses do to fulfill a collaborative role? 1. Graduate with at least a baccalaureate degree. 2. Assume increased authority in practice areas. 3. Redesign unit policies to allow collaboration. 4. Lobby state boards of nursing to approve this collaborative role.

Correct Answer: 2 Rationale: Collaboration without action is incomplete. In order for the nurse to benefit from collaboration, there is a need to assume accountability and increased authority in the area where the nurse practices. A baccalaureate degree is not required. It is not necessary to write specific unit policies to allow for collaboration. The state boards of nursing support the American Nurses Association standard on collaboration, so lobbying is not needed.

Question 2 Why is a review of CAM therapies included in a study guide for the NCLEX? 1. It will be valuable for education of future patients. 2. It is an ethical responsibility for nurses to be knowledgeable about changes in health care. 3. Herbal remedies never interact with prescribed medications. 4. CAM therapies are rarely used by patients.

Correct Answer: 2 Rationale: Complementary and alternative medicine (CAM) therapies are getting increased focus in research and practice as they become a more common choice for many clients. In order to provide comprehensive, individualized care to clients, nurses must be knowledgeable about the modalities that clients are selecting to enhance their health and healing. Sometimes the choices the clients are making to improve their health can actually have detrimental effects on their health.

Question 8 Which action is performed in Westerhoff's stage of owned faith? 1. Participates in activities that characterize a particular faith tradition 2. Puts faith into personal and social action 3. Acquires a cognitive as well as an affective faith 4. Experiences faith through interaction with others who are living a particular faith tradition

Correct Answer: 2 Rationale: In Westerhoff's state of owned faith, in middle adulthood and old age, one puts faith into personal and social action and is willing to stand up for beliefs even against the nurturing community. Experienced faith in infancy and early adolescence means experiencing faith through interaction with others who are living a particular faith tradition. Affiliative faith in late adolescence is participating in activities that characterize a particular faith tradition. Searching faith in young adulthood lists the behavior development as a process of questioning and doubting one's own faith, acquiring a cognitive as well as an affective faith through this questioning

Question 24 What percentage of Medicare dollars are thought to be expended on care provided in the last year of life? 1. A little less than 10% 2. More than 25% 3. At least 40% 4. Just under 60%

Correct Answer: 2 Rationale: In the United States, it is estimated that more than 25% of Medicare dollars are expended for the last year of life.

Question 9 A hospitalized patient requests privacy to say the Kaddish. The nurse realizes this is keeping which spiritual ritual? 1. A daily prayer that Jews say at bedtime 2. A daily prayer that Jews say for one year in remembrance of one who has died 3. A daily prayer that Jews say at meals 4. A daily prayer that Jews say in the morning

Correct Answer: 2 Rationale: Jews may say the Kaddish daily for the first year after the death of a loved one. The time of day when Jews say the Kaddish is not specified.

Question 19 A patient uses therapeutic touch to help with migraines. On what is this therapy based? 1. Biological fields 2. Energy fields 3. Manipulative body movements 4. Mind-body energies

Correct Answer: 2 Rationale: Magnet therapy, therapeutic touch, healing touch, Reiki, and Qi Gong are energy complementary and alternative medicine category-based therapies. Herbs, vitamins, and organic whole foods are biologically-based therapies. Mind-body therapies use prayer, guided self-healing, meditation, and art, music, and dance therapy. Manipulative body-based therapies use cranial-sacral therapy, massage therapy, osteopathic manipulation, and chiropractic therapy.

Question 4 What is faith? 1. The core of a person's being, involving one's relationship with God or a higher power 2. The belief in something that cannot be directly observed 3. An organized belief system shared by a group of people and the practices related to that system 4. Unique to Christianity

Correct Answer: 2 Rationale: Mark and Schmidt (2004) defined faith as belief in something that cannot be directly observed. Faith is deeper and more personal than organized religion. It relates to one's transcendent values and relationship with a higher power or God. It is not unique to Christianity.

Question 16 A patient takes herbal medicines, vitamins, and eats only whole or organic foods. Based on this information, what is this patient practicing? 1. Mind-body alternative therapies 2. Biologically-based alternative therapies 3. Manipulative body-based alternative therapies 4. Energy alternative therapies

Correct Answer: 2 Rationale: NCCAM defines biologically-based therapies in CAM as the use of substances found in nature. This includes herbs, vitamins/supplements, and organic whole foods. Mind-body therapies use prayer, guided self-healing, meditation, and art, music, and dance therapy. Manipulative body-based therapies use cranial-sacral therapy, massage therapy, osteopathic manipulation, and chiropractic therapy. Energy therapies use magnet therapy, therapeutic touch, healing touch, Reiki, and Qui Gong

Question 22 To provide spiritually competent care, what should the nurse do first? 1. Perform a physical assessment. 2. Perform personal values-clarification activities. 3. Read the patient's nursing history. 4. Research information on the patient's cultural group.

Correct Answer: 2 Rationale: Nurses can become aware of their own spiritual values through values-clarification activities. A nurse should first perform personal values-clarification activities prior to beginning actual patient care that may be comprised of performing physical assessments, obtaining or reviewing patient history information and determining the cultural status of a patient. Self-awareness of personal biases is important to prevent compromising patient care. All phases of the nursing process are affected by the client's and the nurse's spiritual beliefs and practices. As the client and the nurse come together in the nurse-client relationship, a unique spiritual environment is created that can improve or impair the client's outcome.

Question 12 A critically ill newborn is the child of two parents who are Catholic. What action should the nurse take regarding the baptism of this infant? 1. Baptize the baby. 2. Ask the parents for direction in whom they want to baptize the baby. 3. Ask the hospital chaplain to baptize the baby. 4. Ask the doctor to baptize the baby.

Correct Answer: 2 Rationale: Respecting the religious wishes of the patients is of utmost importance. The nurse should not assume the wishes of the patient and should assess the situation before acting.

Question 11 The nurse is performing blood pressure screenings at a health fair which is designed to provide information for senior citizens in the community. Which level of health prevention is the nurse providing? 1. Primary 2. Secondary 3. Tertiary 4. Holistic care

Correct Answer: 2 Rationale: Secondary level of health prevention focuses on screening and early detection of disease with the goal of early intervention. Secondary health prevention may include the following screenings: blood pressure, temperature, pulse, vision, hearing, lead, cardiac risk profile, chemistry labs, and mammography. Primary level of prevention focuses on health promotion and education as well as the prevention of illness and disease through health-promoting behaviors. Tertiary level of prevention is the care and restoration of a patient after an insult or injury/disease has occurred. Holistic health care is a concept that evolved in the 1970s and 1980s and is defined as "a comprehensive approach to health care including physical, emotional, psychological, and spiritual attributes of a person."

Question 8 Of what is providing cholesterol screenings an example? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Preventive care

Correct Answer: 2 Rationale: Secondary prevention focuses on screening and early detection of disease with the goal of early intervention. This helps to identify clients who are at risk for certain diseases. Primary prevention focuses on health promotion and education, as well as the prevention of illness and disease through health-promoting behaviors. Tertiary prevention is the care and restoration of a patient after an insult or injury/disease has occurred. Preventive care is not a level of health promotion but a component of all three categories of care delivery.

Question 5 Certification as a holistic nurse can be gained through which organization? 1. American Nurses Credentialing Center (ANCC) 2. American Holistic Nurses Certification Corporation (AHNCC) 3. American Holistic Nurses Association (AHNA) 4. American Nurses Association (ANA)

Correct Answer: 2 Rationale: The American Holistic Nurses Certification Corporation (AHNCC) offers certification for nurses. The certification involves an application, written component, and exam. The AHNA offers a course for nurses to help prepare for the certification exam. The ANA and ANCC are not involved with certification for the holistic nursing.

Question 10 While taking care of a devout Muslim, the nurse might expect which daily ritual? 1. A Muslim prayer that is said at bedtime 2. Muslim prayers said five times a day; at dawn, noon, mid-afternoon, sunset, and evening 3. A Muslim prayer that is said in the morning on awakening 4. A Muslim prayer that is said at meals

Correct Answer: 2 Rationale: The Salat is a daily ritual of saying five prayers a day; at dawn, noon, mid-afternoon, sunset, and evening while facing Mecca. A devout Muslim would pray at each interval during the day, he or she would not say the prayer only one time each day.

Question 23 What is true about poverty in the United States? 1. The number of poor in the United States has decreased sharply in the last 10 years. 2. The number of people living in extreme poverty has increased in recent years. 3. The number of poor in the United States has increased sharply in the last 10 years. 4. The number of people living in extreme poverty has decreased in recent years.

Correct Answer: 2 Rationale: The number of poor in the United States has remained fairly stable in recent years; however, the number of people living in extreme poverty has increased.

Question 4 The physician and nurse have asked the client to make a difficult decision regarding treatment options. The client says, "I don't really know what to do. Do whatever you think is best." According to characteristics of collaborative care, what is true of this situation? 1. The client must make the treatment decisions. 2. The client retains the right not to participate in this decision. 3. The healthcare professionals are responsible for the client's health. 4. The client is asking the healthcare professionals to define what health means to the client.

Correct Answer: 2 Rationale: The patient self-determination states that the client has the right to choose to participate or not participate in healthcare decisions. The client does not have to make decisions, but has the right to make decisions if desired. Responsibility for health falls on the client rather than on healthcare professionals. Each individual's concept of health is important and legitimate for that individual. Although clients lack expert remembering, they have their own ideas about health and illness.

Question 11 The laboratory supervisor states, "I would like to collaborate with nursing services to improve the way they order laboratory tests." What is the error in this statement? 1. Laboratory supervisors should have no influence on nursing service. 2. An integrated delivery system centers on the client's health needs, not on the particular care given by one group. 3. The issues between laboratory services and nursing services are generally related to the way orders are written by physicians. 4. Collaboration cannot occur between disciplines in a hospital.

Correct Answer: 2 Rationale: This statement focuses on what one service (nursing) is doing wrong. This goes against the idea that an integrated system focuses on the client's health needs, not on the particular care given by one group. This laboratory supervisor can have influence on nursing services by collaborating with that service, not by criticizing and directing what nursing will do. This is true no matter what the issue is and what causes the problem. Collaboration often occurs between and among disciplines in a hospital.

Question 7 H. S. Kim developed a theory of collaborative decision making in nursing practice. This theory describes and explains collaborative interactions between nurses and which other group? 1. Physicians 2. Clients 3. Other nurses 4. Ancillary personnel

Correct Answer: 2 Rationale: This theory describes and explains collaborative interactions between clients and nurses in making healthcare decisions and the effect on outcomes. It does not address physician-nurse, nurse-nurse, or nurse-ancillary personnel collaboration.

Question 12 Norton's theory of communicator style describes nine specific communicator styles. Which nurse is using the attentive style? 1. The nurse speaks forcefully to a peer who made a clinical error. 2. The nurse is obviously listening to the client and makes eye contact during the conversation. 3. The nurse monopolizes the lunchtime conversation with other nurses. 4. While the client is describing his or her health history, the nurse interrupts with questions about current complaints.

Correct Answer: 2 Rationale: To use an attentive style of communication, the nurse makes eye contact and obviously listens during conversation. Although verbal feedback is given during this style of communication, the nurse does not interrupt or monopolize conversation. Speaking forcefully may be necessary in some situations, but does not exemplify attentive communication.

Question 19 How does today's healthcare consumerism affect the need for collaboration? 1. Consumers are not interested in how lifestyle affects health. 2. Consumers expect to be involved in decision making. 3. Consumers are hesitant to assume responsibility for their own health. 4. Consumers expect physicians to make decisions for them.

Correct Answer: 2 Rationale: Today's healthcare consumers have greater knowledge about their health than in previous years, and they are increasingly influencing healthcare delivery. Formerly, people expected a physician to make decisions about their care; today, however, consumers expect to be involved in making these decisions. Consumers have also become aware of how lifestyle affects health, and they are not hesitant to assume responsibility for their own health.

Question 29 The clinical documentation committee is facing issues with the nursing staff regarding the upgrading of the documentation software. The committee chair plans to review the stages of conflict with the committee in preparation for implementation of the software. In which order should the stages be reviewed? 1. Overt 2. Latent 3. Perceived 4. Aftermath

Correct Answer: 2, 3, 1, 4 Rationale: There are five stages, or levels, of conflict. Latent conflict is always present when there is a complex organization or when roles are differentiated and may come into conflict. Perceived conflict is when awareness begins. The conflict may or may not progress beyond a latent or perceived level. When it does progress, felt conflict occurs, and hostilities, anxieties, and stress erupt. Overt conflict results when the conflict is acted out and battle lines are drawn. Conflict aftermath comes about with a resolution, which may or may not be optimal. The results may range from full cooperation to active or passive resistance. Although the conflict is resolved, the behaviors may still be affected. There may be difficulty letting go of feelings once there is resolution.

Question 14 A dying patient requests privacy to pray. Which are the forms of prayer? (Select all that apply.) 1. Contemplation 2. Communication to God or other deity 3. A spiritual communion 4. Internal reflection 5. A petition or request

Correct Answer: 2, 3, 5 Rationale: Dossey (1993) identifies seven forms of prayer that may be used when someone is sick: petition, intercession, confession, thanksgiving, adoration, invocation, or lamentation. All prayer is communication; and prayers may be a request, a thanksgiving, or a spiritual communion. Meditation is an internal reflection or contemplation.

Question 20 On what is the holistic health belief view based? 1. The belief that supernatural forces control illness 2. The belief that human life is one aspect of nature 3. The belief that when one's natural balance or harmony is disturbed, illness results 4. The belief that illness results from being bad 5. The belief that forces of nature must be maintained in balance or harmony

Correct Answer: 2, 3, 5 Rationale: The holistic health belief view is based on the spiritual belief systems of many cultures and holds that the forces of nature must be maintained in balance or harmony. Human life is one aspect of nature that must be in harmony with the rest of nature. When one's natural balance or harmony is disturbed, illness results. In the magico-religious health belief view, health and illness are controlled by supernatural forces; the patient may believe that illness if the result of "being bad."

Question 30 The nurse manager is reflecting on a negotiation conducted with the medical director which did not produce a desired outcome. In which order should the manager reflect upon this episode? 1. The goal is to win against the other side 2. Each side has a goal to get as much as possible 3. Each side believes that both sides cannot achieve their goals 4. Resources are limited for each side to get as much as possible

Correct Answer: 2, 4, 3, 1 Rationale: With competitive negotiation the following occurs: the tangible goals are for each side to get as much as possible; there are insufficient resources for each side to attain the desired goal; each side believes it is not possible for both sides to attain the desired goal; and the goal is to win against the other side.

Question 1 Which two components encouraged the change in view of health care from one of biological focus on disease management to comprehensive health care? 1. Medicare and Healthy People 2020 2. Healthy People 2020 and nursing theorists 3. Integrative health and Healthy People 2020 4. Integrative health and foreign exchange of ideas

Correct Answer: 3 Rationale: A blend of both Eastern and Western medicine, known as integrative health and initiatives in Healthy People 2020 have moved the health care system away from a illness/disease-based framework to a more comprehensive approach to health care. Changes in Medicare have not encouraged the change in view of health care. Nursing theorists develop a body of knowledge that is used to support nursing practice. A foreign exchange of ideas assists in transcultural and world health issues.

Question 25 The high school graduate is considering pharmacy as a career. What is true of the level of education necessary for licensure as a pharmacist? 1. The pharmacist can enter practice as an intern pharmacist with an associate degree. 2. Once a person has achieved a baccalaureate degree, he or she is eligible to apply for pharmacy school. 3. The entry level education for a pharmacist is the Doctor of Pharmacy or PharmD. 4. A person wishing to be a pharmacist must earn a master's degree in biologic science prior to beginning pharmacy school.

Correct Answer: 3 Rationale: A person who wishes to become a pharmacist must have at least 2 years of post-secondary education prior to applying for pharmacy school. A baccalaureate degree is not necessary, nor is a master's degree. Once admitted to pharmacy school, the student must achieve a PharmD in order to take the licensure examination for pharmacy. There is no process by which a person with an associate degree can become a pharmacist through an internship.

Question 3 During the admission process, the nurse assesses the patient's spiritual belief system and what other aspect related to that system? 1. Christianity 2. Godly assumptions 3. Religious preference 4. Religious knowledge

Correct Answer: 3 Rationale: Burkhardt and Nagai-Jacobson (2009) defined religion as "an organized system of beliefs regarding the cause, purpose, and nature of the universe that is shared by a group of people, and the practices, behaviors, worship, and ritual associated with that system." Religious preference should be addressed with the spiritual assessment. Christianity is a form of religion that may be indicated by a patient but an assessment of Christianity is not appropriate. Depending on the individual's spirituality they may or may not have a belief in God or have Godly assumptions. Religious knowledge is not part of the admission process assessment.

Question 21 Chiropractic medicine, massage, osteopathic manipulation, and naturopathy are what complementary and alternative medicine category-based therapies? 1. Biologically-based 2. Energy 3. Manipulative body-based 4. Mind-body

Correct Answer: 3 Rationale: Chiropractic medicine, massage, osteopathic manipulation, and naturopathy are manipulative body-based complementary and alternative medicine category-based therapies. Herbs, vitamins, and organic whole foods are biologically-based therapies. Mind-body therapies use prayer, guided self-healing, meditation, and art, music, and dance therapy. Energy therapies use magnet therapy, therapeutic touch, healing touch, Reiki, and Qui Gong.

Question 22 The nurse would like to start a self-help group for persons who would like to lose weight. Which organization would it be helpful for this nurse to contact? 1. American Nurses Association 2. National League for Nursing 3. National Mental Health Consumers' Self-Help Clearinghouse 4. National Coalition of Self-Help

Correct Answer: 3 Rationale: In the United States, the National Mental Health Consumers' Self-Help Clearinghouse provides information on current support groups and guidelines about how to start a self-help group. The ANA and NLN do not provide this information. The remaining option is not a valid group.

Question 6 When considering collaborative practice, interdisciplinary healthcare teams have been particularly effective in which environment? 1. Emergency departments 2. Critical care units 3. Outpatient services 4. Obstetrical services

Correct Answer: 3 Rationale: Interdisciplinary healthcare teams function in all the environments listed. According to the text, the teams have been particularly effective in outpatient services, where clients are seen by a primary care physician or by a nurse practitioner and consultations are implemented as needed.

Question 17 A patient has been experiencing lower back pain for over a year and has decided to seek chiropractic therapy. This form of CAM falls under which integrative therapy? 1. Mind-body therapy 2. Biologically-based therapy 3. Manipulative body-based therapy 4. Energy therapy

Correct Answer: 3 Rationale: Manipulative body-based therapies include cranial-sacral therapy, massage therapy, osteopathic therapy, and chiropractic therapy. Mind-body therapies use prayer, guided self-healing, meditation, and art, music, and dance therapy. Biologically-based therapies use substances found in nature such as herbal medicine, vitamins, and whole and organic foods. Energy therapies use magnet therapy, therapeutic touch, healing touch, Reiki, and Qui Gong.

Question 2 Which phrase describes spirituality? 1. The belief in something that cannot be directly observed 2. An organized belief system that requires religious worship of a Supreme Being 3. The core of a person's being, involving one's relationship with God or a higher power 4. A belief system unique to a specific religion

Correct Answer: 3 Rationale: Mauk and Schmidt (2004) define spirituality as "the core of a person's being, involving one's relationship with God or a higher power." Spirituality may or may not involve a belief in a Supreme Being. Depending on the individual beliefs, spirituality may involve seen and unseen forces. For example, the use of religious articles defines spirituality for some individuals and these items can be seen and held. Spirituality encompasses many religions with varied belief systems

Question 18 The nurses on the unit have approached the nurse-manager with reports that a physician is abusive and rude in interactions with staff. The nurse-manager says, "Don't take the remarks personally and maybe they will stop." This is an example of which negotiation technique? 1. Forcing 2. Bargaining 3. Smoothing over 4. Avoidance

Correct Answer: 3 Rationale: Smoothing over is a short-term resolution focused on minimizing the felt conflict without resolving it. Forcing uses power or influence to impose a preference and may include using a higher authority to enforce change. In this situation, forcing could be done by the nurse-manager complaining to the chief of medical staff about the physician's behavior. Bargaining is the same as negotiating. Avoidance is when one side of the conflict makes the decision to cease discussion and withdraw. If the nurse-manager had said "Just ignore the remarks," that would be avoidance.

Question 17 What is considered the state in which a person experiences a disturbance in the belief or value system that provides strength, hope, and meaning to life? 1. Spiritual awakening 2. Impaired religiosity 3. Spiritual distress 4. Impaired belief

Correct Answer: 3 Rationale: Spiritual distress, a nursing diagnosis, is "the state in which a person or group experiences a disturbance in the belief or value system that provides strength, hope, and meaning to life." Spiritual distress may be the cause of illness, especially with emotional distress; or it may occur as a result of illness as one questions why a situation is occurring in his or her life: "Why would God let this happen to me?" Impaired religiosity is the state in which a person or group has an impaired ability to exercise reliance on beliefs or a particular denomination or faith community, and to participate in related rituals. Spiritual awakening and impaired belief are not appropriately written nursing diagnoses.

Question 19 The nurse notices a twisted cloth bracelet tied around the wrist of a pediatric patient who is Hmong. The child's father explains that the bracelet is to protect the child's soul. What should the nurse recognize that the bracelet represents? 1. Child abuse, because the bracelets could cut off circulation to the child's hands 2. An antiquated practice 3. A religious practice carrying spiritual significance to the family 4. A need for patient and family education

Correct Answer: 3 Rationale: Symbols of religious belief include jewelry, medals, amulets, icons, totems, or body ornamentation that carry religious or spiritual significance. They may be worn as an assertion of one's faith, to provide protection, or as a source of comfort or strength. The Hmong cultural belief is that by placing the twisted cloth around the patient's wrist it will prevent the "soul" from being able to leave the body. It is not an antiquated practice but one of cultural significance; there is not a need for family education and no harm is being done to the child.

Question 5 Collaborative practice creates a synergy among clients and providers. What does this statement mean? 1. The client has the final responsibility for decision-making. 2. Responsibility for health remains with the client. 3. The sum of the actions of the parties is greater than individual efforts. 4. The parties value and respect the diversity of their knowledge bases.

Correct Answer: 3 Rationale: Synergy means that the sum of the efforts of the parties is greater than the parts. It does not mean that the client has final responsibility for decision-making or that responsibility for health remains with the client. It does not mean that the parties value and respect diversity of knowledge bases.

Question 27 The nurse is collaborating with another health care provider to help a client regain skills needed to function in the home environment. This nurse is most likely working with a member of which discipline? 1. Physical therapy 2. Social work 3. Occupational therapy 4. Respiratory therapy

Correct Answer: 3 Rationale: The discipline charged with the responsibility of helping a client regain skills to function in the home or work environment is occupational therapy. The physical therapist's work is focused more on musculoskeletal problems and increasing mobility and decreasing pain. The occupational therapist's work is much broader, focusing on physical, psychological, and social needs. Social workers focus on helping people cope with and solve personal and family problems such as long-term care placement, availability of resources, and referrals to resources. Respiratory therapists focus on management of respiratory issues.

Question 2 Which option represents the highest level of collaboration? 1. The nurse, physician, and dietician have communicated individually with the client. 2. The nurse, physician, and dietician have all written an individual plan of care and included it in the client's medical record. 3. The nurse and physician have discussed the nutritional needs of the client and have referred the patient to the dietician for a nutritional plan and teaching. 4. The physician wrote a medical order for the nurse to contact dietary for a consult.

Correct Answer: 3 Rationale: The highest level of collaboration is co-management and referral, whereby providers retain responsibility and accountability for their own aspects of care, and clients are directed to other providers when the problem is beyond the current caregiver's expertise. In this scenario, the option about the nurse and physician discussing the client's nutritional needs and referring nutritional care to the dietician reflects that level of collaboration. Communicating independently with the client, having separate plans of care, and the unilateral decision making (medical order) options reflect parallel communication and function, which are lower levels of collaboration.

Question 7 Nurses working on a post-op care unit are practicing which level of care? 1. Primary 2. Secondary 3. Tertiary 4. Preventive

Correct Answer: 3 Rationale: The post-op care unit is the most common situation in which nurses would care for clients, as in the past in acute-care settings, after the patient has experienced a health crisis or had surgery. This level of care is considered tertiary, which is defined as the care and restoration of a patient after an insult or injury/disease has occurred. Primary prevention focuses on health promotion and education as well as the prevention of illness and disease through health-promoting behaviors. Secondary prevention focuses on screening and early detection of disease with the goal of early intervention. Preventive care is not a level of health promotion but a component of all three categories of care delivery.

Question 23 What should the nurse do when obtaining spiritual-assessment data? 1. Wait until the patient brings up the topic. 2. Read the physician's history and physical. 3. Perform an assessment using open-ended questions concerning spirituality. 4. Perform an assessment asking direct questions to gain full knowledge of the patient's spiritual status.

Correct Answer: 3 Rationale: To obtain spiritual-assessment data, nurses should use broad statements and open-ended questions that encourage patients to fully express their beliefs. The nurse should not wait until the patient brings up the topic. The patient may not feel comfortable and may need encouragement to talk. The physician's history and physical may or may not contain a spiritual assessment. Direct interview questions can be answered with a "yes" or "no."

Question 5 In Westerhoff's stage of searching faith, what action does the individual take? 1. Participates in activities that characterize a particular faith tradition 2. Puts faith into personal and social action 3. Acquires a cognitive as well as an affective faith 4. Experiences faith through interaction with others who are living a particular faith tradition

Correct Answer: 3 Rationale: Westerhoff's stage of searching faith, occurring in young adulthood, lists the behavior development as a process of questioning and doubting one's own faith, acquiring a cognitive as well as an affective faith through this questioning. Experienced faith occurs in infancy and early adolescence through interaction with others who are living a particular faith tradition. Affiliative faith in late adolescence means participating in activities that characterize a particular faith tradition. Owned faith in middle adulthood and old age puts faith into personal and social action.

Question 21 Which statement reflects a belief that is central to holistic, collaborative health care? 1. Interdisciplinary decisions are made about the client's care. 2. Collaboration involves questioning and ordering. 3. Responsibility for health falls on the client rather than on healthcare professionals. 4. Healthcare providers hold the best idea about what will meet the client's needs.

Correct Answer: 3 Rationale: While interdisciplinary decisions are made and collaboration takes place, the basic belief is that the responsibility for health falls on the client rather than on the healthcare professional. Healthcare providers can offer ideas about what will meet a client's health needs; but in holistic, collaborative care, these are not necessarily the best ideas.

Question 14 The conflict negotiator tells the group that the desire is a win-win solution. What does this desire indicate? 1. Each side of the argument gets all it requests. 2. One side and the negotiator are successful in winning at least one point in the argument. 3. Each side is satisfied with the resolution. 4. In order to achieve resolution, each side compromises on items it views as important.

Correct Answer: 3 Rationale: Win-win is a situation in which each side is satisfied with the resolution. Although each side may compromise on some points, it should not have to compromise on items that are viewed as important. In that case, this would be more of a lose-lose resolution. If each side could get all it requests, there would be no conflict. There is no requirement that either side win a specific number of points, just that each side is satisfied with the resolution.

Question 14 What did Eisenberg learn about one out of three people during the study conducted on the use of unconventional medicine by consumers in the United States? 1. They needed education concerning their choice of alternative medicine. 2. They did not have an assigned primary care provider. 3. They were not practicing any type of unconventional medicine. 4. They were utilizing at least one form of alternative medicine.

Correct Answer: 4 Rationale: Eisenberg and associates (1993) focused their studies on assessing the use of alternative medicine modalities. They found that one out of three people were utilizing at least one form of alternative medicine and spending an estimated $27 million on these forms of treatment. The other options were not reported in the work of Eisenberg and associates.

Question 8 Dalton extended Kim's theory of collaborative decision making in nursing practice to include which group? 1. Social workers 2. Children and vulnerable populations 3. Psychologists 4. Family caregivers

Correct Answer: 4 Rationale: Kim's original theory discussed the nurse and the client. Dalton extended this theory to include family caregivers. This theory extension did not include social workers, children, vulnerable populations, or psychologists.

Question 11 While completing the history, the nurse learns that a patient fasts during Lent. What should the nurse understand about fasting? 1. Religious fasting requirements require only no food intake. Water and other beverages are acceptable. 2. Religious fasting requirements must be maintained at all times or the patient will experience spiritual distress. 3. Religious fasting requirements are observed only during daylight hours. 4. Religious fasting requirements are usually exempted for patients who are ill or are hospitalized.

Correct Answer: 4 Rationale: Many religions require fasting different times of the year or after certain life events; however, believers who are seriously ill are often exempted from such requirements. Many hospitals and health organizations attempt to facilitate ritual observances for patients, patient's families, and staff during these times. Some religious fasting requirements may require restriction of all food and beverage intake. Religious fasting requirements are often removed if the patient is seriously ill. Religious fasting may cover both day and night fasting, depending on the religious observance.

Question 9 What is true about the nurse's role in collaboration? 1. Collaboration occurs mainly with physicians. 2. By law, nurses can collaborate only on client care issues. 3. Peer collaboration can occur only when both nurses are educated at the baccalaureate level. 4. It may include collaboration on health-related research

Correct Answer: 4 Rationale: Nurses collaborate with clients, peers, and other healthcare professionals. They frequently collaborate about client care, but may also be involved in collaborating on such topics as bioethical issues, legislation, health-related research, and with professional organizations. There is not a requirement that the nurses involved have a baccalaureate degree.

Question 13 A patient who is Orthodox Jewish is terminally ill. The family and rabbi spend a great deal of time at the patient's bedside. At the time of death, what should the nurse expect to occur? 1. The family will approve organ donation. 2. The rabbi will say Shiva. 3. The family will approve an autopsy. 4. The patient may want to say the Shema or have it said for him.

Correct Answer: 4 Rationale: Orthodox Jewish patients may want to say the Shema or have it said for them at the time of their death. The Shema is a prayer of praise. Autopsy is discouraged. When autopsy is warranted, it must be limited to essential organs or systems, and all body parts must be buried together. In the Jewish religion, Shiva is a week-long period of mourning following the death of first degree relatives, it is not a spoken prayer.

Question 16 When using the SPIRIT model for assessing spirituality, what does the 'R' represent? 1. Religious beliefs 2. Relationships 3. Requests 4. Ritualized practices and restrictions

Correct Answer: 4 Rationale: The 'R' represents ritualized practices and restrictions. Using this model the nurse would assess for specific rituals or practices related to the patient's daily life. The other options are not part of the SPIRIT model.

Question 1 Which group established a standard of professional performance focused on the nurse's collaboration with clients, families, and other healthcare professionals? 1. The National Council of State Boards of Nursing 2. The National League for Nursing 3. The American Association of Colleges of Nursing 4. The American Nurses Association

Correct Answer: 4 Rationale: The ANA Nursing: Scope and Standards of Practice includes collaboration by the registered nurse with clients and families as well as other healthcare providers. The National League for Nursing and the American Association of Colleges of Nursing accredit schools of nursing. The National Council of State Boards of Nursing manages the administration of licensure examinations.

Question 16 The nursing team is tasked with making a decision regarding implementation of a new unit policy. What is the first step this team should take in this work? 1. Obtain an institutional pledge to finance any necessary changes. 2. Outline the priority needs of the work team. 3. Organize interventions to solve the problem. 4. Clearly define the problem being addressed.

Correct Answer: 4 Rationale: The first step in the decision-making is clearly defining the problem being addressed. After this step is done, the priorities of client care should be addressed, interventions should be designed and organized, and financial support should be considered.

Question 21 Which nursing action exemplifies presence? 1. Calling the patient's spiritual counselor 2. Praying with the patient 3. Ensuring that family can visit at any time 4. Communicating a willingness to care, to listen, and to be available to the patient

Correct Answer: 4 Rationale: The nurse provides presence by communicating a willingness to care, to listen, and to be available to the patient. The nurse can support the patient's religious practices by calling the patient's spiritual counselor. The nurse's responsibility is to ensure privacy and a quiet environment for patients who may choose to participate in private prayer or want group prayer with family, friends, or a spiritual counselor. It is not always possible for family to have unlimited opportunity to visit.

Question 26 The high school graduate is considering a career as a clinical social worker. What is true of the level of education required? 1. Clinical social work is highly dependent upon on-the-job training, so no formal post-secondary education is required. 2. Clinical social work requires a baccalaureate degree in social work and a 3-year residency program. 3. Clinical social work is open to those with bachelor's degrees in any related field. 4. Clinical social work requires a master's degree in social work.

Correct Answer: 4 Rationale: While there are various entry levels into social work, clinical social work requires a master's degree in social work. It cannot be achieved through on-the-job training. A baccalaureate degree is available in social work, but there is no avenue of entering clinical social work through a residency program. Those persons holding bachelor's degrees in related fields such as psychology and sociology may be qualified for some entry-level jobs in social work, but do not have the qualifications to be a clinical social worker.

Question 26 The nurse is preparing an education program on Fowler's stages of faith development. In which order should the nurse explain the developmental tasks associated with this process? 1. Struggle with faith 2. Listen to spiritual stories 3. Discuss religious diversity 4. Develop trusting relationships 5. Adhere to scripture-based codes of behavior 6. Place faith as the basis and framework for living 7. Believe that the Supreme Being is the only one who really knows them

Correct Answer: 4, 2, 5, 7, 1, 3, 6 Rationale: Developing trusting relationships occurs first, during infancy. Listening and reacting to spiritual stories, songs, religious rituals and celebrations occur during early childhood. Adherence to scripture-based codes of behavior occurs during childhood. Believing that the Supreme Being is the only one who really knows them occurs during adolescence. Struggling with faith occurs during young adulthood. Discussions of ecumenicism and religious diversity/pluralism occur during early mid-life. Living a lifestyle that places faith as the basis and framework for living occurs during midlife and beyond.

Question 23 The nurse is preparing an in-service for staff on holistic nursing care. In which order should the nurse explain the four perspectives of reality? 1. Cultural 2. Systems 3. Behavioral 4. Intentional

Correct Answer: 4, 3, 1, 2 Rationale: Holistic nursing incorporates a theory of integral nursing that embraces both the art and science of nursing. In this theory, reality comes from four perspectives: individual interior (personal/intentional), individual exterior (physiology/behavioral), collective interior (share, cultural), and collective exterior (systems/structure).

Question 25 The nurse is admitting a patient onto a medical-surgical care area. The following information is available as part of the patient's past medical history: PMH: Diagnosed with heart failure in 2005; History of gastric ulcer disease; Treated in the past for GERD; Right hip replaced 2001; Left hip replaced 2004; History of elevated blood glucose levels, treated with diet adjustment. Based upon this information, which herbal preparations should the nurse counsel the patient to avoid using? (Select all that apply.) 1. Garlic 2. Olive leaf 3. Vitamin C 4. Glucosamine 5. Black cohosh

Correct Answer: 4, 5 Rationale: Herbal products and supplements may interact with or potentiate certain prescribed medications. Glucosamine products contain sodium which might adversely affect the patient's heart failure. Phytoestrogen black cohosh contains salicylates which might aggravate the patient's history of gastric ulcer disease and GERD. There is no information to support that the patient should avoid taking garlic, olive leaf, or vitamin C.

Question 28 The nurse manager is reviewing the collaboration continuum in preparation for presenting this information during a staff meeting. In which order, from lowest to highest, should the manager explain this continuum? 1. Referral 2. Consultation 3. Coordination 4. Co-management 5. Parallel functioning 6. Information exchange 7. Parallel communication

Correct Answer: 7, 5, 6, 3, 2, 4, 1 Rationale: In the collaboration continuum the lowest level begins with parallel communication, then moves to parallel functioning, information exchange, coordination, consultation, co-management, and ends with the highest level of referral.