Test Bank Contemporary Nursing Issues Trends Management 6th Edition, Cherry
Chapter 01: The Evolution of Professional Nursing
1. Clara Barton is known for:
a. becoming the first African-American public health nurse.
b. establishing the Henry Street Settlement.
c. founding the American Red Cross.
d. publicizing the inadequacies of hospital-based nursing schools.
2. Which bill provided for construction of new hospitals?
a. Social Security Act
b. Hill-Burton Act
c. Sheppard-Towner Act
d. U.S. Civil Service Act
3. The practice of public health nursing and the Henry Street Settlement are credited to:
a. Mary Breckenridge.
b. Mary Seacole.
c. Clara Barton.
d. Lillian Wald.
4. Occupational health nursing features beliefs similar to those of which early nursing pioneer?
a. Lillian Wald
b. Florence Nightingale
c. Clara Barton
d. Mary Seacole
5. What historical event first led to the recognition of the contribution of African Americans to nursing?
a. Florence Nightingale’s acceptance of African-American nurses into the first nursing school
b. The contributions of African-American nurses at the Pennsylvania Hospital, the first hospital in America
c. Mary Seacole’s efforts to care for soldiers during the Crimean War
d. The work done by wives of wealthy African-American nobles who carried food and medicine from house to house during the Middle Ages
6. World War I contributed to the advancement of health care by:
a. increasing the number of private care hospitals and decreasing the role of public health services.
b. employing a large number of civilians to provide care to returning soldiers through the Red Cross.
c. introducing specialists in nursing such as nurse anesthetists.
d. increasing the number of community health nurses.
7. The primary purpose of the Social Security Act of 1935 was to:
a. increase research that focused on minority groups.
b. provide medical care for chemically impaired persons.
c. ensure health care for older adults through a national insurance system.
d. decrease the public’s financial burden by limiting services offered by local health departments.
8. A client asks the nurse, “Can you explain Medicare, an amendment to the Social Security Act?” The nurse responds that Medicare:
a. led to many hospital closings, along with a decrease in acute care hospital–based nursing care.
b. provided medical insurance to those younger adults or children who were not eligible for private insurance because of catastrophic illnesses such as cancer.
c. provided preventive care for women, infants, and children.
d. ensured that individuals ages 65 and older and those with end-stage renal disease or permanent disabilities had health care insurance.
9. A comparison of nursing in the 1980s to nursing in the 1990s reveals that:
a. in the 1990s nursing experienced a significant reduction occurred in preventable diseases caused by unsafe/unhealthy lifestyles.
b. tuberculosis was the primary concern for nursing in the 1980s, whereas the AIDS epidemic emerged and was its focus during the 1990s.
c. a decrease in ambulatory services in the 1980s prompted an increase in public health nurses in the 1990s.
d. the demand for advanced practice nurses increased in the 1980s and the 1990s as a result of the economy and concern about the health of the nation.
10. Which statement accurately describes the historical perspective of nursing practice?
a. Nursing has existed to meet the needs of populations, individuals, and aggregates by providing care that is determined by the needs and beliefs of society in different historical contexts.
b. As men began to become interested in nursing, it changed into a respected profession based on scientific fact rather than superstition.
c. Nursing has historically accepted individuals from all social and ethnic backgrounds.
d. The United States has led the way throughout history to advance nursing and health care by providing the first hospital and medical school.
Chapter 02: The Contemporary Image of Professional Nursing
1. Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by 2020?
a. Positions that historically required registered nurses will be filled by unlicensed personnel.
b. The job growth rate for RNs will surpass job growth in all other occupations.
c. The need for hospital nurses will dramatically decrease.
d. Hospitals will finally achieve the required RN workforce.
2. What effect did the movie One Flew Over the Cuckoo’s Nest have on health care?
a. Funding for mental health care increased, allowing the point of care to change from the community to standardized institutional care.
b. The public and the nursing profession were made aware of the rights of vulnerable populations.
c. Nurses were seen as advocates for individuals who cannot advocate for themselves.
d. Funding for nursing traineeships was eliminated.
3. Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever during the Spanish-American War?
a. Florence Nightingale
b. Margaret Hoolihan
c. Clara Maas
d. Sairy Gamp
4. A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates caring by holding a soldier’s head is an artistic representation of nurses who served in which war?
a. World War I
b. World War II
c. Spanish-American War
d. Vietnam War
5. What was the purpose of the Nurse Reinvestment Act of 2002?
a. Provided disability insurance to RNs who contract a life-threatening illness while on duty
b. Funded public service announcements that promote unlicensed caregivers as an alternative to professional nurses
c. Focused on nurse retention and safety enhancement grants
d. Provided pediatric nursing training grants
6. Potential nursing students are concerned about choosing a profession with job security and ask the recruiter, “Because more people are choosing nursing, will I have a job in a few years?” The recruiter answer that by 2025, on the basis of the U.S. Bureau of Labor Statistics prediction:
a. positions that have historically required RNs will be filled by foreign nurses.
b. the nursing shortage will increase twofold, the largest shortage in almost 50 years.
c. the need for hospital nurses will dramatically decrease as nurses reenter the profession.
d. hospitals will finally achieve the required RN workforce, reducing the need for more RNs.
7. Charles Dickens’ character Sairy Gamp:
a. portrayed nurses as trained professional individuals who put others before themselves.
b. chose nursing because she had no other avenue for employment.
c. was a prostitute who took advantage of sick old men.
d. characterized nurses as being at the forefront of technology and autonomy.
8. What does the Spirit of Nursing statue honor?
a. Florence Nightingale’s accomplishments in public health
b. Edith Cavell’s attempt to help the victims of the Tuskegee experiment seek treatment
c. Clara Maas, who found the cure for yellow fever during WWII
d. All military nurses for their bravery and compassion
9. Although the media portrayed nursing in a negative light in M*A*S*H through the character of a promiscuous, uncaring nurse, it also provided Americans with a promising glimpse of:
a. nurses who can be promiscuous and still help doctors.
b. the fact that caring is not as important as the desire to serve one’s country.
c. the ability of nurses to cope with the dreadfulness of war by using humor.
d. the contributions of male military nurses.
10. With the crisis in health care and the nursing shortage, why is the image of nursing still important?
a. Nursing care is often delivered during a time of uncertainty, and the image of nurses during this time can reinforce trust in the nurse-patient relationship.
b. Physicians have a distinctive body of knowledge that identifies them as professionals, whereas nursing has yet to develop a unique body of knowledge on which to base practice.
c. Nurses must present a unified image if they hope to ever establish nursing as a profession.
d. The dynamic state of today’s health care requires nurses to move from a caring image to one of technologic competence.
Chapter 03: The Influence of Contemporary Trends and Issues on Nursing Education
1. A current trend is for students to be evaluated to determine whether they demonstrate competence in the actual client care environment or with a standardized patient. This process occurs in addition to or instead of traditional pencil-and-paper evaluations. This type of evaluation is referred to as:
a. core practice competencies.
b. continuing competence.
c. distance learning.
d. performance-based assessment.
2. One of the major trends that currently influences nursing education and practice is:
a. increased technology in the field of critical care.
b. a narrowing scope of practice for nurses.
c. incivility or disregard of others’ rights in social interactions.
d. a decrease in ethnicity due to international programs allowing students to study from a distance.
3. Although the use of technology and the Internet provides nursing faculty and students with unlimited resources and current information, an outcome associated with this trend is that:
a. users of electronic resources spend a disproportionate amount of time looking for pertinent content.
b. additional time is available to study and revise curricula because special skills are not needed to access information via the Internet.
c. immediate results and outcomes are expected from students and faculty, thus enhancing time management.
d. skills that require problem solving and reflective abilities are developed.
4. A new trend in nursing education that is consistent with real-world practice is focused on:
d. subjective appraisals.
5. The practice of nurses, nursing students, and faculty is affected by demographic changes due to:
a. the growing percentage of adults ages 50 to 55 years.
b. increasing numbers of obese children and adults.
c. changes by which families are becoming more nuclear.
d. social programs that are essentially eliminating poverty.
6. The first university to offer nursing graduates a baccalaureate degree was:
a. Columbia Teachers College.
b. Yale University.
c. Harvard University.
d. the New York Regents Program.
7. Which nursing model is referred to as the “class without walls”?
b. Career ladder (2 + 2)
c. External degree
d. Second degree
8. In preparing students for professional nursing practice in the twenty-first century, where should the emphasis be placed?
a. Care coordination, direct care for complex clients, and outcomes evaluation
b. Chemistry, biostatistics, and computer programming
c. Illness care, hospice, and ethics
d. Psychomotor skills, obstetrics, and epidemiology
9. A standardized means of determining initial proficiency at the entry level into nursing is:
a. certification in medical-surgical nursing.
b. the National Certification Licensure Examination (NCLEX ).
c. comprehensive instructor-constructed examinations.
d. the ability of the student to answer questions concerning the care provided to a patient during the senior nursing courses.
10. Which trend is an effect of the nursing shortage on nursing education?
a. Only devoted qualified nurses are continuing to provide bedside nursing because of the complexity of care required, resulting in excellent preceptorships for students.
b. The number of applicants to nursing programs has risen, but enrollment is limited because of a decrease in the number of available scholarships and grants.
c. With an increase in the number of nurses who are entering graduate school to escape bedside nursing, students will soon enjoy a lower faculty/student ratio.
d. Students may be assigned to preceptors who have not yet developed expertise in the _eld of interest.
Chapter 04: Nursing Licensure and Certification
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).
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.
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.
4. To ensure that nursing legislation is current and is reviewed by specic 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
5. Current trends in telecommunications and increased mobility of nurses have led to 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)
6. The first field of nursing to certify advanced practitioners was the eld of:
a. adult nurse practitioners.
c. clinical nurse specialist.
d. nurse anesthesia.
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.
8. A nurse who is licensed in Georgia and moves to Oregon:
a. must 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.
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.
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 exam.
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.
Chapter 05: Theories of Nursing Practice
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
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:
3. The statement, “Nursing is a caring profession that focuses on helping people be as healthy as
possible,” is an example of a:
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
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.
6. What are general explanations that scholars use to explain, predict, control, and understand
commonly occurring events?
7. Which type of theory most often guides present nursing practice?
a. Grand theory
b. Middle range theory
c. Developmental theory
d. Values theory
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
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
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
Chapter 06: Nursing Research and Evidence-Based Practice
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.
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.
d. case study.
3. The use of research to guide nursing practice is called:
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:
c. case study.
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
6. Which type of data analysis results in the non-numerical organization of data?
7. A nurse researcher who is seeking funding for a study should identify _____ of funding agencies.
a. board members
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.
c. a needs assessment method.
d. a pilot study.
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.
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?
b. Grounded theory
c. Case study
d. Hypothesis generation
Chapter 07: Paying for Health Care in America: Rising Costs and Challenges
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.
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
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.
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.
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:
b. cost shifting.
c. price sharing.
d. governmental reimbursement.
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
a. Health maintenance organization
b. Preferred provider organization
c. Fee-for-service arrangement
d. Philanthropic agency
7. In the triad of health care, which would be considered the third-party payer?
b. Health care provider
c. Insurance company
d. Government agency that sets reimbursement rules for services
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.
c. diagnosis-related group
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.
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.
Chapter 08: Legal Issues in Nursing and Health Care
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
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
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:
c. defamation of character.
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.
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
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
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.
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.
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.
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.
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. Patient Self-Determination Act.
d. doctrine of res ipsa loquitur.
Chapter 09: Ethical and Bioethical Issues in Nursing and Health Care
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.
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:
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?
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:
5. A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of
his/her own values as they relate to this issue. The nurse must:
a. know his/her own values and how these values relate to beliefs and the philosophy of nursing.
b. rid the impurities in his/her value system.
c. ignore his/her own values.
d. realize that values do not change and that they cannot be influenced by others.
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.
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:
b. human dignity.
d. human rights.
8. The physician who insists on providing treatment in spite of the client’s wishes because he “knows
best” is reflecting:
9. The nurse who admits making a medication error and immediately files an incident report is
c. an injustice.
d. values clarification.
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:
Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care
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.
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?
b. Nervous tension
3. A Mexican-American patient is attacked and beaten. This patient is at risk for “fright disease,” which is
d. mal ojo.
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.
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:
c. cultural accommodation.
6. The nurse is preparing a plan of care for an African-American 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.
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,
a. chronic obstructive pulmonary disease.
c. cirrhosis of the liver.
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.
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.
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.
Chapter 11: Complementary and Alternative Healing
1. A patient observes the practitioner burning a dried herb on the needle during an acupuncture session and asks about this practice. The practitioner responds, “I am inciting the acupuncture points and this is referred to as:
2. An older adult has atrial fibrillation, which causes the heart to have an irregular rhythm. The client uses imagery to alter the dysrhythmia. The client is using which type of complementary alternative medicine (CAM)?
3. A patient with kyphosis is visiting a practitioner of chiropractic medicine for the first time and asks, “How does this therapy work?” The practitioner replies, “I will use my hands along with heat to correct the misalignment of your spine by placing pressure on the nerves that have produced pain. The misalignment of your spine is referred to as:
b. a sprain.”
c. a fracture.”
4. A young adult on a limited income who is having back pain states, “I want to see a chiropractor, but I don’t have any money. However, I do have health insurance.” The most appropriate response that the nurse can provide is:
a. “Most insurance companies will pay for chiropractic treatment.”
b. “Because chiropractors are not licensed in any state, all services must be paid for by the patient.”
c. “Chiropractic medicine is a new CAM therapy that has not yet been recognized by insurance companies.”
d. “Chiropractic medicine is more than 100 years old, but because it is preventive in nature, it is not covered by most insurance.”
5. The use of plants in conventional modern medicine is evidenced by the drug atropine, which is derived from which plant?
a. Digitalis purpurea
b. Cephaelis ipecacuanha
c. Rauwolfia serpentina
d. Atropa belladonna
6. The massage therapist uses kinesthesia, or thinking about how movement is expressed, to correct habits that cause poor posture and limited movement. This type of massage is called:
a. Alexander technique.
b. Feldenkrais method.
c. healing touch.
7. A nurse practices a relaxing massage technique to stimulate and apply pressure to the feet or hands, increasing blood supply circulation to various parts of the body and relieving pain. The massage technique used by the practitioner is referred to as:
b. Feldenkrais method.
8. A patient is placed on reserpine (Serpalan) to decrease mild anxiety and treat hypertension. The patient researches the medication on the Internet and finds that this medication comes from which plant?
a. Atropa belladonna
b. Digitalis purpurea
c. Rauwolfia serpentina
d. Cephaelis ipecacuanha
9. A person who is recovering from a stroke is becoming more forgetful and is unable to recall people’s names. A friend suggests the use of a natural ingredient, ginkgo biloba. The nurse is concerned about the most serious risk associated with this herb, which is:
a. thromboembolism due to increased clotting.
b. seizures due to interaction with anticonvulsants.
c. hypertension due to sodium retention.
d. photosensitivity due to increased melanin production.
10. An older adult woman who stops using complementary alternative medicine (CAM) becomes disoriented and is given a diagnosis of dementia. The family is upset with the family physician and the CAM practitioner for not diagnosing the condition earlier. Which CAM may have interfered with early detection of the dementia?
a. Large doses of calcium caused cerebral plaques to form, thereby disguising atrophy of the brain.
b. Excess doses of folic acid masked a vitamin B12 deficiency that led to dementia.
c. Hypnotherapy focused on current pleasant thoughts, eliminating clues to the past.
d. The electrical current from magnetic fields interfered with normal brain waves, resulting in confusion and inability to concentrate.
Chapter 12: Workforce Advocacy and the Nursing Shortage
1. When an RN is asked to accept an assignment that he or she may not be qualified to perform, the nurse should:
a. accept the assignment as appropriate if assigned by a legitimate power.
b. be primarily concerned with the number of patients being assigned.
c. ask how other nurses have handled the assignment in the past.
d. determine whether he or she is familiar with the types of patients being assigned.
2. One workplace issue—the nursing shortage—is caused by several complex issues, including:
a. movement of nurses into acute care settings.
b. the use of unlicensed assistive personnel to replace RNs.
c. a mass of baby boomers who have chosen nursing as a career.
d. an aging nursing workforce.
3. Studies conducted to determine enrollment trends in nursing schools have found that in the last years:
a. a greater number of individuals chose nursing as a career but could not meet entrance requirements.
b. more young women chose to enter the profession of nursing.
c. fewer career opportunities exist in the profession of nursing and fewer opportunities are projected to exist for women.
d. men have dominated the profession, and women feel that they have experienced discrimination.
4. Qualified nursing school applicants have continued to be turned away, limiting enrollment due to a shortage of faculty, which is attributed to several factors, including:
a. nursing faculty are subject to high levels of burnout and job dissatisfaction.
b. only the number of faculty in Associate Degree programs remain stable.
c. the mean age of nursing faculty continues to decrease and older faculty mentors have left the profession.
d. increasing job competition from higher paying clinical sites, especially in today’s economic turndown.
5. The key to organizational success for health care facilities is:
a. hiring younger, more energetic nurses.
b. offering incentives such as sign-on bonuses.
c. hiring highly qualified advanced practice nurses.
d. retaining professional nurses.
6. A new graduate nurse is applying for the exciting first position and states, “I am only applying to Magnet hospitals because those work environments:
a. attract physicians who are the best health care providers to improve quality of care.”
b. require all registered nurses to be certified in the area of practice.”
c. not only attract but also retain professional nurses.”
d. discourage nurses from advancing their current level of education and I don’t want to return to school for many years.”
7. Which situation would be considered a workforce advocacy issue that is reportable to the state nurses association or the Center for American Nurses if it is not resolved at the local level?
a. Nurses prefer to wear navy blue scrubs, but the institution requires burgundy scrubs, which interferes with autonomy.
b. The cafeteria often serves fried vegetables rather than healthier baked vegetables, causing the potential for hyperlipidemia.
c. The hospital pharmacy does not fill employee prescriptions upon receiving them; instead, they fill employee prescriptions after all inpatient prescriptions have been filled.
d. The key needed to change the sharps container is locked in the supervisor’s office after 3 PM on weekdays and all day on weekends, which prevents changing of the container when needed and places nurses at risk for needlesticks.
8. A newly hired nurse is asked to serve on a committee formed to recruit and retain nurses. At the committee meeting, the nurse learns that:
a. older nurses are being encouraged to retire so that younger, more efficient nurses can practice.
b. Magnet hospitals are able to attract nurses with sign-on bonuses and flexible work hours but fail to retain nurses because insufficient autonomy over professional practice is provided.
c. multitasking is seldom desired by the younger generation of nurses.
d. many younger workers are less concerned with longevity and are willing to change institutions to achieve professional advancement and flexible work hours.
9. Hospitals surveyed nurses who terminated their employment to determine why they chose to leave. One of the most common reasons for leaving was:
a. decreased pay for alternative shifts.
b. that the nurse/patient ratio prevents safe care.
c. that most facilities are choosing an all-RN staff, which decreases opportunities for advancement.
d. that agency and foreign nurses are favored by administration over full-time nursing staff.
10. A nurse is concerned about safe staffing levels at a facility and observes that several units have no RN coverage but instead have RNs who float among several units. In determining whether this staffing concern should be reported to an outside agency, the nurse understands that, with whistle blowing:
a. reporting unsafe staffing levels to The Joint Commission provides protection from the employer.
b. keeping copies of documented inappropriate staffing patterns in the nurse’s personal file is illegal.
c. when observing inappropriate staffing, the nurse should record her personal thoughts concerning the outcomes.
d. one should seek guidance from a trusted individual who can provide an objective point of view.
Chapter 13: Collective Bargaining and Unions in Today’s Workplace
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:
b. binding arbitration.
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.
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.
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.
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/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.
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.
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.
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.
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.
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.
Chapter 14: Information Technology in the Clinical Setting
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.
d. not comparable with the paper-and-pencil record.
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.
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.
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.
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.
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:
d. data capture.
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.
d. ubiquitous computing.
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.
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.
c. robotic technology.
d. biometric technology.
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?
Chapter 15: Emergency Preparedness and Response for Today’s World
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?
b. Relief response
d. Crisis intervention
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:
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.
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).
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.
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.
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.
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.”
9. A nurse who is conducting a staff in-service on the phases of a disaster continuum teaches participants that, during the impact 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.
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
Chapter 16: Nursing Leadership and Management
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?
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.
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.
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?
5. An RN with excellent assessment and psychomotor skills would derive power on the basis of which source?
6. Managers who exhibit an authoritative behavioral style are most likely to use which source of power?
7. The illustration below identifies which type of chart?
8. 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?
9. 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?
10. 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?
b. Closed systems
c. Open systems
Chapter 17: Budgeting Basics for Nurses
1. A nurse manager plans the fiscal budget to include salaries for two RNs for two 12-hour shifts with a patient census of 6 in the short-stay observation room. The nurse manager reviews the budget report 3 months later and notes that the salary expenses are higher than was budgeted because of higher-than-planned RN staff salaries. This additional RN staff is necessary to meet patient care needs because the census has remained constant at 10 patients rather than the 6 projected when the budget was developed. The difference between the planned budget and the actual cost is known as:
d. capital expenditures.
2. A nursing unit’s census consists primarily of long-term residents with a high risk for falls. To meet new safety regulations, the nurse manager must plan to replace all 50 patient beds with new beds equipped with Fall Watch electronic sensors that will detect when patients get out of bed. The manager will be involved in which type of budgeting to replace the beds?
3. A nurse manager is preparing a budget that does not base annual budgets on the revenue and expenditures of the prior year and has the advantage that outdated information is not integrated into the budget. The manager is using which budget method?
4. A nurse on the unit is heard saying, “I am not going to document that I used four catheters to start that IV; it doesn’t matter anyway.” What action can help the staff nurse understand the financial budget goals of the unit?
a. Have the nurse work in payroll for a week.
b. Enroll the staff in continuing education units (CEU) for personal finance.
c. Ask the nurse to represent the unit on the budget planning committee.
d. Make the nurse responsible for monitoring all disposable equipment and supplies.
5. In a large health care facility, the executive administrative leaders set the budget goals to decrease full-time equivalents by 3%, eliminate the cost of agency nurses, reduce lost revenue from lost supplies by 1%, and provide a 0.5% hourly salary incentive for working on a float unit when the assigned unit has a low census. Nurse managers meet with nursing administrators to design their unit budgets to meet these established goals. The budget approach that is being used is the _____ approach.
6. Which component of budgeting might normally be addressed in the annual performance evaluation for a nurse manager?
a. Including in the labor budget costs for overtime and benefits
b. Managing variances in nursing overtime costs and supply usage
c. Accurately predicting revenues on the basis of unit of service
d. Providing qualitative analysis for variances in the capital budget
7. A primary function of the budgeting process is to provide managers with an opportunity to:
a. insist that salary increases for all nurses are included in the annual budget.
b. discuss concerns about resource allocation with leaders of the organization who are capable of resolving issues.
c. develop a mechanism for changing from zero-based budgeting to incremental budgeting.
d. develop for all staff an educational program related to supply usage.
8. Organizations measure the effectiveness of their budgets by examining actual revenues and expenditures versus:
a. planned variances.
b. incremental budgets.
c. productivity metrics.
d. expected performance.
9. When the nurse manager conducts a qualitative analysis of budget variances, he or she is:
a. determining the percentage increase of supply usage from the last quarter to the current quarter.
b. identifying the overall increase in the dollar amount of salaries paid for overtime.
c. comparing productivity metrics across all nursing units in the facility.
d. reconciling with current conditions the underlying assumptions on which the budget was based.
10. A nurse manager is working with the financial officer to develop the budget of the nursing unit for the next fiscal year. The nurse manager tells the financial officer that which of the following pieces of information will affect budget assumptions?
a. The capital budget request for new emergency department equipment has been turned in for consideration by the hospital’s administrative team.
b. The patient census likely will increase during the next fiscal year because two large physician groups have transferred their admission privileges to this hospital.
c. The participatory budgeting approach instituted last year has been helpful in controlling supply costs.
d. Zero-based budgeting will help the managers to be more efficient in establishing next year’s budget.
Chapter 18: Effective Communication and Conflict Resolution
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.
d. false assurance.
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?
d. False assurance
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
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.
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):
c. precipitating event.
d. preconceived idea.
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
d. Preconceived idea
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
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
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.
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.
Chapter 19: Effective Delegation and Supervision
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.
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.
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.
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?
c. Unlicensed assistive personnel (UAP)
d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.
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?
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 simple, routine patient 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.
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.
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.
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.
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.
Chapter 20: Staffing and Nursing Care Delivery Models
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.
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.
3. Nurses 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
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.
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.
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.
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).
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:
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.”
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.
AND MUCH MORE