NUR 206 TESTBANK , Chapter 01: The Evolution of Professional Nursing Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition Questions And Answers

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Chapter 01: The Evolution of Professional Nursing Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. Clara Barton is known for: a. becoming... the first black public health nurse. b. establishing the Henry Street Settlement. c. founding the American Red Cross. d. publicizing the inadequacies of hospital-based nursing schools. ANS: C The American Red Cross, founded by Clara Barton in 1882, assisted in efforts to continue public health nursing. DIF: Knowledge REF: p. 11 2. Students are assigned to write to their state leaders about an issue affecting their community. One student writes about the need among rural community for greater access to acute care services. Which of the following pieces of legislation should the student use as a reference? a. Social Security Act b. Hill-Burton Act c. Sheppard-Towner Act d. U.S. Civil Service Act ANS: B The purpose of the Hill-Burton Act was to provide funding to construct hospitals and to help states in plan for other health care facilities in accordance with the needs of communities. DIF: Knowledge REF: p. 13 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. ANS: D Lillian Wald, a pioneer in public health nursing, is best known for the development and establishment of the Henry Street Settlement. DIF: Knowledge REF: p. 6 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 ANS: A Lillian Wald developed the first nursing service for occupational health. DIF: Comprehension REF: p. 10 5. What historical event first led to the recognition of the contribution of blacks to nursing? a. Florence Nightingale’s acceptance of black nurses into the first nursing school b. The contributions of black 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 black nobles who carried food and medicine from house to house during the Middle Ages ANS: C Although Nightingale’s school refused Seacole, she was able to make a difference in the Crimean War and later was recognized for her efforts. DIF: Comprehension REF: pp. 8-9 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. ANS: C World War I offered nurses a chance to enter into new fields of specialization, as is seen in the example of nurse anesthetists, who became part of surgical teams at the front lines. DIF: Comprehension REF: p. 11 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. ANS: C By providing health insurance for older adults, the Social Security Act of 1935 set the precedent for the passage of the Medicare and Medicaid Acts that followed in 1965, but the act also provided maternal and child welfare services, rehabilitation for the mentally and physically challenged, medical care for blind individuals and crippled children, and unemployment benefits. DIF: Comprehension REF: p. 12 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. ANS: D The Medicare program provides hospital insurance, Part A, and medical insurance, Part B, to all people ages 65 and older who are eligible to receive Social Security benefits; people with total, permanent disabilities; and people with end-stage renal disease. DIF: Comprehension REF: p. 14 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. ANS: D The numbers of advanced nurse practitioners increased as evidence of their cost-effectiveness as providers of primary and preventive health care became established. DIF: Comprehension REF: pp. 16-17 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. ANS: A Nursing has existed since biblical times to address needs ranging from contagious diseases in early times to health prevention in the present time, with care based on health needs and beliefs of the time. DIF: Comprehension REF: p. 3 |pp. 18-19 11. The use of herbs has become a popular alternative to prescription drugs in today’s health care milieu. During which other historical periods did health practices focus on the use of herbs? a. Prehistoric times and the Middle Ages b. Civil War period and World War I c. Renaissance and Reformation periods and the Colonial American period d. Crimean War and Civil War periods ANS: A During prehistoric times, tribes used herbs to rid themselves of disease; in the Middle Ages, women used herbs. DIF: Comprehension REF: p. 6 12. A care provider sacrifices an animal and waves an herb-filled sack over a client who is complaining of painful joints and chest pain with exertion. This ritual represents health care during: a. the prehistoric period. b. early civilization in Egypt. c. the Renaissance. d. the Middle Ages. ANS: A During prehistoric times, illness was thought to be caused by evil spirits that providers attempted to scare away through rituals and dances. DIF: Comprehension REF: p. 3 13. A prospective nursing student who researches universities that offer a baccalaureate degree in nursing would want to ensure that the program is accredited by the: a. American Nurses Association. b. Commission on Collegiate Nursing Education. c. National Institutes of Health. d. National Nursing Council. ANS: B The Commission on Collegiate Nursing Education (CCNE) is the agency that exclusively accredits baccalaureate and graduate-degree nursing programs. DIF: Comprehension REF: p. 4, Box 1-1 14. Nursing in the 1990s was characterized by: a. men leaving nursing to enter the armed services. b. traditional 8-hour shifts to nurse burnout and compassion fatigue. c. a focus on preventable diseases. d. a decrease in nursing research. ANS: C Health promotion and disease prevention were recognized as the means to reduce the high number of mortalities associated with preventable diseases—Healthy People 2000 was published as a nationwide effort to reduce preventable deaths. DIF: Comprehension REF: pp. 16-17 15. A nurse is part of the policy committee for a hospital. The committee is provided with statistics indicating that patients participating in a satisfaction survey felt they lacked sufficient information about new drugs started while hospitalized and continued after discharge. In addition, charts noted high recidivism rates. The committee recommended that a formalized patient education plan be instituted to reconcile all medications and provide patient information about new medications. The committee is using which component of the Institute of Medicine (IOM) 2011 message? a. Nurses should achieve higher levels of education to be effective members of an interdisciplinary team. b. Nurses should have a minimum of a master’s degree to sit on policy committees that affect an entire facility. c. Pay for nurses should be consistent with that of physicians since the committee is interdisciplinary. d. Policy is based on data, which provides the groundwork for decision making. ANS: D The IOM report initiatives include effective workforce planning and policymaking based on better data collection and improved infrastructure. DIF: Application REF: p. 16| p. 18 16. The Affordable Care Act of 2011: a. requires that by 2020 all newly licensed nurses have a bachelor’s degree at minimum. b. would provide health care benefits to millions who were previously uninsurable or unable to afford insurance. c. caps the amount that hospitals and physicians can charge for procedures. d. subsidizes private insurance companies, thereby reducing health care costs for individuals who have chronic or catastrophic illness such as cancer. ANS: B It is anticipated that the ACA (2011) will make insurance coverage possible for millions who have previously not had insurance or had been denied insurance. DIF: Comprehension REF: pp. 18-19 17. It has been said that “history repeats itself because no one was listening the first time.” Which statement is true when comparing the nursing care provided in the Civil War (1861 to 1865) to that provided during the Crimean War? a. Epidemics such as smallpox and typhoid were the primary emphasis of nursing care in both wars. b. Soldiers were housed in substandard conditions, but due to Nightingale’s push for sanitary conditions, in the Civil War soldiers were housed in aseptic conditions. c. Black nurses were widely accepted by society and the profession, receiving equal compensation during the Civil War due in large part to the efforts of Mary Seacole during the Crimean War. d. Both Nightingale (Crimean War) and Dix (Civil War) completed nursing training before accepting positions as nurses in the wars. ANS: A Numerous epidemics plagued the country, including syphilis, gonorrhea, malaria, smallpox, and typhoid. DIF: Application REF: p. 9 MULTIPLE RESPONSE 1. What uniquely twenty-first century issue challenges today’s professional nurse. (select all that apply) a. Caring for an aging population b. Increased patient acuity c. Access to health care services d. Expanding technology e. Increasing intercultural patient population ANS: A, B, D, E Professional nurses in the twenty-first century are faced with many challenges including an aging patient population. Professional nurses in the twenty-first century are faced with many challenges including an increase in high acuity patients. Professional nurses in the twenty-first century are faced with many challenges including an ever expanding array of technologies that affect patient care. Professional nurses in the twenty-first century are faced with many challenges including the existence of an intercultural patient population. DIF: Comprehension REF: p. 18 2. A newly licensed nurse compares the challenges facing nursing today with those faced by nurses when her mentor graduated in 1990. The mentor states, “Prevention was the focus of nursing when I graduated. We stressed preventive health measures such as smoking cessation education to reduce preventable diseases and prevention to reduce the spread of infectious disease such as AIDS.” The mentor asks, “What do you think the challenges will be for nurses graduating now? The correct response would be: (select all that apply) a. coordinating care for a more diverse aging population who have complex health values. b. managing care provided by nurses who are technologically advanced and skilled at interprofessional collaboration. c. providing care to well-informed consumers who are younger with narrow health values. d. redesigning nursing care delivery models to streamline care based on fewer generational differences. e. focusing on care from a systems perspective. ANS: A, B, E Our society, thus our patients/consumers, is aging and better informed about health care options, with health values as diverse as the various populations of patients served. Nurses educated in the twenty-first century are introduced to advanced technologies throughout the curriculum, but a gap still exists between the potential benefits of technology and the use made of it to reduce errors and improve patient care; interprofessional collaboration is a challenge with incivility and workplace violence increasing. Today’s nurses must view health care from a systems perspective rather than a nursing unit perspective to decrease errors/costs that arise from system errors. DIF: Analysis REF: pp. 18-19 3. A nurse who has practiced for 1 year on a medical-surgical unit is very interested in a position in the operating room. She traces the nursing history of surgery to learn how nursing has evolved in this practice. To determine if, historically, surgery methods advanced the practice of nursing, select the correct statements. (select all that apply) a. The Ancient Egyptians were the first to use anesthesia in the operating room. b. The “Barbers” of the Middle Ages used sterile techniques to reduce wound infections. c. The Indian culture from 274 to 236 BC had hospitals staffed with female nurses who practiced much like today’s nurses. d. During the Renaissance, advances in nursing education, including surgery, were nonexistent. e. Following World War II, nurses practiced in mobile army surgical hospitals, where medical and surgical techniques were further refined. ANS: D, E During the Renaissance, major advancements were made in pharmacology, chemistry, and medical knowledge, including anatomy, physiology, and surgery with new emphasis given to medical education, but nursing education was practically nonexistent. Following World War II, nurses volunteered for the Korean War, where care was provided in MASH units and surgical techniques were defined. DIF: Application REF: p. 7 |pp. 13-15 COMPLETION 1. Which group in early civilization is credited with developing a pharmacopoeia to classify more than 700 drugs used in caring for the sick? ANS: Egyptians A pharmacopoeia that classified more than 700 drugs was written by the Egyptians to assist in the care and management of disease. DIF: Knowledge REF: p. 3 Chapter 02: The Contemporary Image of Professional Nursing Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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. ANS: B With an employment rate expected to increase by more than 19%, job production for nurses is projected to grow faster than the average of all occupations (11%) until 2020. DIF: Knowledge REF: pp. 23-24 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. ANS: B One Flew Over the Cuckoo’s Nest reminded us that all individuals have rights and that it is the responsibility of the public and health care professionals to ensure that these rights are protected. DIF: Comprehension REF: p. 26 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 ANS: C Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever. DIF: Knowledge REF: p. 26 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 ANS: D This statue represents the caring provided by nurses during the Vietnam War. DIF: Knowledge REF: p. 27 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 to address the current nursing shortage d. Provided pediatric nursing training grants ANS: C This act provided nursing scholarships, public service announcements promoting nursing as a career, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. DIF: Knowledge REF: pp. 23-24 6. What is the best way for the individual nurse to maintain the most effective professional image? a. Change out of their work attire before running errands. b. Renew membership in a nursing organization. c. Earning an advanced nursing degree. d. Developing effective nurse-physician relationships. ANS: B Professional nurses recognize that their greatest benefit—and one of the most efficient and powerful uses for their money—is less than 1% of their salary they spend for membership in the ANA, the National League for Nursing, Sigma Theta Tau International, and their specialty organization. They look forward to annual meetings because such meetings provide an excellent opportunity to meet colleagues and discuss issues and practice innovations. DIF: Application REF: pp. 33-34 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. ANS: B Sairy Gamp endured nursing because of the lack of other opportunities. DIF: Knowledge REF: p. 25 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 ANS: D The statue the Spirit of Nursing was created to honor all military nurses. DIF: Knowledge REF: p. 25 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. ANS: C The sitcom M*A*S*H did show humor as a coping mechanism for nurses in a war setting. DIF: Knowledge REF: p. 26 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. ANS: A A person who seeks health care is entering a world of uncertainty. The nurse provides continuity and compassion and stabilizes the environment of the patient. DIF: Comprehension REF: p. 23 11. Nurses can combat the nursing shortage by: a. joining unions, which influence employers to provide incentives such as pay raises and free child care, thus encouraging the large percentage of nonworking nurses to return to the workforce. b. demanding that the requirements of the qualifying examination for foreign nurses should be reduced, so they are eligible to sit for the licensure examination. c. working more hours with a higher nurse/patient ratio. d. advocating for funds to pay for nursing education and a safer work environment. ANS: D Advocating for funds to pay for nursing education and a safer work environment is a positive strategy, as can be seen by results attained after the Reinvestment Act P.L. 107-205 provided $20 million for nursing scholarships, public service announcements, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This is the best defense against the nursing shortage. Nursing graduates in many states have increased in number, and enrollment in nursing schools is also on the rise. DIF: Application REF: pp. 23-24 12. The demographics of the twenty-first century nursing population indicate that: a. individuals entering nursing are second-degree students who average 45 years of age. b. more white nurses enter and obtain graduate degrees than any other ethnic group. c. the highest level of nursing education for most RNs is an associate degree. d. the majority of nurses practice in hospitals. ANS: D Fifty-six percent of nurses practice in hospitals. DIF: Comprehension REF: p. 29 13. A nursing student asks, “I wonder if the reason that the nursing shortage is so severe is that registered nurses are unhappy with their jobs.” To research the answer, the National Survey of Registered Nurses was reviewed and found: a. registered nurses change employers every year to prevent burnout and to keep the nursing shortage from increasing. b. nursing faculty are aging or leaving academia due to increased work demands and generational difference from students. c. practicing registered nurses are satisfied with their job and most remain with same employer they worked for the previous year. d. registered nurses were the least satisfied with their job of all health care providers. ANS: C According to the latest National Sample Survey of Registered Nurses (NSSR), 79.8% of practicing RNs were satisfied with their job and 88.4% were with the same employer as they had been in the preceding year (U.S. Department of Health and Human Services, 2010). Among all RNs, nursing faculty are the most satisfied (86.6%). DIF: Comprehension REF: p. 29 14. A registered nurse is on break and checking e-mails. One e-mail contains a picture of a celebrity who is a patient in the hospital, and on the same floor, where the nurse works. Included with the photo is a message, “check out my Facebook,” which contains additional photographs of the patient. The nurse immediately deletes the picture to prevent having to report the “friend” to supervisors. Based on the action of the nurse who received the message, which statement is correct? a. The nurse is not at risk for having his or her license suspended since removing the photos made them temporary and invisible to all others. b. Because the nurse did not send the message and immediately deleted the photo, there is no risk for discipline. c. Failing to report receiving the message demonstrates poor ethical and legal role-modeling as well as placing the nurse at risk for discipline. d. Because the patient is on the same floor as the one on which the nurse works, the information can be ethically and legally shared. ANS: C Failing to report the image can result in discipline. DIF: Comprehension REF: pp. 27-28 15. A nurse executive is concerned that the mortality rate in his or her hospital exceeds the national average and searches the literature finding Aiken’s 2011 Survey on the effects of nurse staffing and education on mortality, including work environment. If Aiken’s recommendations are followed, which change would be most effective? a. Increasing staffing ratios to include more nurses of all levels of educational preparation on all shifts b. Employing bachelor’s prepared nurses who participate in interprofessional rounds with attending physicians where their voices are heard c. Ensuring nurse managers and administrators have at minimum a master’s degree d. Encouraging all unlicensed assistive personnel to attend educational programs to be certified ANS: B Aiken (2011) found that simply increasing the number of RNs was not the only answer to reduce mortality. Increasing the number of BSN-prepared nurses along with developing a positive work environment had the most impact on reducing mortality. The impact on reducing mortality by increasing the educational level of nurse managers/administrators and certified unlicensed assistive personnel was not documented. DIF: Application REF: pp. 30-31 16. In order to best improve patient outcomes on an acute care hospital unit, which intervention should the nursing staff advocate for? a. Staffing only 8 hour shifts on the unit b. Decreasing the number of patients cared for on any specific unit c. Increasing salaries for experienced nurses d. Increasing staffing on the evening shift ANS: D The data clearly indicate that decreased nurse-patient ratios have been associated with higher rates of mortality, shock, urinary tract infections, sepsis, hospital acquired pneumonia, and failure to rescue, especially among surgical patients. DIF: Application REF: pp. 30-31 17. A physician complains to administration that the nurse working last evening is unethical, based on observing the nurse educate the patient about a new medication ordered. The physician demanded the nurse be reprimanded and reminded that only physicians have the educational background to teach patients about new medications. Which comment and action by the administrator would be most effective in changing nurse-physician relationships in this instance? a. Inform the nurse, “You will be suspended for 3 days for going beyond your job description,” and enforce the 3-day suspension because the physician did not write the order to “teach the patient about the new medication” b. Advise the physician that only nurses can teach patients about medications; the physician’s role is to only prescribe. No action will be taken against the nurse. c. After investigating the situation, thank the physician while also providing information that patient education related to medication is within the scope of practice of registered nurses. Share the physician’s concern and administrator’s response with the nurse so both parties are aware of the resolution of the concerns. d. Contact the patient’s family and ask, “Do you prefer that all teaching related to medications be performed by the physician rather than the nurse” to determine what action to take. ANS: C Investigating the situation to provide evidence is the first step. Once the facts are known, action can be taken. In this instance, including the ethics committee would help ensure an unbiased decision. DIF: Application REF: pp. 31-32 18. Which nurse best portrays nursing as a “knowledge worker”? a. Nurse in matched scrubs with lab coat, hair back, small stud earrings b. Nurse in mismatched scrubs, no lab coat, large hoop earrings c. Nurse in white uniform with apron with no jewelry/hair back d. Nurse with nose ring and eyebrow piercing with starched white uniform and cap ANS: A Nursing scrubs have become a popular alternative to the traditional white uniform; clean wrinkle-free matching scrubs presented a professional image. Small stud earrings reduce risk of injury to nurse when caring for confused or combative patients. DIF: Comprehension REF: pp. 30-32 MULTIPLE RESPONSE 1. According to current data related to the nursing shortage: (select all that apply) a. salaries of nurses are competitive with those of other professionals such as teachers. b. only 19% of nurses are minorities. c. overall, nurses are satisfied with their jobs but leave the profession because of fear of contracting fatal diseases. d. the employment opportunities for nurses continue to be strong. e. staff nurses are returning to school to obtain certificates to teach nursing. ANS: B, D Only 19% of nurses are minorities. RNs have one of the highest growth rates of employment of all occupations. DIF: Knowledge REF: pp. 23-24 |p. 29 2. A group of new graduate nurses is asked to speak to a group of politicians to describe the current state of professional nursing and how best to alleviate the nursing shortage. Which statements accurately portray professional nursing today and tomorrow? (select all that apply) a. More RNs attain a bachelor’s degree than an associate degree or diploma. b. Because of pressure to shorten length of stay in hospitals, more RNs practice in outpatient settings and home health than in acute care settings. c. The most popular advanced practice specialty is nurse anesthesia. d. White nurses are more likely to enter graduate school than nurses from other ethnic groups. e. Nursing represents the largest health care professional group, followed by medical doctors. ANS: A, E Recipients of BSN degrees represent the largest graduating educational profile (47.2%). Nurses make up the largest group of health care professionals. DIF: Comprehension REF: p. 29 3. Which actions would result in a greater number of nurses entering and staying in practice, given today’s state of nursing? (select all that apply) a. Determine why few black women enter graduate school. b. Provide incentives for minorities and men to enter nursing. c. Obtain grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs. d. Survey nurses to determine why their job satisfaction is lower than that of other health care professions. e. Develop ad campaigns that target younger students. ANS: B, C, E Core solutions to the nursing shortage include providing incentives for minorities and men to enter nursing. Core solutions to the nursing shortage include obtaining grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs. Core solutions to the nursing shortage include developing ad campaigns that target younger students. DIF: Comprehension REF: pp. 28-29 4. The Nurses of America’s media campaign raised awareness of which aspects of nursing? (select all that apply) a. Nurses are expert clinicians. b. A higher nurse/patient ratio is needed. c. Nurses are invisible in the news media. d. Nurses are caring. e. Nurses are well paid. ANS: A, C The campaign was designed to convey to the public that nurses are expert clinicians. A strategically important part of the campaign raised consciousness among nurses of the invisibility of nursing in the news media. DIF: Comprehension REF: p. 28 Chapter 03: The Influence of Contemporary Trends and Issues on Nursing Education Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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. ANS: D Performance-based assessment is the evaluation of abilities based on an objective demonstration of specific required competencies. This may include performance in actual or simulated situations. DIF: Knowledge REF: p. 44 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. ANS: C Incivility has escalated and can be demonstrated by the common practice of text-messaging during class and an increase in academic dishonesty. DIF: Comprehension REF: pp. 46-47 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. ANS: A Students can easily become distracted by pursuit of the intriguing web of links they encounter while they search websites to complete assignments or find pertinent content. DIF: Analysis REF: pp. 41-43 4. A new trend in nursing education that is consistent with real-world practice is focused on: a. outcomes. b. objectives. c. goals. d. subjective appraisals. ANS: A Outcomes and criteria establish real expectations for clinical practice and have a powerful influence on nursing education and practice at all levels. Outcomes are used in all areas of nursing in the nursing process. DIF: Knowledge REF: p. 43 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. ANS: B The United States is experiencing an epidemic of obesity with major consequences for health and the health care system. DIF: Knowledge REF: p. 46 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. ANS: B In 1924, Yale University offered the first separate Department of Nursing, whose graduates earned a baccalaureate degree. DIF: Knowledge REF: p. 53 7. Which nursing model is referred to as the “class without walls”? a. Articulation b. Career ladder (2 + 2) c. External degree d. Second degree ANS: C An external degree does not require attendance and provides no course classes; it enrolls thousands and is accessible regardless of geographic location. DIF: Knowledge REF: p. 56 8. When focusing on addressing issues identified by the 2000 Institute of Medicine report, the nursing faculty will access information associated with which initiative? a. Quality and Safety in Nursing Education b. Competency Outcomes and Performance Model (COPA) c. The National Organization of Nurse Practitioner Faculties (NONPF) d. Academic Center for Evidence-Based Practice (ACE) ANS: A In response to the Institute of Medicine report (IOM, 2000), The Robert Wood Johnson Foundation funded a national initiative, Quality and Safety in Nursing Education (QSEN), to help nursing programs reorganize curricula to focus on patient safety and quality care. DIF: Application REF: p. 43 9. The number of reported medical errors demonstrates a need for what priority intervention? a. Simulation experiences b. Performance competency exercises c. Comprehensive instructor-constructed examinations d. Detailed care planning exercises ANS: B The increase in reported medical-related errors vividly emphasizes the need for more effective validation of performance competence in schools and the workplace. DIF: Application REF: p. 45 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 field of interest. ANS: D Qualified preceptors are few. DIF: Analysis REF: p. 49 11. The NCLEX® examination is created and administered by the: a. American Association of Colleges of Nursing (AACN). b. American Nurses Association (ANA). c. National Council of State Boards of Nursing (NCSBN). d. National League for Nursing (NLN). ANS: C The NCSBN coordinates licensure activities on a national level and creates and administers the licensure examination (NCLEX®). DIF: Knowledge REF: p. 57, Box 3-1 12. A student is planning to enroll in prerequisite courses after graduating from high school and is researching options for nursing programs. During a career fair the student compares different types of nursing education programs and discovers that: a. diploma programs focus on family and community, with an emphasis on health promotion. b. most practicing RNs graduated from diploma programs because this was the first type of RN program. c. baccalaureate programs focus on technical and hands-on nursing skills in diverse community settings. d. master’s programs such as that for the clinical nurse leader provide entry into practice with a focus on interdisciplinary and bedside nursing care for complex client populations. ANS: D A clinical nurse leader oversees the care coordination of groups of clients and actively provides direct client care in complex situations, evaluates client outcomes, and has the decision-making authority to change care plans when necessary. DIF: Comprehension REF: p. 55 13. When preparing to complete a competency examination involving a neurologic assessment in a simulation laboratory, the nurse reviews the critical elements, which consist of: a. those steps that result in life or death of a client. b. required criteria that must be incorporated into the assessment for the desired outcome. c. fundamental strategies unique to complex dynamic care environments. d. objective data that can be used to determine the likelihood that the client will recover. ANS: B Critical elements include the application of mandatory principles that must be used according to established practice standards. DIF: Comprehension REF: p. 40 14. An RN with a diploma preparation wants to participate in decisions about health care and decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering self-scheduling and a self-paced curriculum. This nurse is taking advantage of: a. educational mobility. b. a traditional nursing program. c. training for advanced practice nursing. d. credit by examination. ANS: A Education mobility is the progressive movement from one level or type of education to another—in this instance, diploma to BSN. Programs are aimed to make the transition possible through creative flexible scheduling. DIF: Application REF: p. 56 15. A nursing student scores 95% on the written examination for the adult health course. To be successful in this course, this same student must then perform an indwelling catheter insertion and wound care in a simulated environment meeting core competencies. The student asks, “What are core competencies?” The nursing instructor replies, “Core competencies are: a. a trend used in nursing education to reduce attrition in prelicensure students.” b. those skills necessary for safe, competent nursing practice.” c. educational opportunities that provide remediation when student is unable to perform psychomotor skills correctly.” d. critical thinking exercises aimed to improve reading and math skills.” ANS: B Core competencies are those skills and elements that are fundamental and essential for safe, competent practice. DIF: Comprehension REF: pp. 39-40 16. A nurse realizes that a health care concern related to globalization was: a. the emergence of epidemic hepatitis A. b. the pandemic of H1N1 “swine flu.” c. reemergence of polio. d. an increase in chronic illnesses. ANS: B In 2009, there was a pandemic of H1N1 on every continent and a reemergence of Staphylococcus aureus (MRSA). DIF: Knowledge REF: pp. 47-48 17. A student nurse is preparing a presentation that requires identification of outcomes for the care of heart failure patients. Which is a correctly written outcome? a. Develop a teaching program to address physical activities that result in improved cardiac function. b. Discuss the clinical manifestations associated with Level 4 heart failure. c. List the most common pharmaceutical approaches to reduce preload in heart failure patients. d. Recognize the economic impact that recidivism has on the patient and health care facility. ANS: A Outcomes use action words, actions that nurses actually do, such as develop, plan, implement, integrate, plan, or conduct. DIF: Application REF: p. 43 18. A member of a nursing students study group comments, “I wish our instructor would just tell us the important information that we will be tested on in our course and on NCLEX®. Instead, we spend some time early in the class discussing key facts then the most of the time working through case studies, then practicing on the simulator rather than caring for ‘real’ patients.” This teaching-learning style represents: a. memorization of basic facts presented early in the lecture. b. Objective Structured Clinical Examinations (OSCE). c. peer-to-peer learning. d. practice-based competency. ANS: D Practice-based competency includes active engagement and application in real practice situations and interactive strategies such as case studies and simulation. DIF: Application REF: pp. 43-44 19. Which experience is best designed to support a nursing student’s preparation for interprofessional team participation? a. Attending a seminar on interprofessional team cooperation b. Completing a preceptorship with an advanced practice nurse c. Carrying for three patients with varying medical diagnoses d. Presenting patient information at the daily care planning meeting on a mental health unit ANS: D While interprofessional educational experiences are encouraged for all health care disciplines, Delunas and Rouse (2014) cite the importance of preparation of students for interprofessional educational experiences, and the need for regular meetings when students are engaged in learning as a member of a health care team. DIF: Application REF: pp. 47-48 20. A person interested in employment in the health care sector has less than 1 year to pursue his or her education and wants to focus on functional aspects of patient care. He/she desires to work in a long-term facility. Which type of nursing program should this person request information about? a. Bachelor’s degree in nursing (BSN) b. Licensed practical nurse (LPN) c. Associate degree in nursing d. Master’s degree in nursing ANS: B LPN programs provide basic technical bedside care and employment opportunities at hospitals, nursing homes, home care, and doctor offices. DIF: Comprehension REF: p. 52, Table 3-2 MULTIPLE RESPONSE 1. A nurse is concerned that the policy of using povidone-iodine (Betadine) to clean foot ulcers may lead to unwarranted allergic reactions and drying of surrounding tissue. A literature review is performed to determine the “best practice” related to care of foot ulcers. This nurse: (select all that apply) a. is applying evidence-based practice to the clinical setting. b. is using critical thinking to change procedures performed in the care of foot ulcers. c. is minimally educated at the master’s level and participating in research to provide cost-effective care (soap is less expensive than povidone-iodine). d. lacks clinical competence in health assessment and in application of theory to the clinical setting. e. is using information to problem-solve and ensure safe, competent care. ANS: A, B, E Critical thinking is an essential part of applying evidence-based practice—that is using research findings to guide actual practice. DIF: Analysis REF: p. 44 COMPLETION 1. The oldest, most traditional type of program that prepares a candidate for RN licensure is the hospital-based _ program. ANS: diploma The earliest training programs for nurses were hospital based and designed to meet the needs of the particular institution; these were referred to as diploma programs. DIF: Knowledge REF: p. 52 2. According to Lenburg, the use of practice-based assessments in nursing education is aimed toward the target of . ANS: competence The target that students need to meet to practice safely in today’s complex health environment is achieving critical competencies and demonstrating of practice-based skills. DIF: Comprehension REF: p. 45 Chapter 04: Nursing Licensure and Certification Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. The advanced practice nurse who is seeking information about requirements for practice in a specialized area should contact the: a. American Nurses Association (ANA). b. National League for Nursing (NLN). c. American Nurses Credentialing Center (ANCC). d. National Council of State Boards of Nursing (NCSBN). ANS: C The nurse should contact the ANCC to determine the education, experience, and examination requirements that must be met if one is to become certified. DIF: Comprehension REF: p. 63 |p. 71 2. The primary purpose of licensure for RNs is to: a. prevent others from using the title nurse. b. demonstrate a specialized body of knowledge. c. protect the public. d. enhance recognition for the profession. ANS: C Protecting the public is one of the essential purposes of the state board of nursing, which regulates licensure. DIF: Knowledge REF: p. 65 3. Nurse practice acts: a. are written and passed by legislators. b. cannot be influenced by special interest groups. c. reflect only the concerns of RNs. d. are affected by the practice of dentists. ANS: A Just as other sections of state codes are written and passed by legislators, so is the nurse practice act of each state. DIF: Knowledge REF: p. 69 4. To ensure that nursing legislation is current and is reviewed by specific dates, if a nurse practice act fails to be reviewed, it is automatically rescinded under which law? a. Nurse review act b. Sunset legislation c. Mandatory revocation d. Grandfathering ANS: B Sunset legislation may be included in a state’s nurse practice act, and this means that the act must be reviewed by a specific date; if not, it is automatically rescinded. DIF: Comprehension REF: p. 70 5. Current trends in telecommunications and increased mobility of nurses have led to the approval of a mutual recognition model of nursing regulation, in which nurses are allowed to practice in states that are compact states without obtaining a license in each state. On which website would a nurse find a list of current compact states? a. National League for Nursing (NLN) b. National Council of State Boards of Nursing (NCSBN) c. American Association of Colleges of Nursing (AACN) d. Commission on Collegiate Nursing Education (CCNE) ANS: B The NCSBN website contains this information. DIF: Knowledge REF: pp. 70-71 6. The first field of nursing to certify advanced practitioners was the field of: a. adult nurse practitioners. b. nurse-midwifery. c. clinical nurse specialist. d. nurse anesthesia. ANS: D In 1946, nurse anesthesia became the first field of nursing practice to certify advanced practitioners. DIF: Knowledge REF: pp. 71-72 7. A graduate of a nursing school in the United States plans to practice nursing in Paris, France. To request licensure to practice in Paris, the nurse: a. must contact the Graduates of Foreign Nursing Schools to complete a special examination. b. realizes that education in the United States is so generalized that he or she is eligible to practice in other countries without additional licensure. c. is required to take a language proficiency examination for the primary language of that particular country, as well as a cultural assessment test, prior to licensure. d. should contact the International Council of Nurses or the nursing regulatory board of that country. ANS: D A nurse who is interested in practicing internationally may contact the International Council of Nurses or the nursing regulatory board of the country in which he or she wishes to practice. DIF: Comprehension REF: p. 69 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. ANS: A Endorsement refers to the original program whereby a nurse who is licensed in one state can apply and seek licensure in another without undergoing repeat examination, in accordance with the nurse practice act of that state. DIF: Application REF: p. 68 9. When practicing in a compact state: a. the nurse must abide solely by the practice act of the largest state. b. patients’ rights in relation to the nurse practice act are protected by the mutual recognition model. c. the nurse must pay for a license in all states that participate in the mutual recognition model. d. the nurse must refer to the nurse practice act for the list of skills that can be performed. ANS: B Nurses who practice in a compact state are responsible for following the laws and regulations of each state in which they practice. DIF: Comprehension REF: pp. 70-71 10. When participating in a nurse licensure compact, the nurse: a. is held responsible for complying with the nursing practice laws in the state where practicing at the time care is rendered. b. must purchase a license in each state but does not retake the licensure examination. c. determines residency based on the state where educated as registered nurse. d. may practice using one license in any state or territory in the United States that recognizes the NCLEX as the source of licensure. ANS: A The nurse is accountable for practicing according to the state practice laws where patient care was provided, although disciplinary action is the responsibility of the state of the nurse’s residency. DIF: Knowledge REF: pp. 70-71 11. A new graduate from a master’s entry program in nursing announces, “I just passed my clinical nurse leader certification examination.” Certification as a clinical nurse leader: a. is granted by the state board of nursing. b. denotes minimum level of knowledge and skills to practice safely. c. allows independent nursing practice, often in primary care. d. recognizes achievement of advanced skills and knowledge. ANS: D Certification provides validation of achievement of advanced education and competence. DIF: Comprehension REF: p. 71 12. A nurse holds a license in one state but wishes to practice in a second state that is not participating in a nurse licensure compact agreement. The nurse is granted licensure on payment of a fee but does not retake the licensure examination. The nurse obtains licensure in the second state: a. by licensure and by endorsement. b. through mandatory continuing education. c. by the statutory process known as being grandfathered. d. through sunset legislation. ANS: A Licensure by endorsement allows a nurse licensed in one state to obtain licensure to practice in a second state without examination. DIF: Comprehension REF: p. 68 13. A nurse practicing in the early 1900s was awarded a permissive license. These licenses: a. were voluntary; however, a nurse who failed the examination could not use the title RN. b. required a maximum of 1 year of formalized nurse training. c. allowed nurses who did not pass the licensure examination to still practice. d. allowed nurses the choice of taking a written or oral licensure examination. ANS: A These permissive licenses permitted but did not require nurses to become registered. DIF: Comprehension REF: p. 65 14. A group of registered nurses with ADN degrees are concerned that the minimum educational standard for licensure as a registered nurse is being raised to the bachelor’s (BSN) level. After contacting the American Nurses Association, they learn they will be “grandfathered” in. Under the “grandfather clause,” nurses with associate degrees will: a. be required to complete a bridge program to earn a BSN and then be tested only on material that was not part of the ASN curriculum. b. continue to use the title “registered nurse.” c. have 10 years to obtain a BSN or the license will be revoked. d. use whatever title is established for associate degree nurses. ANS: B All ASNs licensed before the change would be “grandfathered” in, allowing them to use the title of RN. DIF: Comprehension REF: p. 63 15. Who establishes the “rules” for nursing practice? a. Individual state boards of nursing b. Employer, based on area of practice c. United States Department of Health and Human Services d. Local health officials ANS: A The State Practice Act of each state establishes the rules for practice within that state. DIF: Knowledge REF: pp. 68-69 16. A nurse is completing the degree requirements for an advanced practice role as a nurse practitioner and is concerned about certification requirements. Which statement concerning certification for advanced practice is true? a. All states require certification for all specialty roles that are identified as advanced practice. b. Nurse anesthetists and nurse-midwives are the only advanced practice role that require certification in the state nurse practice acts. c. Scope of practice remains unclear in state nurse practice acts due to the increasing number of new advanced practice roles. d. Certification is automatic when the nurse applies for an advanced practice license. ANS: A All states require evidence of certification in the specialty area, and many require periods of practice in the specialty prior to awarding certification status. DIF: Comprehension REF: p. 68 17. Nurses in Tennessee, Mississippi, and Arkansas gather for a conference related to improving quality and safety in practice and nursing education. They are awarded continuing education (CE) credit for participation and evaluation of the conference. One nurse from California states, “I need these CEs to renew my license.” The nurse from Mississippi replies, “You do not need CEs for license renewal or advance practice certification renewal.” Which statement about CEs would help these nurses? a. All states require proof of continuing education for renewal of license with the number of hours varying. b. The purpose of continuing education is to ensure competence of the workforce after graduation, but each state determines if CEs are required. c. Continuing education is required if nurses work across state lines. d. Initial licensure provides evidence of a minimum safety and competence, so it is illegal for states to require continuing education for renewal of license. ANS: B CE is important to ensure continued competency, and each state determines if CEs are mandatory for renewal and how many units are needed. DIF: Comprehension REF: p. 68 MULTIPLE RESPONSE 1. A nurse who wishes to practice in another state: (select all that apply) a. must retake the NCLEX-RN for that state. b. should determine whether the state is a compact state. c. may obtain licensure by endorsement. d. must revoke licensure in the current state because nurses cannot be licensed in more than one state concurrently. ANS: B, C If the state is a member of a compact state, that state has established an agreement with other states under which nurses are permitted to practice within the state without additional licensure. Licensure by endorsement refers to the original program whereby nurses who are licensed in one state seek licensure in another state without repeat examination. DIF: Comprehension REF: p. 68 2. Which statements concerning licensure as a registered nurse are correct? (select all that apply) a. Nurses who graduate from different types of nursing education programs are granted different types of licenses, those with a baccalaureate degree having the most expanded role. b. A nursing license cannot be revoked, only suspended. c. Each nurse practice act describes requirements for initial licensure. d. It is illegal for states to ask about the mental or physical status of an applicant. e. Students who graduate in the top 10% of their class are exempt from taking the NCLEX-RN for licensure. f. Candidates for licensure must present proof of graduation as required by the state. ANS: C, F A section of each nurse practice act describes requirements and procedures that are necessary for initial licensure. Candidates for licensure must submit evidence of graduation as defined by each state. DIF: Comprehension REF: pp. 67-68 3. A group of graduates were just notified that they had successfully passed the licensure examination. During the orientation process at the hospital, one asks, “I am looking at my license, but I don’t really know the duties performed by the board of nursing.” The staff development nurse explains that the board of nursing: (select all that apply) a. grants nursing licensure. b. constructs the licensure examination. c. assigns disciplinary action when the nurse acts in a manner that results in harm to a patient. d. members are appointed. e. conducts certification examinations for advanced practice nurses. ANS: A, C, D The board of nursing ensures that nursing licenses are granted and renewed. The board of nursing assigns disciplinary action when provisions of the nurse practice act are violated. Members are appointed. DIF: Comprehension REF: pp. 68-69 4. A nursing student is in the final term of an Associate Science of Nursing (ASN) program and is preparing for licensure. Prior to licensure the candidate must provide evidence of: (select all that apply) a. graduation from a nursing program. b. graduation from high school or high school equivalency. c. evidence of current malpractice insurance. d. evidence of plan to continue study to obtain a minimum of a BSN within 2 years. e. validation of skills competence provided by a certifying agency. ANS: A, B Candidates for licensure must provide evidence of graduation through transcripts of course work or letter from the Dean/Director of the nursing program. All candidates must show evidence of graduating from high school or earning a GED. DIF: Comprehension REF: pp. 67-68 COMPLETION 1. The primary purpose of licensure is protection of the . ANS: public DIF: Knowledge REF: p. 65 Chapter 05: Theories of Nursing Practice Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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 ANS: D Madeleine Leininger proposed the theory of cultural care diversity and universality. This theory of transcultural nursing comprises concepts involving caring and the components of a cultural care theory: diversity, universality, worldview, and ethnohistory. DIF: Comprehension REF: p. 85 2. When reading Peplau’s theory, a nurse was unable to determine the relationships among concepts. The nurse listed each concept and drew lines denoting relationships to be able to understand the effect of each element. The nurse created a: a. hypothesis. b. model. c. construct. d. variable. ANS: B A model is a group of concepts that are associated because of their relevance to a common theme. DIF: Application REF: p. 78 3. The statement, “Nursing is a caring profession that focuses on helping people be as healthy as possible,” is an example of a: a. concept. b. construct. c. philosophy. d. model. ANS: C A philosophy is the values and beliefs of the discipline. DIF: Comprehension REF: p. 79, Table 5-1 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 ANS: B Florence Nightingale investigated the effect of the environment on healing, and this serves as the foundation for nursing science. DIF: Comprehension REF: pp. 81-82 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. ANS: A In Roy’s adaptation model, when the client incurs an insult that renders him or her in need of environmental modification, the nurse will be the change agent in assisting the individual with this adaptation. DIF: Application REF: p. 79, Table 5-1 |p. 85 6. What are general explanations that scholars use to explain, predict, control, and understand commonly occurring events? a. Theories b. Constructs c. Systems d. Propositions ANS: A Theories are a group of related concepts that explain existing phenomena and predict events. Theories provide us with a frame of reference, the ability to choose concepts to study, or ideas that are within one’s practice. DIF: Comprehension REF: p. 79, Table 5-1 7. Which type of theory most often guides present nursing practice? a. Grand theory b. Middle range theory c. Developmental theory d. Values theory ANS: B Middle range theory is a nursing theory that refers to a specific population or to a specific situation, thereby making the theory easy to understand. An example is the theory of unpleasant symptoms (Lenz and Pugh), which examines symptoms that are influenced by physiologic, psychological, and situational factors as they relate to performance. DIF: Knowledge REF: p. 79 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 ANS: B Hildegard Peplau’s theory describes interpersonal relations as a nursing process. Nursing intervention in Peplau’s model focuses on reducing related incapacitating stressors through therapeutic interpersonal interaction. DIF: Application REF: pp. 83-84, Table 5-2 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 ANS: D Rogers’ science of unitary human beings, in which humans are seen as energy fields that interact constantly with the environment, is a theory in which the nurse promotes synchronicity between human beings and their universe/environment. DIF: Comprehension REF: pp. 83-84, Table 5-2 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 ANS: C In Orem’s self-care deficit theory, the nurse implements measures to help clients meet self-care needs by matching them with an appropriate supportive intervention. DIF: Application REF: pp. 83-84, Table 5-2 11. A young child is having abdominal pain, and the doctor informs the parents that a computed tomography (CT or CAT) scan of the abdomen will be ordered. The doctor tells the child, “This CAT scan won’t hurt you.” The child is visibly upset because of a fear of cats. According to Mishel’s uncertainty in illness theory, which stage of the framework is represented? a. Stimuli frame b. Appraisal stage c. Initiation of coping mechanisms d. Adaptation ANS: A In the stimuli frame, the client reacts to some stimulus in a negative manner. The nurse at this stage should listen carefully and then initiate, seek, and clarify concerns and questions. DIF: Comprehension REF: p. 81, Case Study 5-1 12. A nurse researcher determines whether findings are substantial by calculating the level of significance. Which aspect of the scientific inquiry is being conducted? a. Hypothesis b. Method c. Data collection d. Evaluation ANS: D During evaluation, results are examined with the goal of determining the relevance of outcome data in answering the hypothesis; the significance of the data and the potential for future research are also explored. DIF: Application REF: p. 77, Box 5-1 13. A nurse who has practiced on an orthopedic unit for 10 years unexpectedly becomes pregnant. At delivery the physician informs the mother, “Your baby has Alport syndrome, but then I don’t have to explain what that means with your medical background.” The mother is unfamiliar with this disease and withdraws as a coping mechanism. Which nursing theory would provide a framework to guide nursing care for this mother? a. Mishel’s uncertainty of illness b. Orem’s self-care deficit model c. Nightingale’s canons of nursing d. Levine’s conservation model ANS: A In Mishel’s uncertainty of illness theory, the core position is that uncertainty in illness must be addressed. When uncertainties are not addressed, clients’ negative perceptions will escalate and they will suffer. Nursing responsibility based on this theory consists of reframing the client’s perceived loss of control, or uncertainty, and helping the client develop new skills of assimilation and accommodation. DIF: Comprehension REF: p. 86 14. If a nurse applies Nightingale’s theory to current practice, the nurse’s first step will be to evaluate the hospital room’s air quality and, second, to: a. make certain that the volume of the television is not too loud. b. consult the dietitian to check that essential nutrients are added to meet requirements noted on MyPyramid. c. ask the client’s family to bring family photographs and bright-colored throws for the bed. d. arrange for the client to go outside, weather permitting, while keeping the room’s window blinds open. ANS: D Nightingale believed the need for light was second only to the need for fresh air. DIF: Application REF: p. 82 15. A nurse develops a new nursing theory related to stress and viability. The nurse determines the theory accounts for historical events in which soldiers suffering from the stress of inadequate clothing to protect them from the cold and lack of correspondence from home had an increased mortality related to gunshot wounds. The theory will predict gunshot victims’ need for proper clothing and letters from significant others as they serve in Iraq. Which criterion for theory acceptance is being validated? a. Inclusiveness b. Consistency c. Accuracy d. Simplicity ANS: C The accuracy of a theory is its ability to explain past occurrences while being useful in determining future outcomes. DIF: Application REF: p. 77, Box 5-2 16. 16. A nurse practicing on a unit where domestic violence is common wants to learn how to apply nursing theory to practice on this unit. She considers the interrelatedness of the constructs of Watson’s Theory of Caring and designs: a. conceptual model of caring. b. hypothesis of the impact of caring on domestic violence. c. proposition of how caring is conceptualized. d. theory of scientific inquiry. ANS: A The conceptual model demonstrate how the concepts of compassion, commitment, conscience, confidence, and competence form a theme of caring (Watson). DIF: Comprehension REF: p. 85 17. A nurse in a rehabilitation unit plans activities of daily living to prevent excessive fatigue, helps the patient dress before the family visits, assists with range of motion, and allows the patient to decide which clothes to wear during the visit. This nurse is best applying which theory to practice? a. Watson’s Theory of Caring b. Rogers’ Theory of Unitary Humans c. Levine’s Theory of Conservation d. Leininger’s Theory of Transcultural Nursing ANS: C Certain parts of all the theories can be applied; however, all the constructs of Levine’s Model of Conservation are applied, including energy conservation, structural integrity, personal integrity, and social integrity. In this situation, the nurse conserved energy by planning ADLs, conserved structural integrity through ROMs, conserved social integrity by helping patient with appearance during family visits thus improving the milieu for social visits. DIF: Application REF: p. 83, Table 5-2 18. A nurse is evaluating Levin’s Theory of Conservation to determine if it can be applied to patients in the initial phases of chemotherapy treatment. During this phase of theory acceptance, the nurse wants to determine if all the concepts of energy, structural integrity, personal integrity, and social integrity are included in the care of cancer treatment. The nurse is applying which criteria of theory acceptance? a. Inclusiveness b. Consistency c. Accuracy d. Fruitfulness ANS: A Inclusiveness asks the question, “Does the theory include all concepts related to the area of interest?” DIF: Application REF: p. 77, Box 5-2 19. A nurse is heard making this comment, “I believe human dignity is based on perceived self-worth while caring is based on perceived role in society that forms the basis of nursing practice.” This nurse is: a. demonstrating a model of human dignity. b. evaluating the relevance of Leininger’s Theory. c. applying Mishel’s Theory of Disease Uncertainty. d. making a proposition concerning the constructs of nursing practice. ANS: D A proposition is a statement that proposes the relationship between and among concepts. DIF: Application REF: p. 76 |p. 78 20. A group of nurses are interested in the how to improve teaching effectiveness for patients who have a hearing impairment and lack family involvement while hospitalized. They believe “hearing loss decreases the teaching effectiveness while hospitalized.” The group plans to evaluate teaching effectiveness using a 10-point Likert scale pre-post teaching, perform a hearing test to determine degree of hearing loss on admission, and have social work evaluate the impact of hearing impairment on patient’s ability to safely live alone prior to discharge. The group is working in which step of the scientific process? a. Hypothesis b. Method c. Results d. Evaluation ANS: B During the method step, the group decides what data will be collected to answer the question and identifies step-by-step procedures that will be used to collect these data. DIF: Application REF: p. 77, Box 5-1 MULTIPLE RESPONSE 1. Which of the following are concepts related to nursing theory? (select all that apply) a. Environment b. Health c. Nursing d. Relevance e. Comfort ANS: A, B, C, E Environment is a concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual model or theory. Health is a concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual model or theory. Nursing is a concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual model or theory. Comfort is a concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual model or theory. DIF: Comprehension REF: p. 83, Table 5-2 COMPLETION 1. The basic ingredients of theory are . ANS: concepts A theory is defined as a group of related concepts that explain existing phenomena and predict future events. DIF: Knowledge REF: p. 76 Chapter 06: Nursing Research and Evidence-Based Practice Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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. ANS: C The institutional review board (also called the human subjects committee) examines research proposals to ensure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected. DIF: Knowledge REF: p. 102 2. A nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes in order to understand the “lived experience.” These characteristics are consistent with the qualitative research method known as: a. grounded theory. b. ethnography. c. phenomenology. d. case study. ANS: C Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. DIF: Comprehension REF: p. 89 | p. 95, Table 6-2 3. The use of research to guide nursing practice is called: a. utilization. b. dissemination. c. generalizability. d. analysis. ANS: A Utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process. DIF: Comprehension REF: pp. 95-96 4. A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. This type of research design is: a. quasi-experimental. b. survey. c. case study. d. ethnography. ANS: B Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. DIF: Application REF: p. 94, Table 6-1 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 ANS: A The National Institute of Nursing Research is a federal agency that provides federal funding for health care research. DIF: Knowledge REF: p. 92 6. Which type of data analysis results in the non-numerical organization of data? a. Descriptive b. Inferential c. Qualitative d. Quantitative ANS: C Qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line in an effort to group common conceptual meanings. DIF: Comprehension REF: p. 95 7. A nurse researcher who is seeking funding for a study should identify _ of funding agencies. a. board members b. priorities c. budgets d. accreditation ANS: B The priorities of funding agencies indicate their preferences for funding; these are more likely to be funded than are studies that are not aligned with funding preferences. DIF: Comprehension REF: pp. 91-92 8. A nurse studied a community to determine if there were clients who would benefit from a hospice program if one were developed. This type of research is: a. a survey. b. quasi-experimental. c. a needs assessment method. d. a pilot study. ANS: C A needs assessment method is a study in which the researcher collects data for the purpose of estimating the needs of a group; the method is commonly used to prioritize the needs of an organization or community. DIF: Comprehension REF: p. 94, Table 6-1 9. The research hypothesis is that aromatherapy reduces stress more effectively than does acupuncture. The researcher does not identify a control group. This study would be a(n) design. a. experimental b. quasi-experimental c. survey d. meta-analysis ANS: B In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing. DIF: Comprehension REF: p. 94, Table 6-1 10. A qualitative researcher reviews data collected with a grief support group to develop a theory of how widows and widowers mourn. The researcher is using which qualitative research design? a. Phenomenology b. Grounded theory c. Case study d. Hypothesis generation ANS: B Grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose. DIF: Comprehension REF: p. 95, Table 6-2 11. Which statement about qualitative research is correct? a. Qualitative research requires less time than quantitative research because complex statistical analysis is not necessary. b. To be statistically significant, qualitative studies must consist of large, randomly selected sample sizes. c. Because qualitative studies deal with human concepts such as suffering and quality of life, results can be generalized. d. Interviews are the primary means of collecting data that enable the researcher to describe unclear phenomena. ANS: D Qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena. DIF: Comprehension REF: p. 95 12. A nurse interested in life satisfaction among patients receiving hemodialysis reviews databases and identifies relevant studies which are then statistically analyzed providing generalization through multiple studies. The nurse researcher is using which type of research? a. Quasi-experimental b. Secondary analysis c. Meta-analysis d. Survey ANS: C Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization. DIF: Comprehension REF: p. 94, Table 6-1 13. A new nurse researcher is interested in tracing the history of nursing research. The researcher learns that nursing research began with: a. the work of Florence Nightingale during the Crimean War. b. studies between 1900 and 1940 following Nightingale’s work. c. studies to improve patient care by doctorally prepared nurses. d. studies based on the naturalistic paradigm. ANS: A Nursing research began with the Nightingale during the Crimean War—more can be read in Chapter 1 of this text. DIF: Comprehension REF: p. 91 14. Nurses on a busy medical schedule want to reduce documentation time and improve order entry. Additionally, patient records from previous visits are often incomplete or do not include care from other providers. To improve patient care, a taskforce suggests using an Electronic Medical Record for 1 month to determine whether this provides the desired outcomes. This unit is participating in which type of study? a. Ethnography b. Pilot c. Secondary data analysis d. Phenomenology ANS: B Pilot studies are small-scale studies often referred to as feasibility studies to determine if a larger more sophisticated research study is needed. DIF: Comprehension REF: p. 89 |p. 95 15. A researcher is interested in learning if elderly persons perceive their health to be satisfactory even with comorbidities and chronic illness. A large multisite assistive living facility will be the site. The researcher lists residents in alphabetical order and chooses every third person on the list. To ensure improved generalizability, the researcher is using: a. triangulation. b. randomization. c. informed consent. d. a meta-analysis approach. ANS: B Randomization is a method of choosing subjects based on chance alone. DIF: Comprehension REF: p. 89 16. A researcher conducts a survey to determine the perceived health status of elderly persons living independently at home. The same subjects participate in a telephone call in which they describe the lived experience of living with chronic illness. When writing up the research study, the nurse would describe using: a. a control group. b. triangulation. c. a pilot study. d. secondary data analysis. ANS: B Triangulation is the use of a variety of methods to collect data on the same concept—in this situation, quantitative research through survey and qualitative research through phenomenology. DIF: Comprehension REF: p. 89|p. 95 17. A nurse is interested in learning how reminiscence therapy can improve memory in cognitively intact persons over the age of 65 years. Findings from three groups are compared. Group 1 receives music therapy, Group 2 receives life review therapy, and Group 3 does not receive therapy, but data are collected from all three groups and compared. Group 3 is known as the: a. pilot study. b. survey. c. needs assessment. d. control group. ANS: D A control group is a set subject in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. DIF: Comprehension REF: p. 89 18. A nurse is reading an abstract about a study related to Rocky Mountain Spotted Fever. The purpose is stated as follows: “To examine the generalizability of two randomized placebo-controlled clinical trials in patients with Rocky Mountain Spotted Fever to determine whether steroid therapy resulted in the positive outcomes.” The nurse knows generalizability refers to the: a. conclusion that findings can be generalized from the sample to the entire population. b. fact that the group of steroids used are from the same organic compounds. c. possibility that the subjects were carefully selected and that outside influence is thus suspected. d. fact that the type of bacteria carried by ticks is universal. ANS: A Generalizability is the deduction that findings from one study can be applied to other populations not involved in the actual research. DIF: Comprehension REF: p. 89 19. A nurse is interested in studying the rituals of a tribe living in remote areas of Africa. The researcher is accepted into the tribe and observes firsthand the rituals practiced. Themes were analyzed to arrive at a description of the culture including rituals. The nurse is practicing which type of research? a. Qualitative, Ethnography b. Qualitative, Phenomenology c. Quantitative, Quasi-experimental d. Quantitative, Secondary data analysis ANS: A Ethnography is a method used to study phenomena from a cultural perspective. Ethnographers spend time in the cultural setting with the research participants to observe and better understand their experience. DIF: Comprehension REF: p. 89 |p. 95, Table 6-2 MULTIPLE RESPONSE 1. The informed consent documents must include: (select all that apply) a. an explanation of potential risks and benefits to participants in the study. b. medical terminology rather than lay terms to prevent misunderstanding of the study. c. a statement on how the anonymity and confidentiality of participants are protected. d. explanation of the cost of the study. e. details on how to contact the investigator. ANS: A, C, E Informed consent explains the study to the participants and assures them of their rights, including their right to refuse to participate or to withdraw from the study. The informed consent must include protection of anonymity and confidentiality, voluntary participation, compensation, and alternative treatment. The informed consent must include specific information on how to contact the investigator. DIF: Comprehension REF: p. 102 2. A researcher is interested in quality of life and after an extensive literature review quantitatively integrates data from identified studies and describes the findings. This researcher is using which approach? (select all that apply) a. Survey b. Triangulation c. Meta-analysis d. State of the science summary e. Quasi-experimental design ANS: C, D Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. State of the science summary is a merging of findings from several studies that explored the same topic. DIF: Comprehension REF: p. 94, Table 6-1 3. A researcher seeks funding from an agency that limits studies to quantitative research. The researcher can select from which of the following study designs? (select all that apply) a. Survey b. Grounded theory c. Phenomenology d. Needs assessment e. Experimental ANS: A, D, E Surveys collect demographics, social characteristics, behavioral patterns, and information bases. Needs assessments are used to determine what is most beneficial to aggregates. The experimental method establishes cause-and-effect relationships while also testing relationships. DIF: Comprehension REF: p. 61, Table 6-1 COMPLETION 1. Development and validation of the body of knowledge and foundation on which practice is based is called . ANS: research Research refines and enhances new and existing knowledge and provides accountability for nursing practice. DIF: Knowledge REF: p. 90 Chapter 07: Paying for Health Care in America: Rising Costs and Challenges Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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. ANS: A DRGs are used in reimbursement for health care services based on a predetermined fixed price per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a diagnostic grouping on the basis of his or her primary diagnosis at hospital admission. Medicare limits total payment to the hospital to the amount pre-established for that DRG. DIF: Comprehension REF: p. 3 |pp. 9-10 |p. 106 | pp. 108-109 2. The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a nurse. a. case management b. quality assurance c. utilization review d. cost-control ANS: C Hospital-based utilization review nurses review medical records to determine the most appropriate DRG for clients. Financial gains can be made through careful diagnosis of clients according to their highest potential DRG classification. DIF: Knowledge REF: p. 109 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. ANS: B Hospitals face a strong financial incentive from the DRG reimbursement system to reduce the client’s length of stay and minimize procedures performed. If hospital costs exceed the DRG payment for a client’s treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. DIF: Comprehension REF: p. 109 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. ANS: C The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor. DIF: Comprehension REF: p. 111 5. Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as: a. charity. b. cost shifting. c. price sharing. d. governmental reimbursement. ANS: B Cost shifting occurs when providers increase their charges against households and public and private insurers who pay for their own care while making some contribution to the care of the uninsured population. DIF: Comprehension REF: p. 111 6. A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement? a. Health maintenance organization b. Preferred provider organization c. Fee-for-service arrangement d. Philanthropic agency ANS: B A preferred provider organization is an arrangement by which the member pays a premium for a fixed percentage of expense coverage. This method includes a required deductible and a copayment. The member may select a physician but pays less for physicians and facilities on the plan’s preferred list. DIF: Comprehension REF: p. 110, Table 7-2 7. In the triad of health care, which would be considered the third-party payer? a. Client b. Health care provider c. Insurance company d. Government agency that sets reimbursement rules for services ANS: C The third-party payer is an organization other than the client and the supplier (hospital or physician), such as an insurance company, that assumes responsibility for payment of health care charges. DIF: Knowledge REF: p. 107 |p. 113 8. A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a payment system. a. prospective b. retrospective c. diagnosis-related group d. capitated ANS: B A retrospective payment system is a method of reimbursing health care providers (such as physicians and hospitals) in which professional services are rendered and charges are billed on the basis of each service provided; this is also known as a fee-for-service payment system. DIF: Comprehension REF: p. 107| p. 110, Table 7-2 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. ANS: B Since 1983, if hospital costs exceed the DRG payment for a client’s treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Hospitals face strong financial incentives to reduce the client’s length of stay and minimize procedures performed. DIF: Comprehension REF: p. 106| pp. 108-109 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. ANS: C Even with improved access as compared with the uninsured, Medicaid recipients are not as likely to obtain needed health services. The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor. DIF: Comprehension REF: pp. 110-111 11. A client who is reading a newspaper asks, “This article about health care states that many providers of health care lack effectiveness. What is the difference between effectiveness and efficiency?” The nurse explains that: a. effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome. b. effective refers to competence in clinical practice and efficiency describes quick completion of the task. c. efficiency means wasting and meeting a minimum standard and effectiveness refers to taking all the time needed to exceed expectations. d. efficiency refers to speed and effectiveness refers to the usefulness of the implementation. ANS: A Efficiency means using the right combination of resources—energy, time, and money—to accomplish a task, and effectiveness means doing the right thing right in health care. DIF: Comprehension REF: p. 115 12. A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services? a. Prospective payment system b. Retrospective payment system c. Single-payer system d. Capitation ANS: D Capitation is a method of reimbursing providers (usually, primary care providers such as physicians or nurse practitioners) in which the insurance company pays the provider a set amount of money each month to provide a defined set of health care services under this plan. Payment is generally received as a per-member–per-month payment. Defined health care services generally include preventive, diagnostic, and treatment services. DIF: Comprehension REF: p. 106 13. In February 2010, Congress passed legislation to support universal health care for all Americans. At a local health fair, an individual asks about the difference between universal health care and a single payer system. The nurse explains the difference is that: a. with universal health, one universal payer, usually the government, pays all expenses for health care. b. single-payer systems offer health care only to eligible persons based on income. c. single-payer systems rely on insurance companies to pay predetermined fees for services. d. with universal health, one payer is responsible for all health care costs, providing health care to all citizens. ANS: D Universal health has one payer (usually the government) and provides health care for all citizens. DIF: Comprehension REF: p. 107 |p. 113 14. An elderly person, age 80, is finding it difficult to live alone and the family is considering long-term care. The elderly person is reasonably healthy, with only normal aging declines, and maintains a healthy appetite. All medications are administered orally and require only minimal assistance. She is financially secure with an income based on retirement from both the military and factory from her deceased husband and herself. The family contacts long-term care and is told that, based on this patient’s information: a. Medicare will cover the cost of stay since skilled services are required. b. Medicaid is only for families with dependent children. c. Medicare will pay for home health services should these additional services meet the needs of the individual. d. Medicare will pay regardless of household income or financial status for nursing home care. ANS: C Medicare does cover home health care. DIF: Comprehension REF: p. 113 15. Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act (PPACA) based on religious beliefs that prohibit circumcision and blood transfusions. These individuals believe the PPACA is unconstitutional because it: a. mandates that all U.S. and legal residents must secure health insurance. b. replaces current Medicare and Medicaid plans. c. requires all citizens to participate in offered preventive services. d. prohibits use of health practices outside of Western medicine. ANS: A The PPACA is a type of national health insurance program to provide funding for U.S. citizens and legal residents to secure health insurance beyond the current programs such as Medicare and Medicaid. DIF: Comprehension REF: p. 106 |p. 110, Table 7-2 16. A nurse is newly employed by a state-owned hospital that provides health care insurance requiring a deductible paid by the employee with the majority of the premium cost covered by the employer. The insurance provided to the nurse is: a. private health insurance. b. a federal insurances program known as PPACA. c. state-subsidized Medicaid insurance. d. single-payer system coverage. ANS: A Private health insurance is a method for individuals to maintain insurance coverage for health care costs through a contract with a health insurance company that agrees to pay all or a portion of the cost of a set of defined health care services and is typically provided through an individual’s employer with a portion of the cost paid by the employer and a portion paid by the employee. DIF: Comprehension REF: p. 106 |p. 113 17. Health care is one of the major stories in newspaper and television and a group of nurses are interested in how the economy impacts their nursing practice. The group critiques the relationship between contemporary economic trends and professional nursing practice and finds: a. the implementation of the DRG system led to the nursing shortage since cost of nursing care is not billed. b. nursing care is focused on technologically advanced acute care rather than preventive, patient-centered care. c. with pay for performance, nurses have a significant effect on the quality of patient outcomes by reducing errors and providing care based on best practices. d. economic issues have little or no impact on nursing practice. ANS: C Pay for performance, where providers are reimbursed based on the quality of care, gives nurses an opportunity to reduce costs and adopt practices that improve quality of care. DIF: Comprehension REF: pp. 113-114 18. A patient is eligible to change health care providers and insurance and asks, “I am interested in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would support these activities rather than just pay for services when I am sick”? Which, if any, health insurance plan would best meet the needs of this patient? a. Health Maintenance Organization (HMO). b. Fee for Service. c. Preferred Provider Organization (PPO). d. None, because health insurance plans currently cover only disease management, not preventive care. ANS: A HMOs encourage preventive care. DIF: Comprehension REF: p. 110, Table 7-2 19. A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women’s health specialist because the primary care physician did not order the referral or the mammogram. Which type of insurance plan adheres to this type of payment system? a. Fee for Service b. Health Maintenance Organization (HMO) c. Preferred Provider Organization (PPO) d. Point of Service (POS) ANS: B HMOs require patients to select a primary care physician approved by the HMO who then must refer or order any test/diagnostic procedures before payment is approved or preapproval must be sought. DIF: Comprehension REF: p. 110, Table 7-2 20. A patient wants to reduce health care costs by being a model for making wise decisions that both promote health and reduce cost. Which statement by the patient would indicate a need for further teaching? a. “I will ask for the brand name drug Tylenol rather than acetaminophen since it works better and I won’t be sick as long.” b. “I looked up urinary tract infection prevention on the Internet.” c. “I had my weight, body fat, and blood sugar measured at a local health fair.” d. “My allergies are really bothering me. I spoke to the pharmacist, who recommended an over-the-counter antihistamine.” ANS: A Ways to reduce health care costs as a consumer include choosing generic drugs whenever possible. DIF: Analysis REF: pp. 115-116 21. A nurse is very interested in learning more about health care economics and how she can use that knowledge to become a better patient advocate. She comments, “Nurses should not only deliver care one day at a time in one facility but should coordinate patient care as they move from acute care to rehabilitation to home care.” This nurse would be a candidate for which nursing role? a. Disease management program (DMP) for chronic illnesses b. A hospital-based utilization management nurse who reviews medical records to determine the most appropriate DRG for patients c. Case management d. Reviewer for Managed Care Organization ANS: C Case management offers nurses the opportunity to demonstrate cost-effectiveness by coordinating patient care at the appropriate level of care across the continuum of care. Patient advocacy and understanding current health care economics are critical to this role. DIF: Comprehension REF: pp. 108-109 MULTIPLE RESPONSE 1. A nurse who speaks at a health fair states that current attempts to increase efficiency of health care include: (select all that apply) a. an increase in acute care, so that specialized care can be provided. b. the growing use of outpatient services. c. shifting toward health promotion and prevention. d. allowing physicians to control health care decision making. e. the use of technology to educate the public about cost-effective measures. ANS: B, C, E Economic forces are motivating the shift toward providing more services and procedures in outpatient settings. Economic forces are motivating the shift toward a model of health promotion and preventive. The Internet can inform and educate consumers (or clients) about how to access health care educational resources more effectively. DIF: Analysis REF: p. 106 |p. 115 2. Medicare would be responsible for: (select all that apply) a. a hospital stay following a total knee replacement for a 70-year-old client. b. nursing home cost for a 67-year-old adult receiving hemodialysis. c. rehabilitation care costs for a 24-year-old client with a broken femur resulting from a fall at work. d. prescription cost for a young mother who meets eligibility for Aid to Families with Dependent Children (AFDC). e. home health services to administer heparin to a 27-year-old truck driver following a thrombus. ANS: A, B Medicare coverage is based on age and Part A covers inpatient hospital services. Medicare eligibility is based on age and disability with hemodialysis resulting from chronic renal failure classified as a disability. DIF: Comprehension REF: p. 110, Table 7-2 COMPLETION 1. The largest single payer of hospital charges in the United States is . ANS: Medicare Medicare is the largest health insurance program; it covers the disabled persons with end-stage renal disease, and persons 65 years of age and older who qualify for Social Security. Since enactment of this program in 1965, the population covered by Medicare has doubled. DIF: Knowledge REF: p. 113 2. A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer. The surgeon removed the left kidney. Medicare will no longer pay for preventable medical errors known as . ANS: never events Medicare identified 28 medical errors that were preventable and with serious consequences for which they will no longer pay. These errors are called never events. DIF: Knowledge REF: p. 114 3. The type of insurance that shifts the largest percentage of costs for goods and services to employees and consumers is insurance. ANS: private Private insurance shifts a more costs to employees and consumers than does any other type of insurance. DIF: Knowledge REF: p. 107 Chapter 08: Legal Issues in Nursing and Health Care Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client is an immigrant and is uninsured. Which act would prevent the client from being transferred to another facility? a. Emergency Medical Treatment and Active Labor Law b. Health Insurance Portability and Accountability Act c. Patient Self-Determination Act d. The Patient Safety and Quality Improvement Act ANS: A The Emergency Medical Treatment and Active Labor Law is a federal statute that was enacted in 1986 to prohibit the transfer of unstable clients, including women in labor, from one facility to another. This law also prohibits refusal of care for indigent and uninsured clients who seek medical assistance in the emergency department. DIF: Comprehension REF: p. 123 2. A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with: a. negligence. b. assault. c. defamation of character. d. tort. ANS: A Negligence is defined as failure to act in a reasonable and prudent manner. The most frequent allegations of nursing negligence include failure to ensure client safety, improper treatment, failure to monitor the client and report significant findings, medication errors, and failure to follow the agency’s policies and procedures. DIF: Comprehension REF: p. 120|p. 132 3. A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse completes the following interventions: places the client on the examining table, completes a thorough history and physical, covers the client with a sheet, places the call button within reach, and goes out in the hall to speak with the client’s physician. The client tries to get up to speak with his family and falls, sustaining a hematoma on the head and a broken hip. The nurse’s actions reflect: a. invasion of privacy. b. libel. c. slander. d. negligence. ANS: D The nurse is failing to ensure client safety after medication administration; this is defined as negligence. DIF: Comprehension REF: p. 120|p. 132 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 ANS: C Failing to report elder abuse can lead to penalty of fine or imprisonment. DIF: Comprehension REF: p. 150 5. When differentiating between slander and libel, the nurse knows that libel: a. results from defamation caused by subjective comments written in the nurse’s notes. b. results from negative subjective comments made to those who are not providing care. c. occurs when the nurse verbally describes to the oncoming nurse assigned to the client objective data that place the client in a negative light. d. consists of repeating prejudiced comments made by the primary caregiver to a neighbor at the local supermarket. ANS: A Libel is defined as comments that are written about a person that are defaming. Nurses may be subject to a charge of libel for subjective comments meant to denigrate the client that are placed in the medical record or in other written materials read by others. DIF: Comprehension REF: p. 149 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. ANS: B The information that constitutes informed consent for the client includes the nature of the therapy or procedure, expected benefits and outcomes of the therapy or procedure, potential risks of the therapy or procedure, alternative therapies to the intended procedure and their risks and benefits, and risks of not having the procedure. DIF: Comprehension REF: p. 152 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. ANS: C The nurse must articulate to the client the dangers associated with leaving the facility if the primary provider is not present. The nurse’s notes on this form should reflect the specific advice given to the client, which should include the fact that leaving the facility could aggravate the current condition and complicate future care, result in permanent physical or mental impairment or disability, or result in complications that can cause death. DIF: Application REF: p. 93 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. ANS: D A written physician’s order that is timed and dated is required for the use of restraints. Renewal of orders must be accompanied by evidence of medical evaluation and nursing reassessment. DIF: Comprehension REF: p. 155 9. When the client is unable to make medical decisions for himself or herself, authorization that allows another person to make these decisions is called: a. living will. b. durable power of attorney. c. informed consent. d. immunity. ANS: B Durable power of attorney involves preselection by the client of a person who has been authorized legally to make health care decisions once the client becomes incompetent to do so. Several states have enacted a Uniform Durable Power of Attorney Act, which sanctions a durable power of attorney for health care. DIF: Knowledge REF: p. 152 10. All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a living will or a durable power of attorney. This act is known as the: a. Emergency Treatment and Active Labor Law. b. Americans with Disabilities Act. c. Uniform Health Care Decisions Act. d. doctrine of res ipsa loquitur. ANS: C The Uniform Health Care Decisions Act of 1993 is a federal statute that was established to support individuals in expressing their preferences about medical treatment and making decisions about end-of-life care. DIF: Comprehension REF: p. 152 11. A nurse who functions in the role of team leader can be held negligent for matters involving: a. inadequate training. b. lack of development of proper policies and procedures. c. failure to discipline unsafe workers. d. delegation of client care tasks. ANS: D Delegation of client care tasks falls within the role of the team leader, and inappropriate delegation of client care tasks could result in negligence. Team leaders, charge nurses, and managers are held to the standard of care of the reasonably prudent nurse employed in that role. DIF: Comprehension REF: p. 144 12. Although a hospital reversed all charges when a client was the victim of wrong site surgery, the court awarded the client $1.5 million. The client was able to return to work in 6 weeks and had no permanent damages. This monetary compensation is termed: a. res ipsa loquitur. b. punitive damages. c. vicarious liability. d. immunity. ANS: B Punitive damages are monetary compensation to an injured client that is greater than amount of loss. DIF: Application REF: p. 120 |p. 135 13. A physician orders a drug for a patient with a known allergy resulting in anaphylactic shock. The nurse: a. realizes that disclosure of the error will result in more severe ramifications for the agency than if the negligence is discovered by the patient or family. b. should disclose the occurrence before speaking with the physician who ordered the drug or with hospital management. c. recognizes disclosure as an essential component of the national patient safety movement. d. should report the occurrence to the patient’s insurance company to decrease patient costs. ANS: C The National Quality Forum identified the process of disclosure as a key element of the national patient safety movement. DIF: Application REF: p. 139 14. A nurse is charged with battery after helping an invalid patient back to bed and not calling for help due to a reduced staffing level. The patient sustained excessive bruising, sore joints, and extended stay. In this case, the: a. patient is the plaintiff. b. nurse can be charged with forcefully restraining the patient without orders. c. nurse is accountable due to the decreased level of staffing. d. charge of invasion of privacy may be withheld. ANS: A The complaining person in a lawsuit is the plaintiff. DIF: Application REF: p. 120 15. A nurse working in a privately owned hospital is charged with a negligent act after failing to check laboratory reports prior to giving a dose of digoxin (Lanoxin) resulting in the patient’s condition becoming critical due to decreased cardiac output and falling leading to a broken hip and concussion. A nurse is brought in who testifies that a professional with the knowledge and skill of an RN should understand that, before administering this drug, potassium level and pulse level is always checked to prevent such an occurrence. The nurse’s testimony as to what constitutes reasonable care is based on: a. the legal definition of standard of care. b. the legal definition of the informed consent process. c. the doctrine of res ipsa loquitur. d. governmental immunity. ANS: A Standard of care is the legal criteria against which the nurse’s (and physician’s) conduct is compared to determine whether a negligent act or malpractice occurred. Nurses are specialists in hospital care who, in the final analysis, hold the well-being—in some instances, the very lives—of patients in their hands. DIF: Comprehension REF: p. 120 16. On a nursing unit all assigned breaks including lunch/dinner breaks are assigned at the beginning of the shift. A nurse caring for a patient with anemia and heart failure prepares to hang a unit of packed red blood cells and realizes her break is in 5 minutes. She decides it is not necessary to have another nurse check the blood against the patient’s information since the patient’s blood type is O+ which she incorrectly remembered to be the universal donor. She hangs the blood, noting the patient is “reading and vital signs normal.” She leaves the floor for her break and does not report leaving or ask anyone to perform required vital signs. Upon returning she meets a family friend who is visiting and time “just flies.” She returns to the patient’s room after admitting a new patient. The patient is hypotensive and color is cyanotic and anxious. She reports the findings to the charge nurse, who then contacts the physician. A blood reaction occurrence is noted. The nurse providing care is charged: a. with comparative negligence. b. with a preventable adverse event. c. with criminal negligence. d. under the doctrine of res ipsa loquitur. ANS: C In this case, criminal negligence charges would be based on “reckless and wanton” disregard for the safety, well-being, or life of an individual; behavior that demonstrates a complete disregard for another, such that death is likely in the transfusion reaction. Type “O” is the universal donor rather than universal recipient; however, regardless of blood type, policy and procedures for assessing vital signs and patient status during blood transfusion must be followed. DIF: Comprehension REF: p. 120|p. 136 17. A physician shares with the patient’s family that, while a central line was being inserted, the patient’s lungs were inadvertently punctured, which required oxygen administration. The physician also explains that a chest x-ray indicated the lung remained intact and no additional treatment was required. The physician’s role in this instance is based on the legal principle of: a. comparative negligence. b. gross negligence. c. disclosure. d. the Emergency Medical Treatment and Active Labor Act (EMTALA). ANS: C Disclosure is a process in which the patient’s primary provider (physician or advanced practice nurse) gives the patient, and when applicable, family members, complete information about unanticipated adverse outcomes of treatment and care. DIF: Comprehension REF: p. 120| p. 139 18. A nurse is assigned to a unit other than the one she is normally assigned due to increased census on the alternate unit. She is assigned to care for seven patients and participates in walking rounds where the patient’s condition and needs are discussed between oncoming and off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall from her pocket, which contain the above information that contains patient sensitive data. The liabilities arising from this incident would be covered under: a. the Health Insurance Portability and Accountability Act. b. the ANA Scope and Practice Act. c. affirmative duty failing to question order. d. personal liability with floating and cross-training. ANS: A HIPAA protects patient information and ensures confidentiality of data. DIF: Analysis REF: p. 125 MULTIPLE RESPONSE 1. Which types of abuse are the nurse required to report or be subject to fines and imprisonment for not reporting? (select all that apply) a. Animal b. Child c. Alcohol d. Infant e. Emotional ANS: B, D State laws have been created as a result of the 1973 Child Abuse Prevention and Treatment Act. These laws dictate that health professionals must report infant and child abuse and specified communicable diseases. Failure by the nurse to comply can result in fines and/or imprisonment. DIF: Comprehension REF: p. 130 2. A patient asks, “What is an advance directive?” The nurse explains that examples of advance directives are: (select all that apply) a. preserving cord blood for possible future needs of a child. b. providing instructions that life-sustaining medical procedures should be withheld in the event of a terminal situation. c. giving someone the legal right to act on one’s behalf when one becomes incapacitated. d. completing hospital admission paperwork before being admitted to the hospital. ANS: B, C Advance directives document an individual’s desires regarding end-of-life care. These wishes are generally stated through the execution of a formal document known as the living will. Right-to-die statutes vary from state to state; therefore, nurses must become familiar with their state-specific statute. DIF: Analysis REF: p. 120|p. 151 3. A nurse learns in orientation that an incident report does not “blame” anyone but concisely documents the events leading up to an occurrence. Which events would warrant completion of an incident report? (select all that apply) a. The client is crying and distraught when he learns of a diagnosis of cancer. b. An intravenous antibiotic given preoperatively does not infuse because of a faulty pump. c. The nurse is unable to carry out orders written by the specialist because of illegibility. d. A client falls while in the shower, although she was told not to get up alone. e. The registered nurse is not available to complete the preoperative checklist. ANS: B, C, D, E Nurses are legally bound to report critical incidents to their nurse managers, agency administration, and risk manager through a formal intra-agency document generally titled the “incident report.” Circumstances under which an incident report should be filed include malfunction or failure of medical equipment. DIF: Analysis REF: p. 146 Chapter 09: Ethical and Bioethical Issues in Nursing and Health Care Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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. ANS: C Nursing ethics is a system of principles intended to guide the actions of the nurse in his or her relationships with clients, clients’ family members, other health care providers, policymakers, and society as a whole. A nurse must make an attempt to understand what values are inherent in the situation. DIF: Knowledge REF: p. 164 2. A family requests that no additional heroic measures be instituted for their terminally ill mother who has advance directives in place. The nurse respects this decision in keeping with the principle of: a. accountability. b. autonomy. c. nonmaleficence. d. veracity. ANS: B Autonomy is the principle of respect for the individual person. Within the concept of autonomy, people are free to form their own judgments and perform whatever actions they choose. They are self-determining agents who are entitled to decide their own destiny. DIF: Comprehension REF: p. 4 |pp. 169-170, Table 9-1 3. An older adult client is comatose and had one electroencephalogram that indicated no activity. The daughter is very distraught and notices her mother’s hand moves when she is talking to her. The daughter asks the nurse, “Is mother responding to my voice?” The nurse, attempting to console the daughter, knows the movement was involuntary but states, “It does appear she did.” The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Deontology ANS: B Veracity is the principle of telling the truth in a given situation. DIF: Comprehension REF: p. 171 4. In attempting to decide which services should be offered to a community, the public health nurse decides to implement hypertension screening and treatment because most of the residents are hypertensive. This decision is based on the principle of: a. veracity. b. values. c. utilitarianism. d. autonomy. ANS: C Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. On the basis of this principle, an attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the situation. DIF: Application REF: p. 162 |p. 169 5. A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of his or her own values as they relate to this issue. The nurse must: a. know his or her own values and how these values relate to beliefs and the philosophy of nursing. b. rid the impurities in his or her value system. c. ignore his or her own values. d. realize that values do not change and that they cannot be influenced by others. ANS: A Nurses must make a deliberate effort to recognize their own values and must learn to consider and respect the values of others. Health care decisions are seldom made independently of other people. Decisions are made with the client, the family, other nurses, and other health care providers. DIF: Application REF: p. 167 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. ANS: A The first step in the situational assessment procedure is to find out the technical and scientific facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and opinions. Assessment can be applied to all areas of patient care, including ethics. Trying to understand the full picture of a situation is time consuming and requires examination from many different perspectives, but it is worth the time and effort. DIF: Comprehension REF: p. 172, Box 9-3 7. A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were associated with a survey of college sophomores. The researcher was applying the principles of: a. beneficence. b. human dignity. c. justice. d. human rights. ANS: A Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their good. DIF: Comprehension REF: p. 170 8. The physician who insists on providing treatment in spite of the client’s wishes because he “knows best” is reflecting: a. autonomy. b. beneficence. c. justice. d. paternalism. ANS: D Paternalism is an action and an attitude wherein the provider tries to act on behalf of the client and believes that his or her actions are justified because of a commitment to act in the best interest of the client. Paternalism is a reflection of the “father knows best” way of thinking. DIF: Comprehension REF: pp. 175-176 9. The nurse who admits making a medication error and immediately files an incident report is demonstrating: a. accountability. b. individuality. c. an injustice. d. values clarification. ANS: A Accountability is an ethical duty that states that one should be answerable legally, morally, ethically, or socially for one’s actions. DIF: Comprehension REF: p. 162 |pp. 176-177 10. Three illegal immigrants with no health insurance or money sustained life-threatening injuries during an automobile accident. Two of these individuals had head trauma and lacerated internal organs. The decision was made to provide extended care in the trauma center after emergency surgery was performed to save their lives. The third individual received only minor injuries, which were treated in the emergency department. The care of the two critical clients was based on the ethical principle of: a. utilitarianism. b. deontology. c. autonomy. d. veracity. ANS: B Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and that compel them to do what is right. Deontological theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. DIF: Comprehension REF: p. 162 |p. 170 11. A 13-year-old female is brought to the family planning clinic by her enraged father, who has just learned that she is pregnant. The pregnant client states, “I want to have this baby and give it up for adoption.” However, the father is adamant that she will disgrace the family and demands that the health care providers tell his daughter that she has a physical condition that would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a conflict that involves the ethical principle of: a. deontology. b. veracity. c. autonomy. d. beneficence. ANS: B Veracity is telling the truth in personal communication as a moral and ethical requirement. DIF: Comprehension REF: p. 170 12. During a seminar on ethics, the educator realizes that more information is needed when a participant describes which situation as a violation of the ethical principle of autonomy? a. An older person with advanced stages of Alzheimer’s disease is denied the right to ambulate in the hallway. b. A mentally competent adult refuses medical treatment for the autoimmune disease lupus erythematosus, stating that this condition reflects the will of a higher power. c. A mentally competent visitor fell during visiting hours but refused to be examined by the physician on call. d. A mentally competent adult with a broken wrist refuses to be given a local anesthetic prior to a procedure. ANS: A Autonomy is defined as personal freedom, the right to make choices. However, in this case, the patient is not able to be fully informed so they can clearly understand the choices being offered. DIF: Application REF: p. 170 13. A nurse who is infected with human immunodeficiency virus (HIV) while working in the operating room seeks revenge by deliberately placing clients at risk by not adhering to universal precautions. This nurse is violating the ethical principle of: a. veracity. b. beneficence. c. nonmaleficence. d. autonomy. ANS: C Nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. The nurse is definitely violating this principle through her actions. DIF: Comprehension REF: p. 170 14. A client and her husband used in vitro fertilization to become pregnant. The unused sperm was frozen so the couple could have more children later. The husband is killed while in combat, and the client journals her choices and the possible ramifications. She comes to the fertility clinic after looking at the situation from many perspectives and after considering many alternatives. She asks that the sperm be destroyed because her husband’s faith prohibited remarrying, and allowing another person to use the sperm would conflict with her late husband’s beliefs. The nurse realizes that: a. the client is in the second step of ethical decision making and that the client’s value system is influencing her choices of alternative actions. b. a logical line of reasoning has led to validation of the decision to destroy the husband’s sperm. c. the client has not been able to navigate the complicated issues inherent in this situation. d. a rational decision was reached that was based on reflection and on the value systems of the wife and the husband. ANS: D After completing all steps in the situation assessment procedure, the client is now ready to justify her selection. In this phase, the person will specify reasons for the action, will clearly present the ethical basis for these reasons, will understand the shortcomings of the justification, and will anticipate objections to the justification. DIF: Analysis REF: p. 172 15. A client is in extreme pain after he was involved in a motor vehicle accident, and morphine has been ordered every hour for pain. The nurse injects saline into the client’s IV line and takes the morphine for herself. The nurse is violating which principle of ethics? a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas ANS: C Beneficence is providing benefit to others by promoting their good. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the client’s pain medication and substituting saline, the nurse did harm, not good, for this client. DIF: Comprehension REF: p. 170 16. The Health Care Reform Act provides insurance for all U.S. citizens and legal residents presenting far-reaching ethical considerations related to diverse individual patient health care beliefs for those delivering nursing care. Nurses must consider their civil rights under the rights of conscience and how new health care agendas such as the Patient Protection and Affordable Care Act (PPACA) could affect their practice in situations that may conflict with their own belief system. Today’s practicing nurse must: a. remember it is one’s professional duty to render patient-centered care—even when it is in direct conflict with the nurse’s own beliefs—or be held liable for withholding treatment. b. consider whether the right to act according to one’s inner beliefs will continue to be permissible when federal health insurance becomes fully enacted. c. discuss with the patient and family different options in hopes they will accept the nurse’s health care beliefs. d. suggest to the hospital administration that they not accept federal funding to prevent controversial health practices. ANS: B With federal funding, many controversial health care services will be covered and provided as part of patient care when desired by the patient; therefore, whether a nurse has autonomy to refuse to provide care may not be as clear even when one might request another patient. DIF: Application REF: pp. 168-169 17. A nurse is assigned to a unit where 95% of all patients required total care. Most days the assistive personnel are able to complete their assignments and provide high-quality care. A patient returning from a procedure was somehow “skipped” when daily baths were performed and requests that her care now be provided. The nurse discovers the bed is rumpled and damp. The RN joins with some other staff to bathe the patient, change the bed, and help make the patient comfortable. These staff members are demonstrating: a. altruism. b. veracity. c. autonomy. d. whistle-blowing. ANS: A Altruism is concern for the welfare of others, including willingness to help others when they are unable to get their assignments completed to ensure that the patient receives high-quality care. DIF: Comprehension REF: pp. 168-169, Table 9-1 18. In which case does the nurse act as “whistle-blower”? a. One staff member on the unit covers for another nurse, who leaves the premises to purchase illegal substances and signals her friend when she must return. b. The nurse reports that another nurse is taking medications out of stock medicine for herself or himself. c. A nurse informs respiratory therapy that a patient is now due a treatment. d. The nurse delegating care to unlicensed assistive personnel makes rounds to ensure all care was rendered properly. ANS: B Whistle-blowing is the reporting of acts or situations that violate the principle of beneficence such as a chemical impairment, negligence, abusiveness, incompetence, or cruelty. DIF: Application REF: pp. 176-177 MULTIPLE RESPONSE 1. Throughout their careers, nurses are in an ongoing state of acculturation, gaining experience from formal nursing school classes, clinical experiences, and the ethical issues they encounter in their clinical practice. The ideal outcomes of these ongoing experiences with cultural decision making include: (select all that apply) a. increased trustworthiness. b. enhanced ability to take into consideration many aspects of ethical situations. c. confidence to make decisions based on experience and ethical intelligence. d. improved clinical decision making and advocacy for patient autonomy. e. authority to make ethical decisions independently that meet personal moral beliefs. ANS: A, B, C, D The desired outcomes of ethics acculturation across the years are integrity, personal growth, practical wisdom, and effective problem solving on behalf of patients and their families (Weaver et al, 2008). These are the qualities that are characteristics of an ethically sensitive and morally mature person. Trustworthiness is a characteristic of integrity. The ability to take into consideration many aspects of ethical situations is due in part to personal growth and practical wisdom. The confidence to make ethically sensitive decisions comes from experience founded on personal growth and personal wisdom. The ability to be the patient’s advocate in ethical decision making is one test of cultural acculturation. DIF: Application REF: pp. 168-169 COMPLETION 1. Practicing nurses participate in employer-sponsored professional development classes that provide case studies related to ethical situations and decision making. Ethical considerations are debated among teams, and an expert helps the class arrive at the “best practices.” The nurses are experiencing ethics . ANS: acculturation Ethics acculturation is the didactic and experiential process of developing ethical reasoning abilities as a part of ongoing professional education. DIF: Knowledge REF: p. 162 Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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. ANS: A In Asian culture, individuals tend to be present oriented and time is viewed as being more flexible than in the Western culture; being on time for appointments is not seen as a priority. DIF: Comprehension REF: p. 194 2. A nurse is admitting a Mexican-American child, and the mother comments that the child was exposed to mal ojo. The nurse should expect to find which symptom associated with this exposure? a. Fever b. Nervous tension c. Bruising d. Somnolence ANS: A The child has what is referred to as mal ojo or “evil eye,” which can lead to diarrhea, fever, and even death. DIF: Comprehension REF: p. 198 3. A Mexican-American patient is attacked and beaten. This patient is at risk for “fright disease,” which is known as: a. susto. b. empacho. c. bilis. d. mal ojo. ANS: A Susto is an emotion-based illness common among Mexicans. An unexpected fall, a barking dog, or a car accident could cause susto. Symptoms include colic, diarrhea, high temperature, and vomiting. DIF: Comprehension REF: p. 198 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. ANS: B The first step to becoming a culturally sensitive and competent health care provider is to conduct a cultural self-assessment. Through identification of health-related attitudes, values, beliefs, and practices, the nurse can better understand the cultural aspects of health care from the client’s perspective. DIF: Application REF: p. 191 5. A nurse is caring for a recent Asian immigrant client and is overheard making the following comment, “These rituals you believe in are false. You live in America now and must believe in realistic health practices, like Americans do.” The nurse is exhibiting: a. stereotyping. b. ethnocentrism. c. cultural accommodation. d. empathy. ANS: B Ethnocentrism is the belief that one’s own ethnic group, culture, or nation is best. DIF: Comprehension REF: p. 180 6. The nurse is preparing a plan of care for an black patient who has had a change of bowel habits from being constipated and having only two firm stools weekly to having three or more loose stools daily. Which comment is related to cultural variation for health information? a. The individual states, “I will need to discuss health care options with my grandmother.” b. The eldest male member of the family will make all health care decisions. c. The patient has high respect for the nurse and nods approvingly, although she has no intention of complying with instructions or plan of care. d. The individual speaks very quietly and gently reaches to hold the nurse’s hand for support. ANS: A In the African-American culture, women, especially “Granny,” play a key role in health care decisions. DIF: Application REF: p. 189 |p. 191, Table 10-1 7. A nurse is submitting a grant application to improve access to health care and mortality for minority groups. The grant focuses on the six causes of death that are identified as priorities for minorities, which include: a. chronic obstructive pulmonary disease. b. malnutrition. c. cirrhosis of the liver. d. cancer. ANS: D Cancer is identified as a leading cause of excessive death among minority group members. The six leading causes are cancer, cardiovascular disease and stroke, chemical dependency, diabetes, homicides/accidents, and infant mortality. DIF: Comprehension REF: p. 182 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. ANS: B Marginalized populations include recently arrived immigrants. Their lives and health care needs are often kept secret and are understood only by them. DIF: Comprehension REF: p. 182 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. ANS: B Most families with racially or ethnically diverse backgrounds have a lower socioeconomic status than is observed in the population at large. Dramatic changes in technology and specialization in the health care field have caused health care costs to skyrocket. Therefore, not everyone can afford health care services. DIF: Comprehension REF: p. 182 10. While completing a nursing degree in Virginia, a student who is interested in teaching in Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of Mexican-Americans live there. This nursing student values: a. cultural competence. b. ethnocentrism. c. prejudice. d. stereotyping. ANS: A Cultural competence is the responsibility of all nurses to become knowledgeable about the values, beliefs, and health care practices of the culturally diverse groups that are dominant in the nurse’s particular practice area. DIF: Application REF: p. 188 11. A Southeast Asian woman brings her baby into the clinic because the baby is lethargic. The nurse determines that the baby has had diarrhea and vomiting for several days, resulting in dehydration. Physical examination reveals small, round burns on the abdomen. These burns probably are the result of cigarettes or burning cotton used to: a. try to quiet the child and is considered child abuse. b. bring out toxic wind from the body. c. balance heat loss from the body. d. brush the body with ruda to allow spirits to return. ANS: C In the Southeast Asian culture, touching a burning cigarette or piece of cotton to the skin, usually the abdomen, is done to compensate for “heat” lost through diarrhea. This type of burning is a common part of self-care. DIF: Comprehension REF: pp. 196-197 12. A cultural phenomenon that is based on biologic variation would include: a. belief that exposure of a pregnant woman to an eclipse can result in cleft lip. b. denser bones in blacks result in less morbidity associated with osteoporosis. c. the grandmother who determines that her grandchild has scoliosis and should seek treatment, then informs the parents of her decision. d. a family that participates in feasts prepared to celebrate and make decisions. ANS: B Biologic variations include denser bones in blacks. Biologic variations such as body build and structure, genetic variations, skin characteristics, susceptibility to disease, and nutritional variations exist among different cultures. Other common variations include skin color, eye shape, hair texture, and adipose tissue deposits. DIF: Analysis REF: p. 191 13. A nurse plans to move to an area that is rich in immigrants from several countries and is concerned about respecting others’ cultural beliefs. The nurse’s first step to ensure cultural competence and sensitivity is to: a. enroll in a nursing theories course to increase knowledge about transcultural practices. b. become immersed in nursing literature about culturally diverse clients. c. participate in continuing education that focuses on health assessment variations among cultural groups. d. conduct a cultural self-assessment. ANS: D A cultural self-assessment allows the nurse to identify attitudes about individuals from different cultures. DIF: Application REF: p. 196 14. A nurse is preparing discharge teaching for an Asian-American woman with a fractured hip. The nurse reviews the client’s diet history while hospitalized and is concerned that the patient refused milk and yogurt, placing her at risk for osteoporosis. What cultural variation is the nurse overlooking? Asian Americans: a. have denser bones than other ethnic groups. b. consume diets rich in pork bone and shells, reducing the risk of osteoporosis. c. would participate in the practice of burning to compensate for this injury. d. would consult a curandero for dietary consultation. ANS: B Pork bones and shells are rich in calcium, reducing the risk of osteoporosis. DIF: Comprehension REF: p. 197 15. A nurse is preparing to teach a class related to risk factors for cancer to a diverse ethnic group attending a health fair. The nurse should be aware: a. that Hispanic women overestimate the prevalence of cancer and strictly following breast self-examination guidelines. b. of the importance of risk factors such as smoking and alcohol consumption that increase esophageal cancer when speaking with black. c. that American-Indian women have a higher rate of ovarian cancer than the general population. d. that cancer as well as heart disease and stroke are lower in ethnic groups. ANS: B Black men have a higher risk for esophageal cancer than the general population so teaching risk factors is needed. DIF: Comprehension REF: p. 191 16. A nurse performing a history and physical on a newly admitted Hispanic patient learns the patient has just used the services of a savador to: a. determine which herbs would best reduce hot flashes in a menopausal woman. b. communicate with a family member who recently died. c. receive treatments to reduce lower back pain. d. receive acupuncture to stop smoking. ANS: C Hispanic patients may want the support and care of a savador, which is similar to that offered by a chiropractor. DIF: Comprehension REF: p. 195 17. An Asian teenager is admitted with an eating disorder which she contributes to by not meeting the academic expectations of her parents. The nurse is overheard saying, “That isn’t the reason; all Asians are really smart.” This nurse is demonstrating: a. cultural humility. b. stereotyping. c. cultural assimilation. d. acculturation. ANS: B Stereotyping is associating certain behavior or competencies with an ethnic group without considering the individual. DIF: Comprehension REF: p. 180 18. A nurse caring for a Hispanic child admitted with diarrhea notices the child is wearing red yarn around the wrist. The nurse compliments the child’s “jewelry,” knowing it is believed to prevent: a. mal ojo. b. susto. c. bilis. d. empacho. ANS: A Mal ojo is due to “admiration” from a stranger resulting in diarrhea. DIF: Application REF: p. 198 19. A Hispanic patient is visited by several family members and the nurse witnessed one visitor who pinches a piece of skin at the waist. The nurse asks the purpose and learns the “provider” is listening for a snap from the abdominal region, which is then repeated several times. The patient most likely suffers from: a. mal ojo. b. susto. c. bilis. d. empacho. ANS: D Empacho is believed to be caused by lodged food particles, causing acute stomach/intestinal pain. DIF: Comprehension REF: p. 198 20. A nurse is seeking to become culturally competent in regard to obtaining information during health history and when performing physical diagnosis. The nurse is aware that which biologic variation is found in all of the following ethnicities: blacks, Asians, Hispanics, and American Indians? a. Mongolian spots b. Sickle cell anemia c. Lactose intolerance d. Thalassemia ANS: C Lactose intolerance is found in all four of the noted ethnicities. DIF: Application REF: p. 193, Table 10-2 MULTIPLE RESPONSE 1. Six cultural phenomena that vary among cultural groups are known to affect health care. The influence of the consequences of these phenomena can be seen in which of the following? (select all that apply) a. Asians and American Indians tend to be nonadherent with medications because they believe that the environment has no control over their fate. b. Some cancers such as stomach cancer occur less frequently among blacks. c. Blacks and American Indians often resist direct eye contact. d. Mexican Americans are more likely to stand close and touch health care providers. e. Whites are often late for health care appointments. ANS: C, D The use of eye contact is a cultural communication phenomenon. Cultures such as black and American Indian may view direct eye contact as rude behavior. Space and touch are cultural phenomena factors. In some cultures, touching strangers is inappropriate. On the other hand, Mexican Americans tend to be comfortable with less space because they like to touch persons with whom they are talking. DIF: Analysis REF: pp. 191-192 2. A nurse involved in researching the leading causes of death for minorities considers the federally defined minority groups, which include: (select all that apply) a. Blacks b. Russians c. Hispanics d. Asians or Pacific Islanders e. Scandinavians ANS: A, C, D The Federally defined minority groups include blacks, Hispanics, American Indians, and Asians or Pacific Islanders. DIF: Comprehension REF: pp. 181-182 COMPLETION 1. On the scale from 1 to 10, with 1 being no prejudice and 10 being extreme prejudice, the placement of hate on the continuum would be at number . ANS: 10 Hate is the extreme negative manifestation of prejudice, followed by contempt, then tolerance, which is more neutral. DIF: Application REF: p. 183, Figure 10-1 2. Although communication varies among members of different cultures, the greatest obstacle to providing multicultural care is differences in _. ANS: language Language can be the greatest obstacle to providing multicultural care. If the client does not speak the same language as the nurse, a skilled interpreter is mandatory. DIF: Comprehension REF: p. 191 Chapter 11: Complementary and Alternative Healing Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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: a. doshas.” b. moxibustion.” c. yoga.” d. kapha.” ANS: B Applying heat to the acupoints is termed moxibustion. DIF: Comprehension REF: p. 205 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)? a. Ayurveda b. Dosha c. Homeopathy d. Biofeedback ANS: D Biofeedback is a type of mind-body intervention that is based on techniques in which the client is taught to alter specific bodily functions such as heart rate, blood pressure, and muscle tension. The client uses various relaxation and imagery exercises to produce desired responses. DIF: Comprehension REF: p. 207 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: a. subluxation.” b. a sprain.” c. a fracture.” d. epicondylitis.” ANS: A The chiropractor corrects misalignments of the spine, called subluxations, by putting pressure on the nerves that are causing pain. DIF: Comprehension REF: p. 207 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.” ANS: A Chiropractic medicine is performed by a licensed professional with reimbursement privileges and is an accepted complementary alternative medicine (CAM) therapy. DIF: Comprehension REF: p. 207 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 ANS: D Atropine is derived from the Atropa belladonna plant; it primarily affects the parasympathetic nervous system. DIF: Knowledge REF: p. 207 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. d. Reiki. ANS: A The Alexander technique teaches improved balance, posture, and coordination through gentle hands-on guidance and verbal instruction. DIF: Comprehension REF: p. 214, Box 11-5 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: a. reflexology. b. Feldenkrais method. c. Reiki. d. Rolfing. ANS: A Reflexology produces pain relief through pressure applied to pressure points on the hands and feet that correspond to various parts of the body. DIF: Comprehension REF: p. 214, Box 11-5 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 ANS: C The drug reserpine is derived from the plant known as Rauwolfia serpentina. It was used to treat depression in the past but currently is used in the treatment of hypertension. DIF: Comprehension REF: p. 207 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. ANS: B Ginkgo reduces the efficacy of anticonvulsants, which may lead to increased seizure activity. DIF: Comprehension REF: pp. 207-208, Box 11-2 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. ANS: B Individuals with Alzheimer’s often have low levels of vitamin B12; thus, large doses of folic acid may have masked the dementia. DIF: Comprehension REF: p. 207 11. The nurse who presents a class on different methods of complementary alternative medicine (CAM) differentiates between imagery and hypnosis in which of the following ways? a. Imagery involves the dependent mental construction of a picture, whereas hypnosis requires the patient to recall and verbally describe difficult times in his or her life. b. Hypnosis requires a trained psychologist, but imagery can be performed by any health care practitioner. c. Imagery produces a temporary sense of well-being compared with hypnosis, which evokes a permanent positive effect. d. Although both therapies focus on specific problems and guide the patient into relaxation, imagery requires the patient to formulate the impression, whereas the hypnotist constructs the image for the patient. ANS: D Both imagery and relaxation are used to reduce anxiety and stress; however, imagery begins with a goal that is to be achieved and a picture that is formulated by the person under treatment, rather than beginning with the hypnotist, who conjures up a desirable image. DIF: Comprehension REF: p. 210 12. A pregnant woman reports back pain and wants to try a complementary alternative medicine (CAM) therapy. The nurse knows that which CAM would be contraindicated? a. Magnet therapy b. Aromatherapy c. Imagery d. Therapeutic touch ANS: A The effect of magnets on fetal growth has not been determined. DIF: Comprehension REF: p. 210 13. Despite the presence of safety aids such as handrails in the bathrooms at an assisted living facility, the number of fractures due to unsteady ambulation upon arising from the bed and when attempting to perform activities of daily living has increased. Which complementary alternative medicine (CAM) would be an effective intervention for this population? a. Yoga b. Acupuncture c. Tai chi d. Magnet therapy ANS: C Tai chi improves coordination, thereby reducing the number of falls and improving gait. DIF: Comprehension REF: p. 213 14. A patient informs the nurse, “I burn a lavender-scented candle for an hour before bedtime to help me relax and sleep.” The nurse realizes this patient is using: a. the mind-body intervention of aromatherapy. b. an energy technique known as qi gong. c. the manipulative method using the Alexander technique. d. conventional medicine, also called allopathic. ANS: A Aromatherapy uses scents of essential oils and is a type of mind-body interaction. DIF: Comprehension REF: p. 203 |p. 205, Box 11-1 15. The nurse caring for a patient who practices Ayurveda would assess for: a. an increased stool osmolality gap resulting from dehydration. b. petechiae resulting from fine-needle punctures. c. use of over-the-counter remedies intended for intended symptom. d. magnets strategically placed on affected joints. ANS: A Individuals practicing Ayurveda may use detoxification and cleansing enemas resulting in dehydration, which increases stool osmolality. DIF: Comprehension REF: p. 206 16. A patient informs the nurse, “I can’t sit in the yard for even 10 minutes without my skin turning red and tender.” The nurse would assess for the use of which complementary alternative medicine (CAM)? a. St. John’s wort b. Ginkgo biloba c. Feverfew d. Echinacea ANS: A St. John’s wort may cause photosensitivity. DIF: Comprehension REF: pp. 208-209, Box 11-2 17. A patient states, “My cancer is in remission finally after all that chemotherapy, my friend used the same chemotherapy and wasn’t so lucky. I want to continue participating in spiritual care and ‘mind games’ to keep my memory intact. I am also enrolled in Tai chi, but I just can’t stop thinking about my sick lung.” This patient adheres to which principle underlying alternative healing? a. A negative alteration in the body produces a parallel effect on the mind and spirit. b. The body can heal itself with the help of complementary alternative therapies. c. Approaches to therapy are individualized. d. There is a focus on the total lifestyle. ANS: A Health and healing are related to a harmony of mind, body, and spirit. DIF: Comprehension REF: p. 205 18. During an admission history and physical, a female patient states, “I use 5000 mg/day of calcium to prevent osteoporosis and to maintain health.” The nurse should assess for: a. excessive bleeding. b. kidney stones. c. lower blood sugar. d. jaundice. ANS: B Excessive calcium places individuals at risk for renal stone. DIF: Comprehension REF: p. 207 19. A patient who is pregnant has used the herb feverfew for a history of migraine headaches. The nurse should provide teaching related to a risk for: a. uterine contractions resulting in possible miscarriage. b. reduced fetal growth. c. insomnia. d. tiredness the following day. ANS: A Feverfew has the potential to cause the uterus to contact, increasing the risk for miscarriage or premature delivery. DIF: Comprehension REF: pp. 208-209, Box 11-2 20. A patient who is just beginning to use homeopathy to treat depression is concerned because symptoms are actually becoming worse with increasing sadness, anxiety, and fatigue. The practitioner of homeopathy bases teaching on the Law of Cure and instructs the patient to: a. discontinue the therapy and seek another alternative therapy. b. concentrate the preparation to increase its potency in hopes to improve depressive symptoms. c. increase the dosage of the substance to increase its effectiveness. d. remain on the current regimen since worsening is a positive sign that healing is occurring. ANS: D The Law of Cure states a worsening of symptoms after a remedy is given is considered a positive sign that healing is taking place. The therapy is therapeutic and should be considered. DIF: Comprehension REF: p. 210, Box 11-3 21. A patient has fallen at home and complains that joints are very painful when trying to climb stairs. The patient desires to use an alternative complementary medicine rather than pain medication. The practitioner begins treatment with touch consisting of rocking, rhythmical motions to loosen tense, sore muscles and joints. The patient is receiving which type of treatment? a. Swedish massage b. Rolfing c. Trager approach d. Reflexology ANS: C Trager approach uses gentle, rhythmic rocking and touch to promote relaxation and energy flow. DIF: Comprehension REF: p. 211, Box 11-4 MULTIPLE RESPONSE 1. Complementary alternative medicine (CAM) is gaining popularity in Western society because: (select all that apply) a. consumers want knowledgeable, trained physicians to control their care. b. CAM consumers want personalized health care. c. quantity, rather than quality, of life is most important in Western society. d. consumers have access to evidence that support CAMs. e. consumers want to remain indifferent to the health care provider. ANS: B, D Consumers are taking greater responsibility for their own health, which is based on personal preference, and many alternative natural therapies provide evidence of their own efficacy. DIF: Comprehension REF: p. 204 2. A patient experiences migraine headaches that are not relieved by traditional Western medical practices. The family physician suggests acupuncture, which: (select all that apply) a. is based on the belief that meridians are vital for life, and when they are out of balance, pain occurs. b. uses strategically placed, slender needles for pain relief. c. uses breathing exercises and meditation to relieve pain. d. corrects metabolic imbalance through purification regimens. e. determines distinct metabolic body types. ANS: A, B Acupuncture is based on the belief that invisible channels are present throughout the body through which energy flows; these are called meridians. This energy, qi, is considered the vital life force, and illness and symptoms occur when the flow of energy becomes blocked or unbalanced. Health is restored when the energy is unblocked; this is achieved by stimulating acupuncture points on affected meridian(s). Tiny needles are placed on the meridians that are affected and are causing pain. DIF: Comprehension REF: p. 205 3. A patient who is interested in herbal medicine attends a seminar to learn more about complementary alternative medicine (CAM). The patient learns that a common belief related to all CAMs includes that: (select all that apply) a. the body is not able to repair itself; thus, natural remedies are used to inhibit the immune system. b. many different CAMs that focus on specific body parts and the mind are needed. c. the focus of CAM is on an intervention for the diseased body part. d. each CAM treatment is unique to the person who is being treated. e. health promotion is incorporated into CAM. ANS: D, E Healing is individualized, and the uniqueness of each person is considered. Standing protocols that are used to treat everyone with similar conditions in a similar way are not found in CAM. Health promotion and positive health habits are incorporated into CAM. DIF: Comprehension REF: pp. 204-205 4. A nurse investigates energy therapies and learns that which therapies would be included? (select all that apply) a. Qi gong b. Osteopathy c. Imagery d. Healing touch e. Magnet therapy ANS: A, D, E Energy therapies include Qi gong, Reiki, healing touch, healing (therapeutic) touch, and magnet therapy. DIF: Knowledge REF: p. 205, Box 11-1 Chapter 12: Palliative Care Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. According to the Palliative Performance Scale which patient is considered to possess 70% of normal function? a. 40 year old diagnosed with AIDS whose condition makes it impossible to hold a job. b. 70 year old diagnosed with end stage renal failure who spends most of the day in bed. c. 50 year old diagnosed with emphysema whose disease has begun to impact normal ambulate. d. 30 year old diagnosed with muscular dystrophy who is bed bound. ANS: A 70% function implies that the patient has a reduction in ambulation and the disease process affect ability to hold a job. DIF: Application REF: p. 225, Table 12-3 2. The Karnofsky prognostication scale is most appropriately used to screen patients with which medical diagnoses? a. Respiratory diseases b. Cancers c. Cardiac diseases d. AIDS ANS: B The Karnofsky scale is more appropriate for the patient with a cancer diagnosis. DIF: Comprehension REF: p. 225 3. A peaceful death is best characterized by which terminally ill patient? a. One who is surrounded by family b. One who uses meditation to help manage pain c. One who has advanced directives in place d. One who has drifted from lethargy to coma ANS: D A peaceful death is generally described as being peaceful and comfortable with the patient drifting though the various stages of alertness to finally being comatose. DIF: Application REF: pp. 224-225 4. Which patient’s decision-making capacity should be a concern for the palliative care nurse? a. The one who asks, “Why do I need palliative care?” b. The patient with a diagnosis of moderate Alzheimer’s disease c. The one whose family is used to being consult about decisions affecting the patient d. The patient who has expressed concerns about “all the decisions I have to make.” ANS: B Decision-making capacity focuses on one’s ability to make decisions about their health care. They must be able to understand the facts, appreciate the alternatives that may exist, and to communicate these decisions to the health care team. Moderate Alzheimer’s disease is likely to have an affect the patient’s cognitive abilities. DIF: Analysis REF: p. 220 5. What is the primary factor that characterizes a patient receiving palliative care a. A diagnosis of a serious, life-threatening disease b. Ability to make sound health care decisions c. An interest in exploring available life sustaining treatment options d. A life expectancy of less than 12 months ANS: C Palliative care is appropriate for the patient diagnosed with a life-threatening disorder who wishes to take advantage of any life sustaining treatments available. DIF: Application REF: p. 222 6. As a patient’s condition moves toward their impending death, which nursing intervention demonstrates how the focus of palliative care change? a. The patient is encouraged to discuss their spiritual needs. b. The patient is educated concerning the physical changes associated with the dying process. c. The patient’s advance care plan is formulated and implemented. d. The patient’s comfort needs are identified. ANS: D The palliative care continuum model of begins comfort care at the time of diagnosis when therapies are aggressive but as the disease progresses towards death comfort care increases. DIF: Application REF: pp. 224-225 7. When first diagnosed with Parkinson disease, how can the patient and family best avoid future ethical dilemmas concerning the patient’s care? a. Work with the patient and family to create an advanced plan of care. b. Explain to the family that the patient’s cognitive function will deteriorate as time passes. c. Discuss the patient’s religious and spiritual concerns to identify potential problems. d. Identify which family members will be in control of decision making for the patient. ANS: A Advance care planning is a process for eliciting a patient’s values and preferences concerning current and future health care decisions. This plan is used to establish a patient’s goals of care during serious illness. Having such a plan in place will help minimize ethical issues regarding how care will be determined and delivered. DIF: Application REF: p. 220 8. What is the initial step when addressing an ethically challenging situation? a. Identify all those who are involved in the situation. b. Review the overall situation to identify the core issues. c. Gather all the relevant facts about the situations. d. Determine what the ethical dilemma is. ANS: B Reviewing the overall situation in order to identify what is going on in this particular situation is the initial step in addressing an ethically challenging situation. DIF: Application REF: p. 221, Table 12-1 9. Which statement correctly applies to a person’s suffering? a. Pain is the cause of suffering. b. Suffering and pain are experienced separately. c. Suffering can exist without the experience of pain. d. Pain is the focus of all nursing assessments. ANS: C Suffering is the experience of a person while pain and other symptoms are the result of physical body or organ changes. Suffering and pain can coexist together, although one can be present without the other. DIF: Comprehension REF: pp. 228-229 10. When working with the family of a patient receiving palliative care, what is the nurse’s initial intervention? a. Determining who will be the patient’s durable power of attorney b. Identifying what types of help the family will need to care for the patient c. Completely an assessment of the family’s strengths and weaknesses d. Discuss the dynamics of the family with the patient ANS: C Any strategy to meet the needs of a patient’s family begins with a comprehensive family assessment including an assessment of family strengths and weaknesses. DIF: Analysis REF: p. 229 11. A daughter tells the nurse that, “Mom will be as good as new when we get this advanced cancer cured.” How can the nurse best help the daughter in the role of caregiver? a. Working toward setting realistic goals for both her mother and herself b. Finding the daughter in home help to assist with her mother’s care c. Discuss with the patient the role her daughter will play in her care d. Encourage the daughter to regularly share her feelings with her mother ANS: A The setting of realistic goals is vital to the physical and emotional well-being of the caregiver. DIF: Application REF: p. 229 12. The principle of autonomy is best supported by what intervention made available to palliative care patients? a. Arranging for in-home health care b. Addressing the patient’s specific pain management needs c. Helping the patient decide on the details of their advanced plan of care d. Conducting a thorough performance status screening on the patient ANS: C Advance directives, if present, can speak for the patient and their wishes thus assuring their autonomy in making the end of life decisions they are in agreement with. DIF: Application REF: p. 230 MULTIPLE RESPONSE 1. Which statements are true regarding palliative care services? (select all that apply) a. Begins at the time of that a diagnosis of a serious illness occurs b. Care can be delivered in most settings. c. Expenses are paid for by Medicare. d. Is appropriate for all patients regardless of age. e. Providers are skilled in symptom management. ANS: A, B, D, E Palliative care does begin with a diagnosis of a serious illness and can be delivered in a wide variety of care settings. The care is appropriate and available to patients of any age and is provided by skilled professionals. DIF: Comprehension REF: p. 224, Table 12-2 COMPLETION 1. occurs when a physician predicts the course and outcome of a disease process. ANS: Prognostication Prognostication occurs when a physician creates a prediction about the course and outcome of a disease, often made with consideration of survival, symptoms, function, and quality of life with or without treatment. DIF: Comprehension REF: p. 220 Chapter 13: Workforce Advocacy for a Professional Nursing Practice Environment Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 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. ANS: D Nurses should always think critically about assignments so they can communicate what makes them uncomfortable about a particular assignment. If nurses do not have the knowledge or experience required for particular patient assignments, then modification of the assignments is in order to ensure patient safety. DIF: Application REF: p. 245, Box 13-5 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. ANS: D Research validates that an aging population and an aging nursing workforce are significant contributors to the nursing shortage issue. DIF: Comprehension REF: p. 241 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 people 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. ANS: B An unexpected number of young people entered the nursing workforce from 2002 to 2009, causing faster growth in the supply than anticipated. DIF: Comprehension REF: pp. 239-240 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, even as the economy recovers. ANS: D Academic institutions, especially those faced with budget cuts, generally cannot compete with nonacademic employers. Faculty salaries continue to be a major contributor to the nursing shortage. DIF: Comprehension REF: p. 241 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. ANS: D Past nursing shortages have proved that retention of professional nurses is the key to any organization’s success. Nurses want to work in an environment that supports decision making and effective nurse-physician relationships. The ability of an organization to retain nurses primarily depends on the creation of an environment that is conducive to professional autonomy. DIF: Comprehension REF: p. 241 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.” ANS: C Magnet hospitals have been identified as both attracting and retaining professional nurses. Magnet hospital nurses have higher levels of autonomy, greater control over the practice setting, and better relationships with physicians. DIF: Comprehension REF: pp. 250-251 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. ANS: D A safe work environment is imperative for the safety of both nurses and patients. Correcting this work environment issue promotes job satisfaction and good patient outcomes. DIF: Analysis REF: p. 250 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. ANS: D The emerging workforce, ages 18 to 35 years, has compensation expectations that differ from those of previous generations. This younger generation prefers to work in an outcomes-based environment, where pay is based on achievement or merit, not on longevity. DIF: Application REF: p. 242 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. ANS: B A number of studies in the late 1990s focused on the work environment as a significant contributor to the difficulties involved in recruiting and retaining RNs. One of the primary factors for the increasing nurse turnover rate was identified as workload and staffing patterns. A more recent study by Aiken (2002) reported higher rates of patient complications and increased death rates when fewer nurses are assigned per patient. DIF: Comprehension REF: p. 242 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. ANS: D One of the many guidelines regarding whistle-blowing specifies that one should seek counsel from a trusted individual outside the situation to gain an objective perspective. DIF: Analysis REF: p. 248, Box 13-6 11. The occupational health and safety nurse would like to develop programs designed to decrease mortality and morbidity among the workforce. When considering factors related to mortality among health care workers, the nurse should focus efforts on prevention of: a. suicide. b. violence related injury. c. bloodborne disease. d. ergonomic hazards. ANS: B A summary of research by the National Institute for Occupational Safety and Health (2014) found that health care workers have almost five times the risk of experiencing a violence-related workplace injury requiring time off from work than individuals in the overall workforce. DIF: Application REF: p. 249 12. According to the Needlestick Safety and Prevention Act (2000): a. employers ask nurses in managerial positions to evaluate safe needle devices. b. registered nurses who sustain a needle stick are required to pass a test before resuming medication administration. c. each state must determine the type of safe needle devices to be used. d. employers are required to document how and where a sharps injury occurred, including the brand of device that was involved. ANS: D The Needlestick Safety and Prevention Act, passed at the federal level, requires the use of safer needle devices to protect from sharps injuries; the law requires employers to maintain a sharps injury log that contains, at a minimum, the brand of device involved in the incident, the department or work area where the exposure incident occurred, and an explanation of how the incident occurred. DIF: Comprehension REF: p. 248 13. A nurse is concerned because novice nurses are having their orientation period shortened and are being placed in charge nurse positions. The nurse has documented unsafe care and decisions by these novice nurses. To be protected from retaliation by the employer, this nurse must “blow the whistle” by: a. holding a public forum in the agency cafeteria to discuss concerns. b. reporting concerns to state and/or national agencies regulating the agency. c. calling coworkers outside the workplace to informally discuss wrongdoing. d. contacting The Joint Commission to report unsafe conditions. ANS: B The whistle-blower is not protected until concerns are reported to the state or national regulatory agency. DIF: Comprehension REF: p. 247 14. A nurse is concerned about a trend in the hospital to regularly “float” nurses to different areas of the hospital based on staff shortage regardless of recent experience in caring for the population on the unit. When deciding to accept a staffing assignment in this situation, the nurse considers a “safe harbor.” What is meant by “safe harbor”? a. In an emergency situation, nurses may move patients to one location designated to be areas safe from natural disasters or acts of terrorism. b. Nurses work in teams to care for patients who have no communicable disease and do not pose a safety issue due to infection. c. Horizontal violence is not tolerated and nurses report any form of violence to administration. d. It is written a notice about recurrent staffing issues that allows nurses to continue to care for patients placed in their care but protects their nurse’s license while an investigation is conducted. ANS: D Safe harbor does not mean a nurse can refuse an assignment unless it would violate the nurse practice act, but it does provide an avenue for nurses to report unsafe staffing by filing a written report that is investigated by administration. DIF: Application REF: p. 239 |p. 248, Box 13-6 15. The Institute of Medicine report (2011): a. recommended that only physicians have the legal privilege to prescribe medications. b. called for increasing the number of baccalaureate-prepared nurses in the workforce to 80% by 2020. c. called for a minimum staffing ratio be in place in no later than 10 years. d. called for nurse technicians to provide care during the nursing shortage. ANS: B The IOM report (2011) addresses the evolving complexities of the current health care system and a need for 80% of the nursing workforce to be baccalaureate prepared by 2020. DIF: Comprehension REF: p. 241 16. The priority intervention to improve work-related quality of life for nurses is to: a. provide safe harbors for unjust or unsafe work assignments. b. improve nurse physician communications. c. require professional development courses for bedside nurses. d. determine strategies to improve vertical working relationships between staff nurses and nursing administration. ANS: D RNs ranked their relationships with administration and management the lowest in the workplace. DIF: Application REF: p. 241 17. Nurses entering the workforce at a large urban hospital soon began volunteering for excessive overtime. A focus group found that upon graduation, many of these nurses purchased expensive cars and furniture. They lacked skills in managing their checkbook and were often unable to pay recurring bills; this finding would be relevant to which component of the Workforce Advocacy Ecosystem Model? a. Staffing b. Workflow design c. Organizational factors d. Personal and social factors ANS: D Personal and social factors include stress, job satisfaction, and professionalism and financial literacy. DIF: Comprehension REF: p. 238, Box 13-1 18. An acute care facility values job satisfaction among its registered nurses.by implementing a shared governance model. Which element is a fundamental characteristic of this model? a. Administration has an open door policy b. Established dispute resolution process c. Implementation of mandatory reporting d. Nurses have an active role in patient care decision making ANS: D The importance of shared governance is that such models provide an organizational framework for nurses in direct care to become committed to nursing practice within their organizations. The implementation of such models allows nurses to have an active role in decision making by providing maximal participation and accountability for the outcomes of those decisions. DIF: Application REF: p. 252, Box 13-9 19. When reading about nursing as a career, a student is interested in learning about violence in the profession. Which statement accurately reflects violence in health care and the profession of nursing? a. Nursing is the most trusted profession and therefore violence is rare. b. All nurses should be advocates for violence prevention programs. c. Physical violence between peers constitutes lateral violence; however, verbal assault is not recognized as violence. d. Professional organizations have recognized a need to evaluate all nurses for the risk of committing acts of violence. ANS: B Nurses in all settings must proactively advocate for interventions that ensure personal safety and a safe work environment. DIF: Comprehension REF: pp. 249-250 MULTIPLE RESPONSE 1. Managers at an acute care facility value the contributions of their aging nursing workforce and make recommendations to accommodate for an aging nursing workforce. They institute for which changes? (select all that apply) a. Supplies such as dressing change and Foley catheter kits are placed on the nursing unit. b. Teamwork and development of new roles such as admission nurse are encouraged. c. Daycare centers for sick children are put into place to prevent the stress of having to find alternative daycare. d. Assistive devices for lifting as recommended by ANA’s Handle with Care are made available. e. A work-design consultant is hired to redesign the nursing unit to reduce wasted motion. ANS: A, B, D, E Placing supplies in a decentralized area prevents the fatigue that would be caused by the need to retrieve items from a distant location. Nurses are integral to quality and their contributions should be noticed. Ill-designed units contribute to fatigue and inability of aging nurses to perform efficiently. Mentoring is one way to acknowledge skills of the aging workforce. DIF: Application REF: pp. 241-242 2. A nurse is interviewing for a job and recently read the American Nurses Association’s (ANA) recommendation for questions to ask regarding before accepting employment. Which questions should the nurse ask? a. Do you have flexible scheduling? b. What are the expectations for advancement? c. How long do staff nurses stay before resigning? d. What is the mission of the parent organization? e. Does the organization have a means for staff nurses to have an active role in decision making by participation and accountability for the outcomes of practice decisions? ANS: B, C, E According to the ANA recommendations, applicants for nursing positions should ask about the opportunities for advancement exist in the organization. According to the ANA recommendations, applicants for nursing positions should ask about the organization’s turnover rate and average longevity of staff nurses. According to the ANA recommendations, applicants for nursing positions should ask about whether the organization has a shared governance model. DIF: Comprehension REF: p. 244, Box 13-3 COMPLETION 1. Nurses who are expected to work overtime as dictated by their employer are being subjected to a hazard in the workplace. ANS: psychological Hazards in the workplace are categorized as follows: biologic, ergonomic, chemical, physical, and psychological. Included in psychological hazards are issues such as stress, shift work, mandatory overtime, and verbal abuse by patients and other health care providers. DIF: Application REF: p. 239 Chapter 14: Collective Bargaining and Unions in Today’s Workplace Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. Nurses in a unionized hospital are paid “compensatory pay” when working holidays equal to the number of hours worked with no extra compensation. Although they have suggested changes during the annual survey of employee satisfaction, management refuses to consider another system for compensatory pay. A trained member listened to both nurses and management to make recommendations that were not legally binding. This type of settlement is termed: a. picketing. b. binding arbitration. c. mediation. d. grievance. ANS: C Mediation enlists the help of a trained person to listen to both sides; however, recommendations are not legally binding. DIF: Comprehension REF: p. 257 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. ANS: A Serving as charge nurse is part of a nurse’s professional role and not a management function. DIF: Comprehension REF: pp. 263-264 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. ANS: D The National Nurses United website gives information about collective bargaining for nurses. DIF: Application REF: p. 259 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. ANS: C The union representative meets with laborers (staff nurses) at a nonwork setting to gather information about grievances. DIF: Application REF: p. 260 5. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. A nurse is approached to sign a union authorization card. If signed, the card: a. authorizes the union to serve as his or her legal representative. b. indicates that the person is requesting additional information about collective bargaining. c. indicates the nurse desires to share information about grievances. d. gives permission for union dues to be deducted from pay. ANS: A A signature on a union authorization card indicates that the nurse gives the union the right to serve as legal representation. DIF: Comprehension REF: pp. 259-260 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. ANS: B An industrial unionism is a single union for all workers in the agency. DIF: Comprehension REF: p. 257 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. ANS: A Occupational unionism indicates separate unions for each occupation in an agency. DIF: Comprehension REF: p. 257 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. ANS: C The Industrial Revolution led to people working in factories where poor and unsafe working conditions were widespread. DIF: Comprehension REF: pp. 258-259 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. ANS: C Nurses are client advocates and promotion of professionalism is valued as evidenced by the public’s opinion related to honesty and professionalism. DIF: Application REF: p. 262 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. ANS: B Binding arbitration requires that both parties meet in formal talks, and all parties must obey the arbitrator’s recommendations. DIF: Comprehension REF: p. 257 11. A large corporation employs nurses all over the United States. Nurses in one agency learned that fellow nurses in another agency are striking because they are required to work 16-hour shifts to cover for nurses who have left due to unsafe staffing practices. The union of the nonstriking agency nurses decides to stop work to support the nurses who are striking; thus, this union: a. is placing nurses at risk for a lawsuit because their direct employer did not cause the strike. b. must be an industry union representing both parties. c. is participating in a sympathy strike, which, if done correctly, is legal. d. must pay for any losses incurred by the agency during the strike. ANS: C A sympathy strike occurs when a union stops work to support the strike of another union. DIF: Comprehension REF: p. 257 12. A group of nurses interested in unionizing decides to contact the largest union in the United States representing registered nurses, which is the: a. American Nurses Association. b. United American Nurses. c. National Nurses United. d. National Labor Relations Board. ANS: C In 2009, the National Nurses United became the largest union representing nurses RNs as a result of a merger between the United American Nurses, California Nurses Association, National Nurses Organizing Committee, and Massachusetts Nurses Association. DIF: Comprehension REF: p. 259 13. A nurse is interested in working in a large trauma center that is unionized but does not want to join the union or pay fees. She accepts the position but is not required to join or pay fees to the union based on which law? a. National Labor Relations Act b. Right-to-work law c. National Labor Relations Act d. Taft-Hartley Act ANS: B The right-to-work law prohibits membership or payment of union dues or “fees” a condition of employment, either before or after hiring. DIF: Comprehension REF: p. 257 | p. 260 14. A group of nurses are assembling outside a hospital protesting the use of foreign nurses after several nurses were terminated due to what the hospital called recurring “decreased census.” The nurses carry signs with messages asking potential patients to seek care elsewhere. The local newspaper picked up the story, and the hospital is receiving negative press. The nurses are participating in: a. picketing. b. collective bargaining. c. a strike. d. arbitration. ANS: A Picketing is a form of protest in which people (called picketers) congregate outside a place of work or location where an event is taking place. Often this is done in an attempt to dissuade others from going in (“crossing the picket line”), but it can also be done to draw public attention to a cause. DIF: Comprehension REF: p. 257 MULTIPLE RESPONSE 1. A hospital is seeking a 2.5% wage reduction for all nurses as part of a new balanced budget plan; however, the plan provides for raises for upper-level management. This plan resulted in a call for a union to protect the nurses. When the union representative arrives, what questions should the nurses ask? (select all that apply) a. Will the dues be used to support charity care when clients are unable to pay? b. How effective has the union been in representing nurses’ best interest? c. What percent of dues pays union personnel salaries? d. Are dues used to promote research for terminally ill clients? e. If arbitration is unsuccessful and a strike occurs, will nurses receive compensation during the strike? ANS: B, C, E Laborers (staff nurses) want a union with a successful track record of improving wages and benefits. Union dues are used to support union personnel, and the amount varies among different union groups; the higher the percentage of money that goes to pay union personnel salaries, the less money will be available to support members. Employers are not obligated to pay laborers during a strike, and unions may choose to pay employees while striking. DIF: Application REF: p. 263, Box 14-1 2. A hospital refused to purchase a better grade of utility gloves, even after learning that the cheaper utility gloves are easily punctured during routine use. This unsafe situation led nurses to seek unionization. During the pre-election phase for unionization, which actions by union representatives are prohibited by the National Labor Relations Board? (select all that apply) a. Scheduling a meeting in the agency’s cafeteria to determine employees’ interest in unionization b. Distributing nondocumented information that female nurses receive lower annual performance evaluations than do male nurses c. Distributing information about the benefits of unionization and grievances in a public parking garage located across from the hospital d. Suggesting to workers the likelihood of job loss should the union not win the election e. Signing authorization cards for employees who are on leave ANS: A, B, D, E Union representatives must meet in nonwork areas. Union representatives must not spread rumors of prejudices. Neither the union nor employers can spread falsehood about potential job loss or repercussion in the event of unionization. Union representatives cannot sign cards for employees. DIF: Application REF: p. 259 3. It is important to realize that nurses may seek unionization if: (select all that apply) a. physicians rotate on-call coverage among group members for complicated long-term clients. b. scheduling is presented that provides adequate staffing on holidays by rotation of time off for holidays among nurses. c. incident report trends indicate medication errors are caused by shift reports being taped and heard after nurses from the prior shift have left the unit. d. physicians, nurses, nutritionists, and physical therapists visit concurrently with clients to plan care. e. staff development activities are planned daily at 8 AM for 2 consecutive days to educate staff on new cardiac monitoring procedures while following normal staffing patterns. ANS: C, E Policies where shift reports are taped and heard after a prior shift has left have proved to lead to errors and unsafe care. Staff development activities should be scheduled to allow nurses to attend, and normal staffing patterns or time of training must coincide with nurses’ availability and ability to listen to and retain information (such as at the beginning or end of the shift while others provide coverage). DIF: Comprehension REF: p. 262 4. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. During the pre-election period, what actions by management are prohibited? (select all that apply) a. Seek individuals to spy on coworkers who are possible union supporters. b. Photograph employees participating in information sessions about unionization. c. Visit managers outside work to gain their perception of popularity of unionization. d. Threaten that, should the union win, the company will relocate when there is no intention to relocate. e. Require employees to declare their position on unionization prior to pick up paychecks. ANS: A, B, D, E During the pre-election period, management may not solicit spying. During the pre-election period, management may not photograph employees engaged in union activities. During the pre-election period, management may not lie about what will happen if the union is the victor in an election. During the pre-election period, management may not question employees about their preferences regarding union activity. DIF: Comprehension REF: p. 261 [Show More]

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