g the Henry Street Settlement. c. founding the American Red Cross. d. publicizing the inadequacies of hospital-based nursing schools. 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 3. The practice of public health nursing and the Henry Street Settlement are credited to: a. Mary Breckenridge. b. Mary Seacole. c. Clara Barton. d. Lillian Wald. 4. Occupational health nursing features beliefs similar to those of which early nursing pioneer? a. Lillian Wald b. Florence Nightingale c. Clara Barton d. Mary Seacole 5. What historical event first led to the recognition of the contribution of 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 6. World War I contributed to the advancement of health care by: a. increasing the number of private care hospitals and decreasing the role of public health services. b. employing a large number of civilians to provide care to returning soldiers through the Red Cross. c. introducing specialists in nursing such as nurse anesthetists. d. increasing the number of community health nurses.   7. The primary purpose of the Social Security Act of 1935 was to: a. increase research that focused on minority groups. b. provide medical care for chemically impaired persons. c. ensure health care for older adults through a national insurance system. d. decrease the public’s financial burden by limiting services offered by local health departments. 8. A client asks the nurse, “Can you explain Medicare, an amendment to the Social Security Act?” The nurse responds that Medicare: a. led to many hospital closings, along with a decrease in acute care hospital–based nursing care. b. provided medical insurance to those younger adults or children who were not eligible for private insurance because of catastrophic illnesses such as cancer. c. provided preventive care for women, infants, and children. d. ensured that individuals ages 65 and older and those with end-stage renal disease or permanent disabilities had health care insurance. 9. A comparison of nursing in the 1980s to nursing in the 1990s reveals that: a. in the 1990s nursing experienced a significant reduction occurred in preventable diseases caused by unsafe/unhealthy lifestyles. b. tuberculosis was the primary concern for nursing in the 1980s, whereas the AIDS epidemic emerged and was its focus during the 1990s. c. a decrease in ambulatory services in the 1980s prompted an increase in public health nurses in the 1990s. d. the demand for advanced practice nurses increased in the 1980s and the 1990s as a result of the economy and concern about the health of the nation. 10. Which statement accurately describes the historical perspective of nursing practice? a. Nursing has existed to meet the needs of populations, individuals, and aggregates by providing care that is determined by the needs and beliefs of society in different historical contexts. b. As men began to become interested in nursing, it changed into a respected profession based on scientific fact rather than superstition. c. Nursing has historically accepted individuals from all social and ethnic backgrounds. d. The United States has led the way throughout history to advance nursing and health care by providing the first hospital and medical school. 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 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. 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. 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. 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. 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. 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. 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 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. 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. 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 REF: p. 3 A pharmacopoeia that classified more than 700 drugs was written by the Egyptians to assist in the care and management of disease. Chapter 05: Theories of Nursing Practice 1. Which nursing theory might a nurse use as a conceptual framework to determine how to meet the needs of immigrants while ensuring provision of high-quality and culturally sensitive care? a. Martha Rogers’ nursing theory b. Dorothea Orem’s nursing theory c. Hildegard Peplau’s nursing theory d. Madeleine Leininger’s nursing theory 2. When reading Peplau’s theory, a nurse was unable to determine the relationships among concepts. The nurse listed each concept and drew lines denoting relationships to be able to understand the effect of each element. The nurse created a: a. hypothesis. b. model. c. construct. d. variable. 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. 4. Einstein’s theory of relativity laid the groundwork for theories of mathematics, and Freud and Jung provided the basis for a philosophy of man. Which nursing theory served as the foundation for nursing science? a. Rogers’ science of unitary human beings b. Nightingale’s theory of practice c. Watson’s theory of human caring d. King’s theory of goal attainment 5. A community health nurse has been visiting a postpartum client who suffered domestic violence throughout the pregnancy, and now the infant may be at risk. The nurse assisted the client in finding shelter and legal protection. The nurse’s role and the conceptual framework involved are: a. change agent, according to Roy’s adaptation model. b. translator, according to Leininger’s theory of cultural care diversity and universality. c. case manager, according to Peplau’s interpersonal relations model. d. caregiver, according to Rogers’ science of unitary human beings. 6. What are general explanations that scholars use to explain, predict, control, and understand commonly occurring events? a. Theories b. Constructs c. Systems d. Propositions 7. Which type of theory most often guides present nursing practice? a. Grand theory b. Middle range theory c. Developmental theory d. Values theory 8. A client is hypertensive, and the doctor prescribes weight reduction. The client is excited about beginning the diet, but on arriving home the spouse states, “You have always been fat, and I am not going to starve because you can’t control yourself.” The client becomes anxious and is unable to participate in the diet plan, resulting in a weight gain of 5 pounds in 2 weeks. Which theorist could best be referred to for guidance regarding interventions in this situation? a. Martha E. Rogers b. Hildegard E. Peplau c. Florence Nightingale d. Myra Estrin Levine 9. A nurse believes that humans use creativity and critical thinking to balance their connections with their surroundings. The nurse decides to conduct a study on the basis of this belief. Which nursing theory would be best for this study? a. Peplau’s interpersonal relations as a nursing process: man as an organism that exists in an unstable equilibrium b. Roy’s adaptation model: assistance with the adaptation to stressors to facilitate the integration process of the client c. Orem’s self-care deficit model: self-care, self-care deficits, and nursing systems d. Rogers’ science of unitary human beings: humans as energy fields that interact constantly with the environment 10. A client involved in a motor vehicle accident is blinded. The nurse helps the client obtain a guide dog so the client may continue grocery shopping and visiting friends and family. This enables the client to cope with the handicap and perform activities of daily living. Which nursing theory can be applied to this scenario? a. Watson’s philosophy and science of caring and humanistic nursing b. Mishel’s uncertainty in illness c. Orem’s self-care deficit d. Rogers’ science of unitary human beings 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 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 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 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. 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 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. 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 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 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. 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 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 1. The basic ingredients of theory are ____________. Chapter 17: Nursing Leadership and Management 1. In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees’ health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin’s planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance 2. One difference between a leader and a manager is that a: a. leader has legitimate authority. b. manager motivates and inspires others. c. manager focuses on coordinating resources. d. leader focuses on accomplishing goals of the organization. 3. The first step in the nursing process and in the problem-solving process is to: a. identify the problem. b. gather information. c. consider the consequences. d. implement interventions. 4. An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Referent 5. An RN with excellent assessment and psychomotor skills would derive power on the basis of which source? a. Rewards b. Coercion c. Expert d. Legitimate 6. Managers who exhibit an authoritative behavioral style are most likely to use which source of power? a. Informal b. Expert c. Coercive d. Reward 7. Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society’s perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory? a. Trait b. Chaos c. Bureaucracy d. Organizational 8. A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? a. Transactional b. Situational c. Transformational d. Contemporary 9. According to the unit’s policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, “You are unfair to me.” Which theory would disprove the nurse’s statement? a. Authoritative b. Closed systems c. Open systems d. Trait 10. A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? a. Every morning at shift change, thank each employee for an excellent job. b. Rotate a monthly “employee recognition award” among all employees on the unit. c. Wait until the annual performance review to recognize accomplishments. d. Give spur-of-the-moment recognition to an employee who has accomplished a goal.   11. Which action represents the key management function of strategic planning? a. Determining that all nurses on the unit understand the current organizational philosophy b. Evaluating the communication process between the pharmacy and the nursing departments c. Monitoring data from the quality management initiative related to the last three orientation programs d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units 12. A hospital’s policy requires that all nurse managers must have a minimum of a bachelor’s degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, “The new nurse manager has book sense but no leadership abilities.” What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit? a. Send memos to all staff except the upset nurse to invite them to a luncheon. b. Ask management to transfer the upset nurse to another unit. c. Assign the upset nurse to committees that do not directly affect that nursing unit. d. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication. 13. A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? a. Coercive b. Transformational c. Laissez-fair d. Legitimate 14. A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet its goal to “provide quality patient care with attention to compassion and excellence.” An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management? a. Transactional b. Clinical consultant c. Corporate supporter d. Autocratic 15. A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit’s representative on the ethics committee, and coaching her daughter’s soft ball team. Many of the staff observes how she manages time and provides care. This nurse’s power comes from which type of power? a. Referent b. Legitimate c. Information d. Connection   16. A staff nurse states, “I really enjoyed having dinner with the Chief of Medical Staff and the President of the hospital. We hope to meet again soon.” Which source of power does this nurse possess? a. Expert b. Legitimate c. Connection d. Reward 17. A nurse manager wants his nursing unit to be a place where all nurses want to work, where patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged to chair taskforces to improve quality of care and he counsels staff in areas of measuring patient outcomes. Other managers want to mimic this manager’s approach to improve their own units. This nurse is which type of leader? a. Transformational b. Transactional c. Laissez-faire d. Authoritative 18. A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform “huddles to update the team” as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. This stage of Lewin’s change is: a. unfreeze. b. moving. c. refreeze. d. resistance. 19. A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function? a. Directing b. Planning c. Organizing d. Controlling 1. Registered nurses who are entering the workforce will have expanded leadership responsibilities that include: (select all that apply) a. serving on interdisciplinary care teams. b. being competent to work in several areas independently when dictated by patient census. c. attending a meeting to plan advanced training for unlicensed assistive personnel. d. evaluating outcomes of care that are reported to a standing committee. e. managing units with higher acuity, shorter length of stay, and more diverse patients and staff. 2. A nurse asks, “What is meant by ‘internal’ customers?” The correct response is: (SATA) a. insurance companies b. accreditors such as The Joint Commission c. X-ray technicians d. clinical pharmacist e. chief financial officer Chapter 19: Effective Communication and Conflict Resolution 1. A nurse is listening to a patient’s apical heart rate. The patient asks, “Is everything okay?” The nurse says nothing and shrugs her shoulders. The nurse is demonstrating: a. open communication. b. filtration. c. blocking. d. false assurance. 2. A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations? a. Blocking b. Filtration c. Empathy d. False assurance 3. In today’s world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d. Electronic messaging 4. Which statement accurately describes communication? a. The components of communication are mutually exclusive. b. Communication is linear. c. Communication involves only the sender and the receiver; everything else is superficial. d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback. 5. A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor’s degree is hired. Before the RN arrives on the unit, the LPN is heard saying, “She’ll try to tell everyone what to do because she makes more money. She’ll sit at the desk and let us do all the work.” This is an example of a(n): a. interpretation. b. context. c. precipitating event. d. preconceived idea. 6. A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, “I don’t think she is really hurting. Let the next shift give the pain medication.” The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? a. Personal perception b. Past experiences c. Filtration d. Preconceived idea 7. A nurse gives Dilantin intravenously with lactated Ringer’s solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, “Everyone just pushes the medicine slowly. No one checks for compatibility. There isn’t even a compatibility chart on the unit.” Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Appeal to emotion d. Appeal to tradition 8. An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, “My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn’t care how hard I try to get here, and I am raising a child by myself.” The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect 9. The new director of nurses has instituted “walking rounds” on all nursing units, rather than the usual taped shift reports. A veteran nurse exclaims, “She doesn’t know how we do things here!” The nurse is demonstrating: a. appeal to emotion. b. appeal to tradition. c. red herring. d. straw man. 10. A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, “You don’t care that I threw the needle in the trash. You just want an all-female staff,” putting the team leader in a defensive position. This communication technique is known as: a. straw man. b. red herring. c. slippery slope. d. confusing cause and effect. 11. A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin (Dilantin) before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? a. The nurse is upset and states, “I am sure I have injected this before without a problem” and the supervisor interprets this to mean the nurse often take shortcuts. b. The nurse states, “You are just upset because I am certified in chemotherapy administration and you are not.” c. “The nurse who started the IV didn’t get a blood return but determined the IV was the patient’s—that is the problem.” d. “This drug always occludes the line because it is so viscous.” 12. During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting: a. assertive communication. b. active listening. c. empathy. d. passive communication. 13. The nurse is demonstrating active listening when: a. while assessing the patient’s vital signs, the nurse records the data and states, “You are improving, your vital signs are normal.” b. eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. c. he or she states, “I know how you feel, I recently lost my father and I am still hurting.” d. cultural values are in opposition to the patient but shares that “I agree with your decision to use herbs rather than the prescribed medications.” 14. An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, “Can I just please stay and hold my dad’s hand? He was so afraid of dying alone.” Which response by the nurse shows empathy? a. “You are just too late for that. Where were you when he needed you?” b. “Did you ever consider purchasing a cell phone for your dad to prevent this from happening?” c. “I’ll close the door so you can spend time with your dad. I will check back in a few minutes.” d. “I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you.” 15. A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. “Do you exercise?” b. “Do you like to exercise?” c. “When do you exercise?” d. “What exercise practices do you participate in?” 16. Which component of an e-mail shown below would be both effective and concise? a. Subject: A short concise subject line: Meeting. b. Body: I would like you to answer these questions before the next meeting: Where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, or ext. 5582. 17. During height and weight assessments at a school’s health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, “Drinking coffee stunts a child’s growth.” This logical fallacy is referred to as: a. appeal to common practice. b. confusing cause and effect. c. ad hominem abusive. d. red herring. 18. A patient’s spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, “I am so mad. How can you get cancer without smoking?” Which statement by the nurse represents empathy? a. “Research is identifying many risk factors for cancer besides smoking.” b. “I understand how you could feel angry about the diagnosis.” c. “He is still a good husband.” d. “Why do you think he got cancer?” 19. A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is? 20. The nurse caring for a patient states, “Your blood pressure is dangerously high. Are you taking antihypertensive medicine?” The patient states, “I can’t afford my medicine. I have no insurance.” The nurse states “I feel really sorry for that patient. I wish it wasn’t against policy to give her money.” The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that “She was so sick last evening when she came to the ED. I can’t believe they don’t provide insurance. I can’t give her money but you all can help.” This nurse: a. is showing empathy and as long as she lets the patient know the money is not from her, she is not violating any social media guidelines. b. is at risk for HIPAA violations. c. has properly followed policy and protected the patient by not using her name. d. is demonstrating the logical fallacy of slippery slope. 21. A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through: a. empathy. b. positiveness. c. supportiveness. d. accommodation. 22. A nurse is asked to “float” to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, “I’ll come back and eat lunch with everyone here.” When she enters the elevator she hits the wall and mutters, “Always me. Don’t I have any rights”? The nurse is demonstrating which communication style? a. Assertive b. Aggressive c. Passive d. Passive-aggressive 23. A nurse is overhead saying, “I don’t mind working during the election and holiday. My parents are divorced, money is tight, and honestly I don’t trust any politicians anyway. I plan to take a few weeks off next month.” She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, “Let’s think the suggestions over and come back together next week.” This nurse’s communication style is consistent with which generation? a. Baby Boomers b. Traditionalist c. Generation X d. Millenniums 1. The healthiest form of communication is the ________ style. Chapter 20: Effective Delegation and Supervision 1. The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to: a. the registered nurse (RN). b. the licensed practical/vocational nurse (LPN/LVN). c. unlicensed assistive personnel (UAP). d. all levels of staff, because the information is about the past and cannot change. 2. An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that: a. the role of the LPN/LVN is the same from state to state. b. the LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided. c. he or she must review the state’s nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN. d. The Joint Commission has certified and established roles for the LPN/LVN. 3. Which task is most likely to be considered in a state’s practice act as appropriate to delegate to a LPN/LVN if the patient’s condition is stable and competence in the task has been established? a. Administer an enema for an elective surgery patient. b. Administer an antiarrhythmic medication IV while interpreting the patient’s rhythm on the cardiac monitor. c. Develop a plan of care for a stable patient admitted for observation after a head injury. d. Teach a patient how to instill eye drops for glaucoma. 4. A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? a. RN b. LPN/LVN c. Unlicensed assistive personnel (UAP) d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.   5. A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment “does not require decisions based on the nursing process.” The nurse is correctly using which of the five rights of delegation? a. Supervision b. Communication c. Person d. Circumstance 6. A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to: a. supplement the staffing pattern when an RN is not available. b. aid the RN by performing appropriately delegated care tasks. c. replace the RN when the health care facility provides long-term care. d. provide patient teaching, allowing more direct care to be provided by the RN. 7. An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for: a. delegating the task to another UAP if he or she does not have the time or skill to complete the task. b. keeping the RN informed of any abnormal blood pressure readings. c. calling the physician when the patient’s vital signs are not within established parameters. d. informing the dietary department to initiate a low-sodium diet for patients who are hypertensive. 8. Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegatee has had experience and training? a. Evaluate the ability of a patient to swallow ice after a gastroscopy. b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system. 9. An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision? a. There is no supervision, because at times the LPN/LVN is not with the RN. b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care. c. Continual supervision is being provided until the RN determines competency. d. Initial supervision is being provided because this is the LPN/LVN’s first day on the unit. 10. An RN is counseled by the nurse manager regarding inappropriate delegation when the: a. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their rooms. b. nursing assistant informs the RN that she has not been trained to collect a sputum specimen and the RN states, “I will show you this time and you can show me the next time.” c. RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube. d. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a patient before she is discharged home. 11. An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient’s medication administration just before entering the patient’s room. The priority intervention by the RN is to: a. check the patient’s drug packages to ensure that the correct drugs were given. b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. c. contact the nurse manager and ask that the LPN/LVN’s license be suspended. d. call the pharmacy and ask for replacement medications for the patients. 12. Which statement related to delegation is correct? a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act. b. Nursing practice can be delegated only when the LPN/LVN and UAP have received adequate training. c. Supervision is not required when routine tasks are delegated to a competent individual. d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP. 13. During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that: a. the health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. UAPs cannot be held responsible for their own actions or inactions. d. the nurse practice act and state regulations related to delegation override the organization’s policies. 14. A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should: a. query the state nursing association to determine their stance on the role of LPNs. b. ask the LPNs on the unit to list what tasks they routinely performed. c. contact the state board of nursing to determine legal scope of practice for LPNs. d. refer to California’s nurse practice act because the scope of LPNs/LVNs is consistent across the United States. 15. An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation? a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin. b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound. c. An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington’s disease to ambulate a short distance in the hallway. d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3. 16. The RN instructs the LPN to “Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given.” Which of the five rights was missing in this situation? The right of: a. direction and communication. b. task. c. person. d. circumstances. 17. Which of the following situations would be appropriate for the supervisory level of initial direction and/or periodic inspection? a. Experienced RNs work together to provide care for a group of patients newly diagnosed with meningitis. b. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly. c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the patient status every 15 to 30 minutes and asks the graduate to explain “next steps.” d. No supervision is necessary since both are registered nurses. 18. A registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult the state board of nursing to determine scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). She also realizes there are common policies which exist in most state practice acts that include: a. the RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee. b. the RN may only delegate tasks that are not in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task. c. since the LPN is licensed, they practice professional nursing. d. to determine what tasks can be safely delegated, the RN must first assess the patient. 19. A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee? a. Actually observe the delegatee perform the assigned task. b. Ask the delegatee how many times he/she has performed the task. c. Ask the patient if the care provided was satisfactory. d. Ask other nurses if they feel the delegatee is competent. 20. Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria? a. The RN administers all medications to all patients. b. The LPN performs sterile dressings and IV tubing changes on all central lines. c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor. d. The RN administers an enema to a stable patient who has an order “administer fleet enema PRN when no bowel movement in 2 days.” 1. Which statement made by an RN regarding delegation indicates the need for additional teaching? (SATA) a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely. b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for the purpose of increasing renal perfusion. d. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency. e. Responsibility can be delegated to the UAP, but the delegator retains accountability. 2. A nursing administrator who is considering the feasibility of an all-RN staff reviews the report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) and determines that RNs: (select all that apply) a. are more costly and less efficient than LPNs. b. have little or no effect by being proactive but instead are reactive to patient care errors. c. have a positive effect on patient outcomes when managing patient care. d. are effective overseers of patients’ overall health condition. e. lack the training to be effective delegators. 3. Which functions can be delegated only to another RN with appropriate experience and training? (SATA) a. Assessment of skin integrity on third day of hospitalization b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises c. Nursing judgment related to withholding medication based on vital signs d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed assistive personnel e. Formulation of nursing diagnosis “potential for fall”