Test Bank for Nursing in Today's World 10th Edition by Ellis€¦ · approach to documentation and...

Test Bank for Nursing in Today's World

10th Edition by Ellis

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Chapter 1 - Exploring the Growth of Nursing as a Profession

Multiple Choice

1. Which of the following statements most accurately describes the practice of medicine in Greece from 800 BC to 300 BC? A) Greek culture stressed natural causes for disease, a patient-centered approach, and the necessity of accurate observations and record keeping. B) Greek culture borrowed medical practices from the countries it conquered, and physicians were often slaves. C) Major and minor surgery, childrens diseases, and diseases of the nervous and urinary systems were described in Greek culture. D) Medicine men (known first as shamans and later as priests) were responsible for curing ills of body and mind.

Ans: A

Client Needs: B

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 4, Table 1.1 Feedback: Hippocrates, born about 400 BC, was a Greek citizen who became known

as the Father of Modern Medicine. He emphasized natural causes for disease, a

patient-centered approach, and the necessity of accurate observations and record

keeping. These priorities influenced the practice of medicine both in Greece and beyond. Persia was known to utilize slaves as physicians, and Rome borrowed

medical practices from the countries it conquered. Ancient India emphasized hygiene

and prevention of sickness and described major and minor surgery, childrens diseases,

and diseases of the nervous and urinary systems. Medicine men were characteristic of

the Mayan and Aztec civilizations.

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2. Florence Nightingale fostered the development of nursing as a profession. What was the basis of her nursing theory? A) The nurses role is to assist individuals (sick or well) to carry out those activities that they would perform unaided if they had the necessary strength, will, or knowledge. B) The goal of nursing is to put the patient in the best condition for nature to act upon him, primarily by altering the environment. C) The focus of nursing is the spiritual subjective aspects of both the nurse and the patient and the caring moment relating to the time when the nurse and the patient first come together. D) The focus of nursing is the care of human beings who are viewed as open systems in constant interaction with their environments. Ans: B Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Difficult


Objective: 2

Page and Header: 21, Early Definitions of Nursing Feedback: Florence Nightingale, in her Notes on Nursing: What It Is and What It Is Not, described the nurses role as one that would put the patient in the best condition

for nature to act upon him (Nightingale, 1954, p. 133), a definition that often is quoted today. This action was prioritized over physically assisting the patient. Watson emphasized the spiritual subjective aspects of the nurse and the patient, and the open

systems concept is central to Kings theory of nursing. 3. Which one of the following statements accurately describes an element of the process of providing a definition of nursing? A) Researchers can pinpoint the period in history when nursing first evolved. B) Nurses agree on a single definition of nursing, partly because of the history of nursing. C) There is an obvious distinction between nursing and medicine. D) Nursing theorists developed definitions of nursing consistent with their conceptual frameworks. Ans: D

Client Needs: A-1 Cognitive Level: Analysis



Objective: 7, 8

Page and Header: 23, Influences on the Definition of Nursing

Feedback: As nursing has grown into a true profession, many nursing theorists have developed definitions of nursing consistent with their conceptual frameworks; these

frameworks provide the foundation for any given definition of nursing. The historical emergence of nursing did not take place at one particular time, and there are multiple definitions of nursing. While nursing and medicine indeed differ, the distinctions

between the two professions are not always clear.

4. A nurse wishes to document nursing actions using a standardized language. Which of the following systems might the nurse use? A) NANDA International (NANDA-I)

B) Nursing Outcomes Classification (NOC) C) Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS) D) Nursing Interventions Classification (NIC) Ans: D Client Needs: A-1

Cognitive Level: Application


Integrated Process: Communication and Documentation

Objective: 12

Page and Header: 40, Nursing Interventions Classification Feedback: Started in 1996 at the University of Iowa, the Nursing Interventions Classification (NIC) is a comprehensive, standardized language that describes actions that nurses perform in all settings and in all specialties and includes both physiologic and psychosocial interventions. NANDA and NOC provide standardized language for

nursing diagnoses and outcomes. The MDS is an assessment tool specific to long-term care settings. 5. An RN who practices in a community clinic recognizes the need for a standardized

classification and documentation system. Which of the following systems of nursing

care classification and documentation would best fit the RNs needs?

A) NANDA International (NANDA-I) B) Nursing Outcomes Classification (NOC) C) The Omaha System D) Patient Care Data Set (PCDS) Ans: C Client Needs: A-1 Cognitive Level: Application



Objective: 13

Page and Header: 41, The Omaha System

Feedback: The Omaha System is a research-based comprehensive practice documentation standardized taxonomy designed to document client care from

admission to discharge. It was designed as a three-part, comprehensive yet brief approach to documentation and information management for multidisciplinary healthcare professionals who practice in community settings. NANDA and NOC

provide frameworks only for nursing diagnoses and outcomes, while the PCDS is specific to hospital settings.

6. The number and size of nursing schools in the United States grew significantly in the years of the early 20th century. Which of the following characteristics was emphasized in these schools? A) A thorough knowledge of anatomy, physiology, and epidemiology B) Critical thinking, assertiveness, and autonomy C) An understanding of the relationship among mind, body, and spirit D) Religious devotion and subservience to authority Ans: D

Client Needs: A-1


Difficulty: Easy


Objective: 3

Page and Header: 12, Characteristics of the Early Schools Feedback: In early nursing schools, the nurse in training was expected to yield to her superiors and demonstrate the obedience characteristics of a good soldier with actions

governed by the dedication to duty derived from religious devotion. These expectations superseded the importance of critical thinking, scientific knowledge, or the holistic nature of health. 7. Florence Nightingale is acknowledged as one of the individuals who contributed most significantly to the development of nursing as a profession. What other phenomenon contributed most to this development? A) Labor-saving technology that freed many women from working in the home B) The social recognition of the importance of public funding for the treatment of disease C) Increased understanding of the pathophysiology of illness and the importance of infection control D) The high mortality rates that existed during times of war Ans: D Client Needs: A-1




Objective: 4

Page and Header: 8, The Nightingale Influence

Feedback: The death and disease that accompanied conflicts such as the Crimean War and the Civil War provided the impetus for much of the development of the nursing profession. Nursing did not primarily grow out of the availability of a female workforce, public funding for health, or increased scientific knowledge.

8. Nurses have historically had difficulty identifying a single, comprehensive definition of nursing. What factor most accounts for this difficulty in agreeing on a definition for nursing? A) It can be challenging to reconcile the theoretical and practical aspects of nursing. B) Nursing exists in the psychomotor (hands-on) domain rather than in the cognitive domain.

C) Compared with medicine, nursing has a relatively short history. D) Nurses have traditionally been reluctant to acknowledge the outcomes of their practice. Ans: A

Client Needs: A-1




Objective: 5

Page and Header: 21, Developing a Definition for Nursing Feedback: A major factor that has made it difficult to define nursing is that it is taught as encompassing both theoretic and practical aspects, but it is pursued (and continues to be defined) primarily through practice, until recently a little-studied area. Nursing

spans psychomotor and cognitive domains, and it has a very long history. Nurses have often failed to document and publish the results of their practice, but there is no indication that nurses tended not to acknowledge their influence on health. 9. One of the challenges that nurses have faced in the past, and which continues to the present, is the need to distinguish the practice of nursing from that of medicine. Which of the following statements best conveys a defining characteristic of nursing?

A) Education within a formal, credential-granting setting B) An emphasis on objective, rather than subjective, health assessment C) A holistic perspective on the health of individuals D) A recognition that health is not always attainable for all individuals Ans: C Client Needs: A-1




Objective: 6

Page and Header: 22, Distinguishing Nursing from Medicine

Feedback: Nursing is concerned with caring for the person from a holistic perspective in a variety of health-related situations. Both nursing and medicine are

taught in formal educational settings, though these settings differ. Nursing does not denigrate subjective health assessment nor does it claim that health is unattainable for some individuals.

10. Society has sometimes questioned whether nursing can be considered to be a true profession and whether nurses can be considered to be professionals. What characteristic of nursing is among the characteristics that social scientists use to define a profession? A) The median annual nursing wage is greater than $45,000. B) Nurses use the scientific method to enhance their body of knowledge. C) Nurses can be held legally accountable for their actions. D) Nursing has a demonstrated commitment to the well-being of the public. Ans: B Client Needs: A-1




Objective: 7

Page and Header: 27, Table 1.8 Feedback: Social scientists have identified seven criteria for a profession, including the use of the scientific method to enhance knowledge. Earnings and commitment to the public are not among the defining characteristics of a profession. Autonomy and accountability are criteria that are used to define a profession, but legal accountability

for actions is not restricted to professionals. 11. Among the traditions that exist in nursing education is a passing of the lamp ceremony that is sometimes conducted during graduation. This ceremony communicates

A) the light that nursing provides in communities and society. B) an acknowledgment of the contributions made by important nurses in history. C) the continuity of care from practicing nurses to newly graduated nurses. D) the need to continually build the nurses base of knowledge. Ans: C Client Needs: A-1

Cognitive Level: Knowledge Difficulty: Easy


Objective: 9

Page and Header: 31, Ceremonies Associated with Nursing Programs Feedback: Some schools use the tradition of a passing of the lamp. A representative of the graduating class hands a lamp to a representative of the next graduating class, thus

reinforcing the concept of the continual caring represented in nursing. This ceremony does not primarily emphasize the light of the profession, the contribution of nurses in history (though the lamp symbolizes the lamp carried by Florence Nightingale), or the need to add to existing knowledge.

12. A nurse who provides care on a medical unit at a community hospital is concerned about negative portrayals of nurses in the media. Why should this nurse be concerned with the image of nurses and nursing? A) A negative image of nursing can dissuade potential nurses from entering the profession. B) A negative image of nursing reduces patients adherence to treatment regimens. C) A negative image of nursing interferes with professional accountability in hospital settings. D) A negative image of nursing reduces the development of nursing knowledge. Ans: A Client Needs: C




Objective: 10

Page and Header: 32, The Image of Nursing Today Feedback: Negative attitudes about nursing may discourage many capable prospective

nurses, who will choose another career that offers greater appeal in stature, status, and salary. The image of nursing is not noted to influence patient adherence to treatment or accountability. A negative image may indirectly limit nursing knowledge through

reduced funding for research, but this phenomenon is less pronounced than the effect on potential nurses. 13. Megan, a 21-year-old junior college student, has been frustrated by her

unsuccessful attempts to gain entry to the nursing program at the local university despite her strong academic record and work experience. Which of the following factors has most contributed to the limited number of seats available in many

nursing programs? A) Technological developments that have decreased the projected need for nurses B) The tendency of practicing nurses to delay retirement until after the age of 65 years C) The high cost to educational institutions of providing nursing education D) The negative image of nursing in the media and popular culture Ans: C Client Needs: A-1




Objective: 10

Page and Header: Nursings Image and the Nursing Shortage

Feedback: A factor affecting the nursing supply is the limited number of spaces in nursing programs. Because nursing education is costly, many educational institutions

have not been able to increase the size of their programs in the past decade. This trend is not attributable to technological change, increased length of service, or the negative image of nursing.

14. Mrs. Jimenez is a 28-year-old pregnant woman who is in labor. Due to the fact that her labor was progressing very slowly, she was started on an infusion of oxytocin, a drug used to increase the progression of her labor. In the planning of Mrs. Jimenezs

care, the nurse has documented a Risk of Fluid Volume Excess in light of this common adverse effect of oxytocin. The nurse has demonstrated the use of what nursing classification system? A) The Minimum Data Set (MDS) B) Nursing Outcomes Classification (NOC) C) Nursing Interventions Classification (NIC) D) NANDA International (NANDA-I) Ans: D

Client Needs: A-1




Objective: 12

Page and Header: 40, NANDA International Feedback: Risk of Fluid Volume Excess is an example of a nursing diagnosis, which is the focus of NANDA-I. This does not denote an intervention or desired outcome. The MDS is an assessment tool specific to long-term care settings. 15. During the years of the 20th century, there was exponential growth in the number and quality of research studies that were conducted about nurses and nursing. What factor provided the original motivation for these studies? A) The entry of larger number of men into nursing schools and the nursing profession B) A desire to lessen the knowledge gap between nurses and physicians C) The low quality of nursing schools and nursing graduates D) Allocation of federal and state funding for nursing research Ans: C




Objective: 11

Page and Header: 35, Studies for and About Nursing

Feedback: In the early 20th century, nurses, doctors, friends, and critics of nursing became concerned that the preparation being offered was inadequate. Before the

problem could be corrected, it was necessary to learn more about the programs and how nurses were being used in the employment market. To accomplish this, studies about nursing and nurses were initiated. These studies did not primarily result from

increased funding opportunities, the entry of men into the profession, or the knowledge gap between doctors and nurses.

Chapter: Chapter 2: Educational Preparation for Nursing Multiple Choice

1. Manuel has a baccalaureate degree in biology and wishes to make a career change to eventually become an advanced practice RN. Which of the following courses of study would be the most time-efficient choice to meet his educational goals?

A) Masters degree in nursing B) Baccalaureate degree in nursing C) Doctoral degree in nursing D) Associate degree in nursing Ans: D Client Needs: A-1




Objective: 2

Page and Header: 53, Characteristics of Associate Degree Education Feedback: Students may be admitted to masters programs in nursing with a baccalaureate degree in another discipline and are granted a masters degree in nursing after completing an established 2-year program of study that prepares them

for RN licensure. However, people who already possess baccalaureate or higher degrees in other fields sometimes seek admission to an associate degree program, often because it can be completed in a shorter period of time than would be needed to earn another baccalaureate degree (though accelerated baccalaureate programs are

becoming more common). 2. Which nursing report recommended that nursing education move away from the system of apprenticeship that predominated at the time and move toward a planned program of education similar to that offered by other professions? A) The Surgeon Generals Consultant Group Report on Nursing B) The Brown Report C) The American Nurses Association Position Paper D) The Pew Health Profession Commission Study Ans: B

Client Needs: A-1




Objective: 4

Page and Header: 72, The Brown Report

Feedback: In Nursing for the Future, Brown (1948) recommended that nursing education move away from the system of apprenticeship that predominated at the time and move toward a planned program of education similar to that offered by other

professions. This predated the Surgeon Generals Consultant Group Report on Nursing, the American Nurses Association Position Paper, and the Pew Health Profession Commission Study.

3. Which of the following accurately states a major position of the ANA Position Paper on Educational Preparation? A) The education of those who are licensed to practice nursing should take place in hospitals. B) Minimum preparation for beginning professional nursing practice at the present time should be an associate degree in nursing. C) Minimum preparation for beginning technical nursing practice at the present time should be a baccalaureate degree in nursing. D) Education for assistants in health service occupations should be short, intensive preservice programs in vocational educational institutions. Ans: D

Client Needs: A-1


Difficulty: Moderate Integrated Process: Nursing Process

Objective: 5

Page and Header: 74, Display 2.2 Feedback: One of the four major positions of the ANA Position Paper on Educational

Preparation is that education for assistants in the health service occupations should be short, intensive preservice programs in vocational education institutions, rather than on-the-job training programs. It also states that the education of all those who are licensed to practice nursing should take place in institutions of higher education, not

in hospitals. The paper specifies an associate degree as the minimum for technical nursing and a baccalaureate degree for professional nursing. 4. Sister Calista Roy identified an adaptation model that characterizes the individual as being in constant interaction with a changing environment, therefore requiring adaptation. Which of the following identifies an adaptive mode listed in her theory? A) Role function B) Nutrition C) Spirituality D) Genetic makeup

Ans: A

Client Needs: A-1




Objective: 9

Page and Header: 84, Table 2.2

Feedback: Roy identifies four adaptive modes, or ways in which a person adapts through: (1) physiologic needs, (2) self-concept, (3) role function, and (4) interdependence relations. Nutrition, spirituality, and genetic makeup are not discrete concepts within this theory.

5. Mr. Van is a 79-year-old widower who is being transferred to a long-term facility following hip replacement surgery. The nurse in charge of his care hopes to provide holistic nursing care for him based on his response to the interaction between his internal and external environment. This approach represents the model

of care proposed by which of the following theorists? A) Dorothy Johnson B) Madeleine Leininger C) Dorothea Orem D) Myra Levine Ans: D Client Needs: A-1


Difficulty: Difficult Integrated Process: Nursing Process

Objective: 9

Page and Header: 84, Table 2.2 Feedback: Levine supports a holistic approach to nursing based on recognition of the total response of the person to the interaction between the internal and the external environment. This approach is not specified by Johnson, Leininger, or Orem. Multiple Selection 6. A college sophomore has become disillusioned with her current field of studies and has begun exploring careers in nursing. To her surprise, she is unable to identify any

hospital-based programs of study in her home state. Which of the following factors have contributed to the demise of hospital-based diploma programs? (Select all that apply.) A) Increased patient acuity in hospitals B) Increased popularity of college- and university-based nursing programs C) The growth of managed care and its influence on hospital management D) Increased costs to hospitals for maintaining nursing programs

E) The emergence of the baccalaureate degree as the entry to technical nursing practice Ans: B, D

Client Needs: A-1




Objective: 1

Page and Header: 52, Hospital-Based Programs Today Feedback: The elimination of hospital-based programs occurred because hospitals could not sustain the costs of supporting the programs and because students became more attracted to programs located in colleges and universities. Patient acuity and managed care have not been identified as causative factors. The baccalaureate degree

has been proposed as the entry to professional nursing practice, not technical nursing. Multiple Choice 7. Kirsten is a 22-year-old woman who has just been granted admission to an associate degree program at a local college. During her course of study, Kirsten should expect to complete A) the National Council Licensure Examination (NCLEX).

B) a preceptorship under the direction of a licensed practical (vocational) nurse.

C) a major, original research project immediately prior to graduation. D) numerous nonnursing courses in a variety of disciplines. Ans: A Client Needs: A-1 Cognitive Level: Application

Difficulty: Easy


Objective: 1

Page and Header: 53, Characteristics of Associate Degree Education Feedback: In a typical ADN program, approximately 40% of the credits needed for the associate degree must be fulfilled by general education courses such as English,

anatomy, physiology, speech, psychology, and sociology; the rest are to be fulfilled by nursing courses. Original research is not a component of undergraduate nursing education, and preceptorships are normally completely under the direction of an RN. The NCLEX is written after graduation. 8. Ben is a 30-year-old man who has applied for an accelerated baccalaureate program at a university because the 15-month program of study will allow him to accommodate his family and financial responsibilities. In order to be granted admission, what will Ben most likely require? A) A varied work history that demonstrates initiative and responsibility

B) A baccalaureate degree in another field

C) A mentor or sponsor within the nursing field D) Volunteer experience in a health-related setting Ans: B Client Needs: A-1




Objective: 3

Page and Header: 59, Accelerated Programs Feedback: Building on previous learning experiences, accelerated programs are designed to transition adults with baccalaureate and graduate degrees in other fields

into nursing. A strong work history, volunteer experience, and an available mentor in the field are all assets for success, but these are less likely to be absolutely required for admission. 9. Julia has just graduated with her Bachelor of Science in Nursing degree from her state university and has begun seeking employment. However, she is anxious about

her level of clinical competence due to the fact that she completed far fewer clinical hours than many practicing nurses. Which of the following has the potential to ease Julias transition to practice? A) Completing a residency or internship at the hospital where she will be employed

B) Auditing courses in a nonnursing, health-related discipline

C) Working for several months as a nursing assistant in order to gain confidence D) Taking online courses in advanced nursing practice Ans: A Client Needs: A-1




Objective: 2

Page and Header: 68, Residencies and Structured Orientation for the New Graduate Feedback: Internships and residencies for new graduates have been instituted by

hospitals to ease the transition from the role of student to that of staff by providing the opportunity to increase clinical skills and knowledge as well as self-confidence. Taking more academic courses and/or working as a nursing assistant are unlikely to

increase Julias confidence and competence in her clinical nursing role. 10. According to the ANA Position Paper on Educational Preparation, which of the following four individuals is adequately prepared to provide care? A) A nursing assistant who has just completed an on-the-job training program in a local hospital B) A nurse who graduated from a hospital-based diploma program

C) A nurse in a high-acuity setting who possesses an associate degree in nursing (ADN) degree D) A nursing assistant who graduated from the training program at a community college Ans: D

Client Needs: A-1




Objective: 5

Page and Header: 74, Display 2.2 Feedback: The ANA Position Paper specifies that education for assistants in the health service occupations should be short, intensive preservice programs in

vocational education institutions, rather than on-the-job training programs. The Paper also specifies a minimum of an ADN degree for all nursing practice and a baccalaureate degree for professional nursing (e.g., in high-acuity settings). 11. Nurse. L. provides care in a state that has mandatory continuing education

requirements for nurses. What are the consequences of this policy for Nurse L.?

A) Nurse L. must demonstrate a commitment to making practice improvements. B) Nurse L. must have a baccalaureate degree in order to provide professional nursing care. C) Nurse L. is obliged to update her diploma to an associate degree. D) Nurse L. must demonstrate continuing education for license renewal. Ans: D Client Needs: A-1




Objective: 6

Page and Header: 69, Continuing Education Feedback: Mandatory continuing education affects licensure, meaning that any nurse renewing a license in a state requiring (mandating) continuing education will have to satisfy that requirement. However, this does not necessarily mean that a nurse must update his or her degree or diploma or undertake practice improvements. 12. The administrators of a large, university hospital have expressed a commitment to differentiated nursing practice. Which of the following most clearly exemplifies differentiated practice? A) Each nurse performs a role that is commensurate with his or her education and experience level. B) Each nurse in the hospital is expected to provide competent care in a variety of different settings.

C) Nurses demonstrate evidence of continuing education in two or more different specialties. D) Each nurse in the hospital possesses an ADN or baccalaureate degree in nursing. Ans: A Client Needs: A-1




Objective: 7

Page and Header: 77, Differentiated Practice Feedback: Differentiated nursing practice can be defined as the practice of structuring nursing roles on the basis of education, experience, and competence. It does not necessarily specify the provision of care in diverse settings, evidence of continuing education, or the possession of a nursing degree. 13. A nurse manager who oversees the provision of community-based care to a large number of clients has been mandated to implement differentiated care over the next year. In order to carry out this directive, the nurse manager must be able to

A) teach each nurse to become a generalist rather than a specialist.

B) identify the evidence that underlies the nursing care that is provided.

C) clearly identify the specific roles and tasks that these nurses perform. D) hire more licensed practical (vocational) nurses. Ans: C Client Needs: A-1

Cognitive Level: Application Difficulty: Difficult


Objective: 7

Page and Header: 77, Differentiated Practice Feedback: Differentiated practice requires that the specific roles that are performed in the provision of care be clearly identified and delineated. This is necessary in order to appropriately match individual care providers to particular tasks and functions. Nurses do not need to become generalists nor are more practical nurses necessarily required. Evidence underlying nursing care should be identified, but this is not necessary for differentiated care. 14. Pressure from students and the healthcare industry has prompted the nursing educators at a college to implement new technology into the nursing education that they provide. Which of the following statements is true of technological change and nursing education? A) Technology is typically high in colleges and universities but low in hospitals and other care settings.

B) Many of the purported educational benefits of technology have not been demonstrated in the nursing literature. C) Computer literacy is high among students but most nursing educators lack computer skills. D) The costs of integrating new technology into nursing education can be prohibitive. Ans: D Client Needs: A-1




Objective: 8

Page and Header: 80, Computer Technology in the Classroom Feedback: High-technology equipment is often expensive, a fact that often presents a challenge to educational institutions. The benefits of technology in learning have been demonstrated and computer literacy is nearly universal. Hospitals are high-technology work environments. 15. The faculty members of a college-based school of nursing have taken action to increase the teaching and clinical time in the curriculum that is devoted to community-based nursing. Which of the following phenomena provides the most valid rationale for this change? A) Public mistrust of hospitals is increasing and many individuals prefer to remain at home. B) The number of patients who qualify for Medicare and Medicaid is increasing.

C) Patients are typically discharged from the hospital much earlier than in the past. D) Evidence demonstrates that students learn more in the community than in the hospital. Ans: C

Client Needs: A-1




Objective: 8

Page and Header: 82, Increasing Community-Based Practice Experiences Feedback: Earlier hospital discharge to the home and an increasing emphasis on prevention has created new demands on nursing in the community. This shift is not rooted in mistrust of hospitals, a lack of learning in hospitals, or trends in Medicare and Medicaid. Chapter: Chapter 3: Credentials for Healthcare Providers Multiple Choice 1. What is the major advantage of sunset laws?

A) Nurses can modify their standards of practice on a daily basis.

B) They guarantee that the legislature will review and evaluate agencies and programs.

C) The legislature can close facilities that do not meet governmental requirements. D) Facilities must renew their accreditation in a specified amount of time.

Ans: B

Client Needs: A-1




Objective: 4

Page and Header: 102, Sunset Laws and Nurse Practice Acts

Feedback: Because sunset laws are set to expire at a specified point in time, legislatures are obligated to review and evaluate them prior to expiry. Sunset laws do not directly influence the nurses standards of practice, the quality of healthcare facilities, or the accreditation process.

2. A nurse who is licensed to practice in Pennsylvania decides to seek a nursing position in Florida. This nurse would obtain this license by which of the following methods? A) Licensure by endorsement

B) Licensure by examination

C) Licensure by renewal

D) Reciprocal licensure Ans: A Client Needs: A-1

Cognitive Level: Comprehension Difficulty: Moderate


Objective: 6

Page and Header: 104, Obtaining a Nursing License Feedback: The method of obtaining a license when the nurse is already licensed in another jurisdiction is called licensure by endorsement; this is an alternative to license by examination. This transfer is not termed reciprocal licensure or licensure by renewal. 3. A nursing board asks the court to stop a nurse from practicing until it investigates allegations that the nurse was providing care while under the influence of alcohol. What is the name of the process that allows this action? A) Revocation

B) Suspension C) Injunctive relief D) Court investigation Ans: C Client Needs: A-2




Objective: 7

Page and Header: 100, Grounds for Disciplinary Action

Feedback: A board of nursing may be authorized to ask a court to halt a specific practice that it believes is contrary to the law until a full hearing can be held. This is

called injunctive relief. This term refers to the court order called an injunction that requires an individual or organization to stop a particular activity, such as practicing nursing. The investigation is performed by the board, not the court. Revocation

involves the removal of a license, and suspension does not typically involve the courts.

4. Which of the following is a recommendation of the Institute of Medicine report Health Profession Education: A Bridge to Quality (2003)? A) Developing separate core competencies to regulate each health profession B) Revising the processes of accreditation bodies to require outcomes related to core competencies C) Allowing each profession to educate, practice, and dialogue within its own boundaries D) Changing healthcare workforce regulations based on what is termed a safe focus Ans: B Client Needs: A-1



Integrated Process: Nursing Process Objective: 10

Page and Header: 117, Institute of Medicine Recommendations Feedback: The IOM report recommended that both licensing bodies and specialty

certification bodies require health professionals to demonstrate in some way their continued competence in the previously determined core competencies. The report does not advocate the development of separate core competencies, the

isolation of each profession, or changes to workforce regulations. 5. A nurse administers insulin to a diabetic patient via an insulin pump. Based on the NCLEX examination, this action would fall under which of the categories of client needs? A) Safe effective care environment B) Health promotion and maintenance C) Psychosocial integrity D) Physiological integrity Ans: D Client Needs: A-1




Objective: 6


Feedback: The client needs category of physiological integrity encompasses nursing actions that address a clients physical needs and the treatment of illness. Administration of medication is not normally considered a health promotion activity,

an aspect of psychosocial integrity, or a demonstration of safety measures.

6. A nurse who has provided care in acute settings for several years has begun the process of gaining additional credentials. Which of the following statements best describes credentials? A) Credentials indicate that an individual has demonstrated a continuing commitment to competence. B) Credentials recognize an individuals professional superiority to his or her peers. C) Credentials indicate that an individual has met specific criteria and standards. D) Credentials indicate that an individual has the authority to direct practice in a particular care setting. Ans: C

Client Needs: A-1




Objective: 1

Page and Header: 89, Introduction Feedback: Credentials indicate that an individual (or organization) has met specific standards that are important to fulfilling a professional mandate. This is not necessarily synonymous with a continued commitment, though such a commitment may help facilitate the attainment of credentials. Individual credentials do not necessarily indicate superiority or leadership potential. 7. After completing an associate degree in nursing and passing the NCLEX-

RN examination, a nurse has been granted a license to practice. A license to practice provides the nurse with

A) formal recognition of the nurses graduation from an accredited school of nursing.

B) legal permission to practice the nursing profession.

C) the authority to practice nursing in any state. D) recognition of advanced learning and competence in a particular care setting. Ans: B Client Needs: A-1


Difficulty: Easy


Objective: 2

Page and Header: 92, Licensure

Feedback: A license is a legal credential awarded by an individual state that grants permission to that individual to practice a given profession. A license is normally specific to a particular jurisdiction. It does not denote advanced learning in a specific setting. Graduation from a school of nursing is required for licensure, but a license does not explicitly document this education.

8. The students and faculty of a school of nursing are pleased that the school has recently been granted a renewal of its current accreditation. Accreditation of a school of nursing is based primarily on which of the following? A) The proportion of graduates who pass the NCLEX-RN B) The academic credentials of faculty members C) The findings of an external review committee D) The overall contribution of the school to the body of nursing knowledge Ans: C Client Needs: A-1




Objective: 3

Page and Header: 89, Accreditation of Educational Institutions Feedback: Accreditation of a school of nursing is primarily based on the findings of nursing experts who visit the institution and appraise the education that is provided. Other factors may be considered, such as the success of graduates, the credentials of

instructors, or the research that is conducted, but the findings of external reviewers are paramount. 9. A state board of nursing is legally empowered to carry out the provisions of the Nurse Practice Act. Which of the following activities best demonstrates the mandate and jurisdiction of a state board of nursing? A) Advocating for nurses during labor negotiations B) Organizing information campaigns to enhance the public perception of the nursing profession C) Specifying the way that nursing care is organized in public hospitals D) Establishing the standards that nurses must meet in order to be licensed Ans: D Client Needs: A-1




Objective: 5

Page and Header: 103, The Role of the State Board of Nursing

Feedback: State boards of nursing perform multiple functions, including examination and licensure of nurses. Participation in labor negotiations, advertising to increase awareness of the profession, and specifying the way that care is provided are activities that are normally beyond the purview of a state board of nursing.

10. A registered nurse who completed her education in the Philippines and who is in

the process of immigrating in the United States is attempting to obtain a license to practice in New Jersey, her intended state of residence. In order to obtain a license, the nurse will primarily be in contact with

A) the New Jersey Board of Nursing.

B) the American Nurses Association (ANA).

C) one of the accredited schools of nursing in New Jersey. D) the National Council of State Boards of Nursing, Inc. (NCSBN). Ans: A Client Needs: A-1


Difficulty: Easy


Objective: 5

Page and Header: 103, The Role of the State Board of Nursing Feedback: Licensure is one of the main responsibilities of state boards of nursing, and a nurse seeking a license to practice in a particular state must obtain a license from that states board of nursing. Schools of nursing, the ANA, and the NCSBN do not directly grant licensure. Multiple Selection 11. Amanda is a nurse who currently works in a community clinic in a city near state lines. She is exploring employment possibilities in a neighboring state and hopes to obtain a license through mutual recognition of licensure. Which of the following conditions must be met in order for Amanda to obtain a nursing license in this manner? (Select all that apply.) A) Amandas home state must be party to the Nurse Licensure Compact. B) Amanda must obtain a nursing license in the intended state as well as in her home state. C) Amanda must meet the standards for licensure in the state where she intends to practice. D) The state in which Amanda wishes to practice must belong to the Nurse Licensure Compact. E) Amanda must possess an ADN or baccalaureate degree in nursing. Ans: A, C, D Client Needs: A-1




Objective: 8

Page and Header: 109, Mutual Recognition of Licensure

Feedback: Obtaining a license through mutual recognition of licensure requires that an individuals home state and the intended state of practice be party states. As well, an applicant must qualify for licensure in the intended state. A diploma in nursing

does not preclude transfer of licensure, and an individual may not possess licenses in both states simultaneously.

Multiple Choice

12. Under the provisions of the Nurse Licensure Compact (NLC), a nurse who is licensed in Arizona has been practicing for the past year in New Mexico. The nurse is alleged to have become involved in an inappropriate relationship with a patient in New Mexico and grounds for disciplinary action appear to exist. How will the

discipline of this nurse most likely proceed? A) The New Mexico Board of Nursing may withdraw the nurses license if this is deemed necessary. B) The nurses discipline is referred to the American Nurses Association because two state boards of nursing have interest in the matter. C) The New Mexico Board of Nursing will undertake investigation, but the Arizona State Board of Nursing will implement appropriate discipline. D) The New Mexico Board of Nursing will be unable to change the Arizona licensure status of the nurse. Ans: D

Client Needs: A-1 Cognitive Level: Application



Objective: 8

Page and Header: 110, Concerns Regarding Mutual Recognition of Licenses Feedback: A major concern with mutual recognition is the disciplinary process. Although the board of nursing can investigate nursing practices and enforce its own

standards in the state, it cannot change the licensure status of the person whose licensure originates in a different state. The ANA does not participate in disciplinary matters, and a state would not normally undertake discipline based on an investigation in another party state. 13. Nurse T. has been notified by her state board of nursing that a complaint has been lodged regarding her practice. How should Nurse T. best respond to this news? A) Retain the services of an attorney. B) Organize a private meeting between her and the complainant. C) Have colleagues write statements attesting to her competence. D) Explore practice opportunities in other states.

Ans: A

Client Needs: A-1




Objective: 8

Page and Header: 110, Revocation of Limitation of a License

Feedback: The individual being investigated for any violation of the Nurse Practice Act should have an attorney who is knowledgeable about professional disciplinary issues from the time of notification of the complaint. This is an important action,

whether or not there are grounds for the accusation. A meeting with the complainant would be inappropriate, and enlisting support from colleagues would be a secondary concern compared with hiring an attorney. It would be premature, and likely

inappropriate, to explore options out-of-state at this early stage.

14. A nurse has been working in pediatrics for 6 years since graduating from an accredited nursing school. The nurse is now interested in pursuing American Nurses Credentialing Center certification as a pediatric Clinical Nurse Specialist. What factor will primarily determine whether the nurse obtains this ANCC certification? A) Enrollment in a PhD, DNS, or DNP degree program B) A review of the nurses marks from nursing school and interviews with managers and colleagues C) Completion of an original research project related to pediatric nursing D) The demonstration of knowledge and skills in beyond those required for licensure as an RN Ans: D

Client Needs: A-1




Objective: 9

Page and Header: 114, American Nurses Credentialing Center Certification Feedback: ANCC certification is a method of recognizing nurses who have special

expertise. Applicants must demonstrate current practice and knowledge beyond that required for licensure as an RN. Enrollment in a doctoral program is not necessary. Marks from nursing school, the opinions of supervisors, and the completion of

research do not form the basis for certification. 15. The Institute of Medicine (IOM) report Health Profession Education: A Bridge to Quality (2003) came to several conclusions around the issues confronting health professions education. Which of the following issues was addressed in the report? A) The tendency of each health discipline to educate and practice independently of the other disciplines

B) The lack of recognition of credentials and the credentialing process outside of the field of nursing C) The trend toward managed care and the inability of nursing educators to adapt to this change D) The historical animosity between nursing and medicine and the failure to bridge this gap Ans: A

Client Needs: A-1




Objective: 10

Page and Header: 117, Institute of Medicine Recommendations Feedback: The IOM noted that each health profession tends to educate, practice, and dialogue within a silo. These narrowly constructed walls make it difficult for interdisciplinary collaboration to occur. The report does not focus on the relationship between medicine and nursing, the trend toward managed care, or the lack of recognition of credentials. Chapter: Chapter 4: Making Professional Goals a Reality Multiple Choice 1. Which organization developed the most definitive statements on the competencies needed by the newly licensed practical nurse (PN) and the RN? A) National Council of State Boards of Nursing (NCSBN)

B) American Association of Nurses (ANA) C) National League for Nursing (NLN) D) American Association of Colleges of Nursing Ans: A Client Needs: A-1


Difficulty: Easy


Objective: 2

Page and Header: 124, National Council of State Boards of Nursing Competencies Feedback: The most definitive statements on the competencies needed by the newly licensed practical nurse (PN) and the RN have been developed by the NCSBN based on its job analysis studies, which serve as the basis for the NCLEX-RN and NCLEX-PN. 2. In what type of healthcare setting are the most RNs currently employed?

A) Ambulatory care centers

B) Doctors offices

C) Acute care hospitals

D) Long-term care facilities Ans: C Client Needs: A-1

Cognitive Level: Knowledge

Difficulty: Easy


Objective: 1

Page and Header: 122, Employment Opportunities Today Feedback: As of 2008, over 89% of nurses worked in hospital settings, 4.8% worked in long-term care, and 4.3% worked in community-based or ambulatory care settings. Only 1.7% of nurses indicated that they worked in other settings. 3. Which of the following statements accurately reflects what employers generally should expect when hiring a newly graduated RN? A) The RN should be proficient with the documentation system used by the institution. B) The RN should be able to perform all nursing skills, enabling him or her to work independently. C) The RN should function with speed comparable to that of the other nurses. D) The RN should be able to develop plans of care and follow plans developed by the agency. Ans: D

Client Needs: D-1




Page and Header: 126, Employers Expectations Regarding Competencies Feedback: New graduates should be able to develop plans of care and follow plans, such as care pathways, that have been developed by the agency. Proficiency, speed, and complete independence are developed over time and with increased experience

and orientation. 4. A nurse decides to apply for a position in a hospital in her hometown. Which of the following statements provides good advice for her job quest? A) She should call the human resources department and speak to the person who is in charge of hiring nurses. B) She should include a cover letter with her rsum that is no more than two pages long and briefly reiterates the information found in the rsum. C) She should invest in a professionally prepared rsum to make a better impression on potential employers. D) She should focus her rsum on accomplishments and use active verbs to describe her skills. Ans: D

Client Needs: A-1




Objective: 5

Page and Header: 138, Employment History

Feedback: In a rsum, it is best to focus on accomplishments and use active verbs to describe skills. Professional preparation of a rsum is not necessary, and telephone communication is generally discouraged. A cover letter should ideally not exceed one page in length.

5. Which of the following is a recommended guideline when resigning a position? A) Provide the employer with 2 weeks to seek a replacement. B) Clearly state the details if you wish to be compensated for any vacation or holiday time accrued. C) If resigning because of problems in the work setting, it is a good idea to put the reason in the resignation letter. D) Place comments regarding positive factors experienced in the workplace in a separate correspondence from the resignation letter. Ans: B

Client Needs: A-1




Objective: 5 Page and Header: 151, Resignation Feedback: If you have accrued vacation or holiday time and want to take the time off or be paid for it when resigning, clearly state that. A months notice is ideal, and a resignation letter should not go into detail regarding the contributing problems in the workplace. Positive factors experienced in the workplace may be included in the

resignation letter. 6. A student nurse is scheduled to graduate in a few weeks and is preparing to begin searching for employment. Which of the following statements best conveys an aspect of the current job market for nurses? A) Most nursing graduates are expected to perform in the role of a nursing assistant or practical (vocational) nurse after graduation. B) The majority of nursing opportunities for new graduates are in international settings. C) Job openings in acute care have decreased in many places but long-term care openings continue to grow. D) The increasing severity of the nursing shortage means that job opportunities for nursing graduates are greater than ever.

Ans: C

Client Needs: A-1




Objective: 1

Page and Header: 122, Employment Opportunities Today

Feedback: Positions for new graduate RNs have recently decreased. This is due in part to the effects of the economic recession. Although hospital vacancies have decreased in many places, those in long-term care continue to increase. Some, but not most, graduates may find work in other roles, and a minority of positions are in international settings.

7. A recent nursing graduate is attempting demonstrate the competencies that she learned as a nursing students and to reconcile the expectations of her new colleagues and employer with her own abilities. Which of the following tasks is the most important and most frequently performed? A) Helping patients and families navigate the healthcare environment B) Applying the principles of infection control and standard precautions C) Initiating vascular access and maintaining peripheral and/or central IV access D) Liaising with members of other health disciplines to ensure safe and continuous care Ans: B

Client Needs: A-1

Cognitive Level: Application Difficulty: Moderate


Objective: 2

Page and Header: 125, Display 4.1 Feedback: Apply principles of infection control (e.g., hand hygiene, room assignment,

isolation, aseptic/sterile technique, universal/standard precautions) is among the most

common, and most important, nursing actions as identified by nursing organizations.

Patient advocacy, interdisciplinary cooperation, and IV therapy are all important, but none is performed as frequently as infection control measures. 8. Healthcare institutions expect that nursing graduates will be able to apply their theoretic knowledge for safe client care. Which of the following actions best demonstrates this?

A) Creating a nursing care plan for a newly admitted patient

B) Responding appropriately to a patient complaining of chest pain C) Advocating for a patients interests with members of other disciplines D) Conducting a thorough and thoughtful search for nursing employment Ans: B

Client Needs: A-2




Objective: 3

Page and Header: 126, Employers Expectations Regarding Competencies Feedback: Responding appropriately to an emergent health threat is a demonstration of safe care and the appropriate application of knowledge. Patient advocacy and creating care plans are functions that are less closely related to patient safety. Searching for a job is not linked to safe client care.

9. The expected competencies of new nursing graduates are not standardized and can vary between institutions and organizations. Most nursing and healthcare

organizations, however, agree that recent graduates should be able to use the nursing process in a systematic way. Which of the following nursing activities best exemplifies this competency? A) The nurse identifies a nursing diagnosis of Impaired Skin Integrity based on an assessment and plans to reposition the patient. B) The nurse administers an ACE inhibitor to a patient with high blood pressure. C) The nurse makes a referral to occupational therapy for a patient with a neurological deficit. D) The nurse attends an inservice on pain control that is conducted by a nurse educator. Ans: A




Objective: 3

Page and Header: 126, Employers Expectations Regarding Competencies Feedback: The nursing process includes assessment, analysis, planning, intervention, and evaluation. Identifying a nursing diagnosis on the basis of an assessment exemplifies the early stages of this process. Learning about pain management, administering a medication, and making a referral to another discipline may also exist

within the framework of the nursing process, but the steps of this process are not as clearly evident in these examples. 10. A patient has just been transferred to the acute medicine unit from the intensive care unit and the patients arterial line has not yet been discontinued. The nurse on the acute medicine unit is a recent graduate and does not have experience in caring for an arterial line. As a result, the nurse is unsure how to safely address this aspect of the patients care. How should the nurse best respond? A) Look up arterial lines in the policy and procedures manual on the unit.

B) Inform the unit manager that this patient assignment is inappropriate.

C) Enlist the help of a more senior nurse on the unit. D) Have the patient transferred back to the intensive care unit.

Ans: C

Client Needs: A-2




Objective: 3

Page and Header: 126, Employers Expectations Regarding Competencies Feedback: To provide safe care, the nurse must identify when a situation requires greater expertise or knowledge and when assistance is needed. Asking a colleague for

assistance is an appropriate demonstration of this competency. Looking up a procedure in a policy manual is an appropriate action but does not show a willingness to ask others for help. It would likely be premature to refuse the care of this patient or to have him or her transferred.

11. After several months of working on an acute care for elders (ACE) unit following her graduation, Theresa has decided to focus her nursing career on working with older adults. What action is most likely to help Theresa meet this career goal? A) Cultivating a passion for the health of the older adult population B)

Networking with prominent older adults in the community C) Performing original research that adds to the knowledge of this populations needs D) Working toward certification in gerontological nursing Ans: D Client Needs: A-1




Objective: 4

Page and Header: 128, Focusing Your Goals Feedback: Certification in a particular nursing specialty has the potential to increase a nurses opportunities in that field. Passion, networking, and research may all be of some benefit, but certification is more likely to create tangible career opportunities. 12. After identifying a job posting in his or her field of specialty, a diabetes nurse has submitted a letter of application and a rsum. What is the primary function of a letter of application? A) To introduce the applicant to the employer in a personal way B) To state why the nurse left his most recent position C) To demonstrate the nurses work ethic D) To summarize the content of the rsum in a succinct way Ans: A

Client Needs: A-1




Objective: 5

Page and Header: 133, Letter of Application

Feedback: A letter of application provides the opportunity for a nurse to reveal a bit of

his or her personality and connects his or her experience to the positions requirements.

The purpose is not primarily to summarize the rsum or demonstrate a work ethic. It is

inappropriate to state reasons for leaving previous positions in a cover letter.

13. During her final clinical placement, a nursing student worked with two of her fellow students to plan a health fair that took place in a local community center. How should she best characterize this activity on her rsum? A) I was a member of the steering committee for a community health fair. B) Organized a community health fair. C) I have strong organizational skills. D) Assisted with the organization of a community health fair. Ans: B Client Needs: A-1




Objective: 5

Page and Header: 139, Display 4.3 Feedback: Option B provides the most succinct and action-oriented description of the activity. Option A lacks an action verb, while option C is imprecise and not descriptive. Option D is less direct and less action oriented than option B. 14. A nursing student who has held a variety of nonnursing positions is scheduled to graduate in a few weeks and is searching for a nursing job. The student has responded to a posting at a local hospital that asks for two references. Which of the following individuals would be the best choices for these two references? A) A trusted coworker and a nurse who supervised the student during a preceptorship B) A family friend who knows the student well and the associate dean of the nursing school C) The two work supervisors with whom the student has the strongest rapport D) A nursing instructor and the supervisor of the students latest job Ans: D

Client Needs: A-1




Objective: 5

Page and Header: 142, References

Feedback: A primary reference should be an instructor from your basic educational program. This person would be able to affirm your ability in the nursing field. Another reference should be someone who has employed you and who can describe your work habits and effectiveness as an employee. Coworkers and family friends are not normally appropriate references.

15. In response to her recent job application, a nurse has been contacted by a member of the hospitals human resources (HR) department in order to schedule an interview. The nurse should A) bring several copies of her rsum to the interview.

B) ask the HR representative how she should dress for the interview. C) do research so that she can avoid asking questions during the interview. D) ask the interviewers about their work history and areas of career interest. Ans: A

Client Needs: A-1




Objective: 6, 7

Page and Header: 145, Things to Take with You Feedback: Take several copies of your rsum with you to the interview. You may want

to refer to it, or you may find it appropriate to leave a copy with someone. It is best to dress formally rather than asking for direction in this matter. It is appropriate to ask questions during an interview, but these should not focus on the work of the

interviewers. Chapter: Chapter 5: The World of Healthcare Employment Multiple Choice 1. What is the basic tenet of shared governance? A) It allows nursing staff and management to be involved in decision-making. B) It

establishes the control of the institution over the actions of the nursing staff. C) It

allows the administrative decision area to be controlled by management. D) It supports the traditional role of the supervisor as one who hires, evaluates, promotes, and fires. Ans: A Client Needs: A-1




Objective: 3

Page and Header: 166, Shared Governance Model

Feedback: Shared governance may be viewed as a system in which nurses have organizational autonomy as reflected in control over their practice, and have input into

decision relating to patient care. It is a professional practice model in which both the nursing staff and the nursing management are involved in decision-making, as opposed to the administrative decision area being controlled by management. In this

way, it is an alternative to traditional supervision models and hierarchies.

2. A nurse is assigned for the care of each patient from the time the patient is admitted to the hospital until that patients discharge. What system of care delivery is most likely in place? A) Functional care B) Primary care C) Modular

care D) Team care Ans: B Client Needs: A-1




Objective: 5

Page and Header: 171, Primary Care Nursing Feedback: In a pattern of primary care, one nurse was assigned the responsibility for

the care of each patient from patient admission until that patients discharge. The primary nurse was responsible for initiating and updating the nursing care plan, patient teaching, and discharge planning. An associate nurse worked with this same

patient on other shifts and on the primary nurses day off, carrying out the plan of care developed by the primary nurse. 3. Nurses working in a hospital initiate a negotiating session in which they offer to take a pay cut to allow management to provide job security and to hire more nurses to alleviate understaffing. What is the term for this type of session? A) Interest-based bargaining B) Collective action bargaining C) Concession bargaining D) Good faith bargaining Ans: C Client Needs: A-1 Cognitive Level: Analysis



Objective: 6

Page and Header: 177, Bargaining and Negotiating

Feedback: Concession bargaining is a process in which there is an explicit exchange of reduced labor costs for improvements in job security. This specific tradeoff is not a characteristic of interest-based bargaining, collective action bargaining, or good faith bargaining.

4. Nurses decide to go on strike to try to force improvement in the quality of

patient care in their facility. Once the strike is resolved, what are their options for being rehired by the facility under the reinstatement privilege that is in effect in their contract? A) They will be rehired after the strike whether or not it is decided that the strike was lawful. B) They will be rehired after the strike as positions become available provided they have not engaged in unfair labor practices. C) They will be rehired to replace nurses hired during the strike who were hired to replace them. D) They will be rehired at their former job as soon as the strike is resolved. Ans: B Client Needs: A-1




Objective: 7

Page and Header: 181, Reinstatement Privilege Feedback: A reinstatement privilege is a guarantee offered to striking employees that they will be rehired after the strike as positions become available, provided that they have not engaged in any unfair labor practices during the strike, and provided that the strike itself is lawful. 5. Which of the following statements accurately reflects the general use of the grievance process by nurses? A) Grievances usually are related to interpretations of a contract or to policies and procedures. B) Although either the management or an employee can file grievances, in most instances it is management that initiates the case. C) A grievance involves informal talk between the management and the employee until the issue is resolved. D) Employees may have grievances about the contract negotiation process itself. Ans: A Client Needs: A-1




Objective: 9

Page and Header: 173, Grievance Process

Feedback: A grievance is a circumstance or action believed to be in violation of a contract (or of policies of an institution if a contract is not in place). Grievances

usually are related to interpretations of a contract or policies and procedures and they are usually initiated by employees. Although resolution may begin with an informal talk, this proceeds to a formal process if resolution is not achieved.

6. As part of the development of a new inner-city clinic, a group of nurses and members of other health disciplines have drafted a mission statement for the clinic. This statement will most likely specify

A) the priorities for the health of the identified population.

B) the main goals and functions that the organizers envision for the clinic. C) the philosophies and beliefs that underlie the existence and functioning of the clinic. D) the health outcomes that the organizers see as currently lacking in the community. Ans: B Client Needs: A-1




Objective: 1

Page and Header: 156, Mission Statement and Philosophy Feedback: The purpose of an organization is often expressed in the form of a mission statement, which outlines what the organization plans to accomplish, including its goals and function. This may or may not identify the philosophy of the organization, specific health outcomes, or priorities for the health of residents. 7. Which of the following conditions must be met in order to ensure the efficient and effective operation of a healthcare organization? A) Span of control must be kept as narrow as possible.

B) The chain of command must be explicitly and clearly delineated. C) The formal organizational structure must closely mimic the informal relationships that exist (the grapevine). D) Registered nurses must occupy positions in employee, middle management, and executive roles. Ans: B




Objective: 2

Page and Header: 162, Chain of Command

Feedback: The effective operation of a healthcare organization requires a detailed and

clear chain of command. A narrow span of control is not always preferable to broader

spans of control and formal structure does not necessarily have to replicate informal

structures, though each should be acknowledged and recognized. It is certainly possible,

and potentially beneficial, for nurses to occupy a variety of roles in the organizational

hierarchy but this is not a precondition for successful organization.

8. A nurse has concerns about some of the practices on the hospital unit and met with the unit manager to explain these concerns. After the meeting, the nurse felt misunderstood and rebuffed by the manager. How should the nurse determine who in the organization to meet with next? A) Consult with the hospital bureaucracy B)

Enlist the help of a union representative C) Ask colleagues about who is most influential in the organization D) Refer to the hospitals chain of command Ans: D

Client Needs: A-1




Objective: 2

Page and Header: 162, Chain of Command Feedback: The chain of command represents the path of authority and accountability from individuals at the top of the organization to those at the base of the organization. The nurse should most likely meet with the person who is above the manager in the

chain of command. The hospital bureaucracy, the union, and the persons who are informally influential are less likely to help the nurse identify the appropriate person with whom to meet. 9. There is general agreement on a postsurgical unit that the admission assessment template that is used is lengthy, unwieldy, and includes many parameters that are not relevant to the care of the patient population on the unit. Which of following aspects of amending the assessment template best exemplifies the concept of shared governance? A) Managers and nurses cooperatively make a change and share accountability for the outcomes. B) The unit manager consults with nurses and members of other disciplines prior to changing the document. C) The decision-making process reflects the chain of command that exists at the hospital. D) Nurses collectively present the change in practice to the manager, who is then accountable for the outcomes of the change. Ans: A

Client Needs: A-1




Objective: 3

Page and Header: 166, Shared Governance Model

Feedback: Shared governance encompasses a collaborative model of decision-making and shared accountability for the outcomes of these decisions. It does not involve nurses announcing an independent change to management or management being solely accountable for the decisions of others. Shared governance is not

necessarily linked to the chain of command in an organization.

10. The staff, the administrators, and the executives of a large, urban hospital are currently celebrating the fact that the hospital has recently been granted Magnet Recognition by the American Nurses Credentialing Center (ANCC). This designation suggests that the hospital A) pays nurses higher wages than the national median.

B) has lower staff turnover than most hospitals. C) integrates the principles of evidence-based practice into care. D) has a committed and responsive bureaucracy. Ans: B

Client Needs: A-1



Integrated Process: Communication and Documentation Objective: 4

Page and Header: 168, Magnet Hospitals Feedback: While all of the given options may underlie or contribute to a hospitals Magnet designation, low staff turnover is one of the key attributes of such a hospital. Magnet Recognition is not explicitly based on high wages, effective bureaucracy, or

evidence-based practice.

11. A nurse who has a baccalaureate degree in nursing has begun working at a hospital in which the principles of primary care nursing are used to organize care. Which of the following actions should the nurse anticipate? A) Performing the most complex nursing tasks on the unit for all of the patients B) Taking action to ensure that neither too much nor too little care is provided for each patient

C) Directing a team of practical (vocational) nurses and unlicensed care providers D) Being responsible for specific patients from the time of their admission to the time of discharge Ans: D

Client Needs: A-1




Objective: 5

Page and Header: 171, Primary Care Nursing

Feedback: In a pattern of primary care, one nurse is assigned the responsibility for the care of each patient from patient admission until that patients discharge. Patient care is not fragmented according to complexity, as in functional nursing. Collaboration of a group of RNs, PNs. and UAPs is characteristic of team nursing. Tight control of the amount of care a patient receives is a key characteristic of case management.

12. Collective bargaining has a long history in nursing. Which of the following milestones in the history of collective bargaining resulted from the 1974 amendment of the Taft-Hartley Act (Labor Management Relations Act)? A) Nurses were granted the right to form unions and engage in collective bargaining. B) The maximum length of a work week and the minimum nursing wage were established. C) Nursing was formally recognized as a professional occupation. D) Nonprofit hospitals were obliged to bargain with nurses around wages and working conditions. Ans: D

Client Needs: A-1

Cognitive Level: Knowledge



Page and Header: 176, Table 5.1 Feedback: Under the 1974 amendment of the Taft-Hartley Act, nonprofit hospitals were required to bargain with nurses for better salaries and working conditions.

The formation of unions and the recognition of nursing as a profession predated this act. The 1974 amendment did not specify wages and hours of work. 13. Contracts are essential to the maintenance of high quality care in healthcare institutions. As well, they are necessary to protect the interests of nurses who provide this care. Which of the following issues is most likely to be addressed in a contract for nurses? A) The process that should be followed when distributing overtime work B) The obligation of nurses to participate in nursing research C) The details of the organizational structure of a hospital D) The relationships among nurses, physicians and members of other health disciplines Ans: A

Client Needs: A-1




Objective: 9

Page and Header: 182, Issues Negotiated in Contracts

Feedback: Contracts commonly address such issues as overtime work. Relationships

between care providers, participation in research, and organizational structure of a

hospital are issues that are normally outside the purview of a nursing contract.

14. Despite the long history of collective bargaining in the nursing profession, many nurses have concerns regarding membership in a collective bargaining unit. Which of the following statements by nurses best conveys one of the primary concerns that are prevalent among nurses? A) I think that physicians recognize our value and sufficiently advocate for our best interests. B) I think that a collaborative model results in higher wages than a confrontational model such as collective bargaining. C) Im not sure that joining a union is congruent with the philosophy of the nursing profession. D) In the end, I think that the costs of being in bargaining unit outweigh the potential benefits. Ans: C

Client Needs: A-1


Difficulty: Difficult Integrated Process: Communication and Documentation

Objective: 10

Page and Header: 184, Issues Related to Collective Bargaining and Nursing Feedback: Among the major issues of collective bargaining that affect the nursing profession is the fact that some nurses see collective bargaining as unprofessional. The other most common concerns involve the matter of which bargaining group will represent nursing when nurses participate in collective bargaining, the question of whether to join a union when one exists, and the issue of the role of the supervisor. 15. Nurses, as well as individuals outside the profession, have sometimes expressed concern around the involvement of state nurses associations in collective bargaining. What factor most often underlies such concerns? A) State nurses associations lack the legal authority to engage in bargaining though this has been their traditional role. B) State nurses associations tend to be unaware of many of the issues that nurses face when providing care. C) It can be difficult to reconcile the professional obligations of nurses associations with their role in bargaining.

D) Few practicing nurses participate in the activities of state nurses associations. Ans: C Client Needs: A-1




Objective: 11

Page and Header: 185, Activity of the ANA Feedback: Some individuals contend that it is not realistic for state nurses associations to work with the professionalism aspect of nursing as well as with the issues of wages, benefits, and working conditions. State nurses associations do not lack the legal right to bargain and participation of nurses in the operations of state nurses associations

does not directly affect their right or ability to bargain.

Chapter 6: Understanding the Healthcare Environment and Its Financing Multiple Choice

1. Which of the following clients would be a good candidate to receive care in an assisted-living facility? A) A 30-year-old victim of a car accident who has been in a coma for the past 2 months. B) A 78-year-old widower who is living independently but needs help with preparing meals, doing laundry, and remembering to take his medications. C) A husband and wife approaching retirement age who have no difficulty with ADLs but desire to age in place. D) A 72-year-old woman diagnosed with Alzheimer disease who is described by her daughter as having good days and bad days. Ans: B

Client Needs: A-1




Objective: 2

Page and Header: 205, Assisted-Living Facilities Feedback: The assisted-living facility provides care for those needing help with up to

three ADLs. In an assisted-living arrangement, the resident can maintain maximum independence and use a shared decision-making model to decide when additional help or support is needed. A patient in a coma, an individual with significant cognitive deficits, and a couple with no difficulty in achieving ADLs would not be appropriate

for assisted-living.

2. Mr. Kline is a construction worker who is recovering from surgery on his dominant hand that he injured on the job. Which member of the healthcare team would the nurse contact to help Mr. Kline learn how to feed himself using modified utensils? A) Registered physical therapist B) Doctor of osteopathy C) Registered dietitian D) Occupational therapist Ans: D

Client Needs: B




Objective: 3 Page and Header: 210, Roles of Healthcare Workers Feedback: Occupational Therapists are educated in the assessment and management of ADLs, especially when assistive devices are required. A physical therapist focuses primarily on mobility and would not introduce assistive devices aimed at achieving ADLs. Osteopaths and dietitians would not manage the use of assistive devices. 3. Which of the following is a current trend related to the education and scope of practice of healthcare providers within the healthcare system? A) The Flexner Report limited the involvement of hospitals in research and education of medical students, resulting in a decrease in internships and residencies. B) Pressure from insurers has mandated an increased use of specialty physicians over general practice physicians. C) There is a short supply of qualified individuals in most health occupations, including nursing. D) As the healthcare system has grown more and more complex, it is imperative for one individual educated to a specific role, to manage all aspects of care. Ans: C

Client Needs: A-1




Objective: 4

Page and Header: 212, Healthcare Worker Supply Feedback: Nurses are not the only healthcare workers in short supply. There are predicted shortages in almost all areas of healthcare over the next 15 years. As the population ages and more people enter the system due to expansion of healthcare

insurance coverage, the shortages are likely to persist. The Flexner Report increased the involvement of hospitals in research and education of medical students. There is pressure to increase the involvement of general practice physicians. As the healthcare

system grows more complex, it is clear that it is impossible for one individual educated to a specific role, to manage all aspects of care.

4. Which of the following statements is an accurate representation of the nature of healthcare coverage available worldwide? A) In the United States, healthcare is seen as a right or entitlement of every citizen. B) In developing nations, healthcare is adequately provided by governmental agencies and nonprofit organizations, such as the World Health Organization. C) The US healthcare system has been simplified by the existence of standards for funding and controlling healthcare. D) In most of the industrialized world, governmental healthcare systems are in place to accomplish overall health outcomes. Ans: D

Client Needs: A-1 Cognitive Level: Comprehension



Objective: 5

Page and Header: 213, Paying for Healthcare Feedback: In most of the industrialized world healthcare is seen as a right, or an entitlement, of every citizen. This stands in contrast the views of many in the United States. Developing nations often lack basic healthcare and the US healthcare has increased in complexity over the years. 5. Mr. Gomez is a patient on Medicare receiving care in a hospital following cardiac surgery. What method would be used to determine payment for the services provided for this client? A) Resource utilization groups B) Minimum data sets C) Capitation D) Diagnosis-related groups Ans: D Client Needs: A-1


Difficulty: Easy


Objective: 5 Page and Header: 224, Diagnosis-Related Groups Feedback: Diagnosis-related groups (DRGs) are used to determine the payment for each Medicare client admitted to the hospital. Payment is not determined using resource allocation groups, minimum data sets, or capitation.

6. A nurse provides care in a hospital that is owned and operated by the Roman Catholic Church. According the classification system of healthcare organizations that is based on ownership, how would this hospital be classified? A) Proprietary corporation B) Sole proprietorship C) Nonprofit organization D)

Community organization Ans: C Client Needs: A-1


Difficulty: Easy


Objective: 1 Page and Header: 196, Table 6.2 Feedback: Healthcare institutions that are operated by religious organizations are normally categorized as nonprofit. They are not proprietorships or community organizations.

Multiple Selection 7. The number and importance of hospitals increased greatly during the development of the American healthcare system. Which of the following phenomena have contributed to this trend? (Select all that apply.) A) Increased health literacy of the American public B) The development of more sophisticated medical technology C)

Increased incidence and prevalence of chronic diseases D) The development of professional nursing E) The growth of the health insurance industry Ans: A, B, D, E Client Needs: A-1




Objective: 4

Page and Header: 198, Factors Affecting the Development of Hospitals Feedback: The growth of the hospital as a primary healthcare institution was the result of numerous factors, including the medical technology, the growth of professional nursing, and the emergence of the health insurance industry. This trend has not been closely linked to changes in health literacy and chronic diseases. Multiple Choice 8. Historically, health insurance was for hospital care and related services only. What effect did this characteristic have on the health behaviors of individuals enrolled in such plans?

A) Some individuals neglected health promotion measures.

B) Many individuals began to pay out-of-pocket for superior care. C) Individuals avoided hospitals because of the association of hospitals with illness. D) Some individuals who qualified for Medicare did not enroll in the program. Ans: A Client Needs: A-1




Objective: 5

Page and Header: 215, Health Insurance Plans Feedback: Insurance coverage for inpatient treatment created a disincentive towards preventative measures and health promotion activities since these were nor insured benefits. The focus on inpatient care did not prevent participation in Medicare or dissuade people from visiting hospitals. 9. In 2010 the US Congress passed the Patient Protection and Affordable Care Act, commonly referred to as the Healthcare Reform. This Act aims to change the provision of healthcare in the United States by A) bringing the health insurance industry under the umbrella of the federal government. B) increasing the number of nonprofit and public hospitals. C) placing limits on healthcare costs and limits on the growth of health maintenance organizations (HMOs). D) requiring every American to be enrolled in some type of health insurance plan. Ans: D Client Needs: A-1




Objective: 5

Page and Header: 213, Paying for Healthcare; 32, Paying for Healthcare Feedback: Healthcare Reform set up a process through which the United States would move toward healthcare coverage for all by requiring everyone to be enrolled in some

type of health plan. This goal of universal coverage is not being sought through taking control of the insurance industry, building public hospitals, or limiting the role of HMOs. 10. A 63-year-old man has qualified for Medicaid. His qualification for Medicaid will be based primarily on what factor? A) His medical history and present health status

B) His income

C) His employment history

D) His military service Ans: B Client Needs: A-1


Difficulty: Easy


Objective: 5

Page and Header: 221, Medicaid Feedback: Medicaid provides funds for healthcare for those dependent on public assistance and certain other low-income individuals. Qualification is not based on work history, health status, or military service. 11. A hospital is currently undergoing scrutiny in terms of a number of hospital healthcare outcomes. Which of the following would be considered an outcome? A) The ratio of care providers to managers and administrators in the hospital

B) The incidence of nosocomial infections in the hospital

C) The demographics of the population that the hospital serves D) The major sources of revenue for the hospital Ans: B Client Needs: A-1




Objective: 6

Page and Header: 236, Hospital Healthcare Outcomes Feedback: Outcome measures are specific, measurable aspects of healthcare that show the effectiveness of the system as a whole. An example of an important outcome measure is the incidence of nosocomial infections in a care setting. The staffing mix, the demographics of the community, and the revenue sources of the hospital may be important data but they are not considered to be outcomes. 12. Historically nurses have had limited power in the healthcare system. How can a nurse best exercise power to move the provision of healthcare in a positive direction? A) By participating in shared governance

B) By providing evidence-based care

C) By establishing collaborative relationships with physicians D) By becoming accredited in a specialty area Ans: A Client Needs: A-1


Difficulty: Easy


Objective: 7

Page and Header: 239, Nurse Power

Feedback: One of the most effective ways for nurses to effect change in the healthcare system is by taking advantage of opportunities to participate in shared governance. Accreditation, collaboration, and high-quality care are all positive actions, but they are less directly related to the exercise of power and influence.

13. There has been a great increase in the sophistication of healthcare technology in recent decades. What effect has increased technology primarily had on the provision of healthcare? A) Health technologies have made healthcare more accessible to larger numbers of Americans. B) High-technology equipment requires a large capital investment in the short-term but reduces healthcare costs in the long-term. C) Health technologies improve patient care and provide an incentive for innovative people to enter the healthcare field. D) Sophisticated health technologies can improve patient outcomes but increase healthcare costs greatly. Ans: D

Client Needs: A-1




Objective: 8

Page and Header: 226, High Technology and New Facilities Feedback: Health-related technologies often have the potential to improve patient outcomes but they typically increase costs to healthcare institutions and, ultimately, to healthcare consumers. They do not normally result in decreased costs in the longer

term and their ability to directly attract innovators to the healthcare industry has not been proven. 14. Many consumers and advocacy groups in the United States have raised concerns around the practices of the pharmaceutical industry. These concerns are most often motivated by the fact that A) drug research and development is conducted overseas but most drugs are sold domestically. B) residents of other industrialized countries have better availability of drugs. C) drug costs are higher in the US than in many other industrialized countries. D) pharmaceutical companies have shown an unwillingness to develop new drugs. Ans: C Client Needs: A-1




Objective: 8

Page and Header: 226, High Technology and New Facilities

Feedback: Drug companies often sell identical drugs in other countries for far less money than what they charge consumers in the United States, a fact that contributes to the high cost of healthcare in the United States. Overseas research and development is

not a contentious issue and drug companies are continually active in the development of new drugs. Despite the high costs, the availability of drugs in the United States is unmatched.

15. Nurse T. has been providing care for Mr. James for the past several days during his admission to hospital for the exacerbation of his chronic obstructive pulmonary disease (COPD). How can Nurse T. best help Mr. James, and other patients, navigate the healthcare system effectively and efficiently? A) Encourage Mr. James to take ownership of his health and be proactive with prevention measures. B) Teach patients how to use technology to minimize their reliance on care providers. C) Educate patients about the varied roles that nurses can play in the provision of healthcare. D) Become familiar with the organization of healthcare and apply this knowledge to patient teaching. Ans: D

Client Needs: B



Integrated Process: Teaching/Learning Objective: 9

Page and Header: 240, Implications for Nurses Feedback: Nurses should become familiar with the complexities of healthcare and use this knowledge to help patients and families navigate the system. Technology and the roles of nurses of not topics that are likely to benefits patients in a tangible way. Prevention measures are important for health but they do not necessarily aid in navigating the system. Chapter: Chapter 7: Legal Responsibilities for Practice Multiple Choice 1. Which of the following statements accurately reflects an element of the crisis surrounding liability insurance in the United States? A) Professional liability insurance does not provide coverage when the nurse assists in an emergency. B) Malpractice insurance premiums are not affordable for nurses in independent advanced practice and traditional nursing roles. C) Laws in some states are being amended to restrict the monetary liability of any party according to the percentage of responsibility.

D) Nurses are being named in fewer lawsuits, but the judgments being awarded are larger. Ans: C

Client Needs: A-1




Objective: 5

Page and Header: 259, Liability Insurance Feedback: Laws in some states are being amended to restrict the monetary liability of any party according to the percentage of responsibility. Liability laws continue to be a major concern for nurses, because nurses are being named in an increasing number of suits, although the total number is still low. Nursing liability insurance tends not to be

expensive and it provides coverage in emergency situations. 2. The law requires that a person give voluntary and informed consent for medical treatment. Which of the following statements accurately describes this legal obligation? A) It is the responsibility of the nurse to obtain informed consent.

B) Informed consent must be obtained in the form of written documentation. C) A blanket consent for any procedures deemed necessary is usually considered adequate consent for specific procedures. D) The courts do not accept the clients medical condition alone as a valid reason for withholding information when seeking consent. Ans: D




Objective: 6

Page and Header: 266, Consent for Medical Treatment Feedback: Courts do not accept the patients medical condition alone as a valid reason for withholding complete and accurate information when seeking consent. Obtaining consent is not normally a nursing responsibility. Verbal consent and implied consent may have legal standing and blanket consent is insufficient to cover any and every procedure. 3. A nurse working in a hospital setting is accused of malpractice. Which statement accurately represents a legal element of this type of negligence? A) Malpractice is present only if a breach of duty was the cause of the harm. B) When the harm is not clear and needs to be proved in court, the legal term res ipsa loquitur is used. C) Breach of duty is clearly defined as the expression of malicious intent.

D) A breach of duty is a failure to act as a prudent professional according to standards of care designated by the federal government. Ans: A

Client Needs: A-1




Objective: 7

Page and Header: 252, Display 7.1 Feedback: One of the essential elements of malpractice is a breach of duty by the professional. When the harm is so clear and the responsibility for the harm so straightforward that it does not need to be proved in court, the legal term res ipsa loquitur is used. Breach of duty is not synonymous with malicious intent. The

standards by which breach of duty is evaluated are not defined by the federal government. 4. An attorney representing a client in a malpractice case attends a deposition. What might occur in this proceeding? A) A sworn, verbatim record is made by a court reporter.

B) A settlement is made out of court.

C) A legal proceeding presided over by a judge takes place in a courtroom. D) Damages are awarded to the plaintiff. Ans: A Client Needs: A-1

Cognitive Level: Application Difficulty: Moderate


Objective: 9

Page and Header: 281, Discovery Feedback: A deposition is a formal proceeding in which each attorney has an

opportunity to question a witness outside of court, and a sworn verbatim record is made by a court reporter. A deposition is not the usual venue for a settlement or the awarding damages. A trial, not a deposition, is a legal proceeding presided over by a judge that takes place in a courtroom. 5. A nurse is called to testify as an expert witness in a malpractice suit. Which of the following guidelines contains prudent advice for this nurse? A) Volunteer as much information as possible when explaining medical procedure. B) Use medical jargon as appropriate to describe the treatment provided by the defendant. C) Pause during the testimony to allow your attorney to object if appropriate. D) Discuss your testimony with the opposing attorney before the court date. Ans: C

Client Needs: A-1




Objective: 10

Page and Header: 282, Display 7.4

Feedback: A nurse who is testifying should listen carefully to the entire question before

answering and pause to let your attorney object if appropriate. The nurse should not offer

additional information voluntarily or use medical jargon unless it is necessary.

Testimony is not discussed with the opposing attorney prior to a court date.

6. A nurse is aware that the nurse practice act in her state provides the legal framework for her scope of practice. A nurse practice act is an example of A) common law. B) constitutional law. C) enacted law. D) judicial law. Ans: C Client Needs: A-1


Difficulty: Easy


Objective: 1

Page and Header: 246, Enacted Law Feedback: Enacted law includes all bills passed by legislative bodies; nurse practice acts in the various states are examples of enacted law at the state level. A nurse practice act is not an example of constitutional law or common law. Judicial law consists of decrees or judgments from the courts. 7. The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 addresses patient rights within the healthcare system. Which of the following actions may constitute a violation of HIPAA? A) A nurse identifies a patient whom he recently cared for on his Facebook page. B)

A nurse completes a charting entry without providing her initials after the entry. C) A

nurse inserts a central venous catheter without the consent of the patient.

D) A nurse makes a crude comment to a patient while providing morning hygiene. Ans: A Client Needs: A-1

Cognitive Level: Evaluation



Objective: 1

Page and Header: 248, Rights and Responsibilities in Healthcare

Feedback: HIPAA specifically addresses matters related to patient privacy and confidentiality. Identification of a patient by a nurse would be considered a violation

of confidentiality. Failing to sign documentation is not a contravention of HIPAA. Making inappropriate comments and performing interventions without consent are both serious violations of professionalism, but these are less likely to be addressed by

HIPAA.

8. The risk manager at a large, university hospital has become aware that there may be a discrepancy between a longstanding protocol on one of the hospital units and the nurse practice act of the state. Which of the following statements regarding the legal standing of institutional policies is most accurate? A) Institutional policies do not have legal standing. B) Institutional policies supersede enacted law but do not supersede common law. C) Established policies may be considered common law by a court D) Discrepancies between policies and legislation are usually resolved by professional associations such as a board of nursing. Ans: C

Client Needs: A-1




Objective: 2

Page and Header: 249, Institutional Policies, Protocols, and Procedures Feedback: Established agency policies may be considered the standard of practice for that agency and, therefore, common usage (common law) by the court, and may

become important as a basis for legal decisions. However, policies do not normally have the power to supersede enacted laws. Discrepancies are ultimately the jurisdiction of the courts, not professional associations. 9. Nursing practice is subject to a wide variety of laws and regulations. Which of the following actions is the clearest violation of criminal law? A) A nurse left a patients bed in a raised position and the patient subsequently fell. B) A nurse withheld opioids from a patient and then sold them. C) A nurse left the unit before her replacement had arrived. D) A nurse applied restraints to a patient in alcohol withdrawal without first obtaining an order. Ans: B Client Needs: A-1




Objective: 3

Page and Header: 251, Criminal Law and Nursing

Feedback: Thefts and the sale of controlled substances are not only violations of professional standards but also crimes. Abandoning patients, performing interventions without orders, or committing an action that leads to injury are most often violations of civil law.

10. On a night shift, a nurse who provides care in an inpatient psychiatric setting

admitted a patient with a recent history of violence but placed the patient in a two-bed room. The patient subsequently attacked and injured the other patient in the room. Which of the following principles will be considered in the courts determination of liability? A) The nurse may be held liable if institutional factors are not noted to have contributed to the situation. B) The nurse is exempt from liability if institutional protocols specify that room allocation is a nursing responsibility. C) The nurse may be held liable provided the action was a crime. D) The nurse may be held liable if the action constituted a violation of the standard of care. Ans: D

Client Needs: A-1




Objective: 4

Page and Header: 254, Personal Liability Feedback: A violation of the standard of care is likely to create a situation of legal liability for a nurse. The violation need not be a crime, however. Institutional factors and protocols do not negate the nurses potential liability 11. Mrs. Howe, age 59, had a bilateral mastectomy with axillary node dissection and was discharged home 2 days later with drains in situ. Contrary to the nurses predischarge teaching, Mrs. Howe attempted to remove one of her drains

independently once output ceased, resulting in pain, tissue trauma, and bleeding. Mrs. Howe claims that her injuries were the result of negligence by the nurses on the unit. How would the court apply the principle of comparative negligence in this case? A) The court would determine what proportion of the patients injuries was the result of her own actions. B) The court would compare Mrs. Howes actions with those of a reasonable person. C) The court would determine whether it was medically appropriate to discharge Mrs. Howe with her drains still in situ. D) The court would decide if the nurses on the postsurgical unit are legally obliged to teach patients. Ans: A

Client Needs: A-1




Objective: 4

Page and Header: 257, Limits on a Patients Claim to Negligence

Feedback: In the application of comparative negligence, the courts determine what percentage of injury resulted from a patients negligence and what part rested with the

nurse, and reduce the damage award accordingly. The court would also likely examine the patients actions in light of those of a reasonable person, but this is not a direct application of the concept of comparative negligence. The court would not likely

focus on the appropriateness of the patients discharge or the nurses abilities to teach patients.

12. Mr. Yamata was recently admitted to the hospital after a fall in which he suffered a fracture of his femoral head. Over the past 2 days, he has begun to refuse care. Which of the following factors is most significant in the determination of Mr. Yamatas legal competence to refuse care? A) Mr. Yamata was recently diagnosed with early-stage Alzheimer disease. B)

Mr. Yamata defers most of his important decisions to his oldest son. C) Mr. Yamata has previously expressed a preference for complementary and alternative therapies. D) Mr. Yamata attempted to transfer to the commode independently, despite the nurses instructions to the contrary. Ans: A




Objective: 6

Page and Header: 267, Competence to Give Consent Feedback: Cognitive ability is an important consideration in the determination of competence. The patients preference of alternative therapies, his previous reckless behaviors, and his deference to his son are not factors that would significantly affect his legal competence. 13. An 80-year-old woman has been admitted to the emergency department after a

sudden loss of consciousness and computed tomography indicates a serious ischemic stroke. The patients son is adamant that the patient would not want thrombolytic therapy. The son would have the right to refuse this treatment on his mothers behalf

if A) there is a reasonable belief that such a treatment would not result in improved outcomes for the patient. B) a durable power of attorney for healthcare names the son as a healthcare proxy.

C) the son is able to show evidence that his mother was legally incompetent prior to her stroke. D) there is unanimity among other immediate family members.

Ans: B

Client Needs: A-1




Objective: 6

Page and Header: 270, Durable Power of Attorney for Healthcare

Feedback: A durable power of attorney for healthcare (DPOA-Healthcare) is a document that legally designates a substitutionary decision maker, should the

person be incapacitated. This document may also be referred to as designating a healthcare proxy. Previous disabilities, the agreement of other family members and a low likelihood of benefit are not factors that confer legal rights for surrogate

decision-making.

14. A nurse who works in the emergency department of a large, urban hospital often provides care for patients who must be temporarily restrained for their own protection. Which of the following measures lessens the chance that the nurse will be faced with a false imprisonment suit? A) Utilize physical restraints whenever possible and chemical restraints only as a last resort. B) Use the least restrictive means possible to restrain patients. C) Delegate the management of confused and aggressive patients to unlicensed care personnel. D) Have all patients sign blanket consent when admitted. Ans: B Client Needs: A-1




Objective: 8

Page and Header: 275, False Imprisonment Feedback: Any time patients pose a danger to themselves or others, the law requires that

the least restrictive means available be used to protect patients and others. Physical

restraints are not usually preferable to chemical restraints and neither method exempts

the nurse from potential liability. It would be inappropriate to delegate the care of

patients who pose a danger and blanket consent does not have legal standing. 15. Despite the fact that all nurses face the potential risk of being named in a lawsuit there are measures that nurses can take to significantly reduce this risk. Which of the following measures has the greatest potential to prevent a malpractice claim?

A) Complete continuing competence requirements on time

B) Carry adequate liability insurance that provides comprehensive coverage C) Avoid interacting with clients or patients without a witness

D) Maintain a high-quality standard of nursing care

Ans: D

Client Needs: A-1


Difficulty: Easy


Objective: 8

Page and Header: 278, Maintaining Excellent Standards of Care

Feedback: There are many actions that nurses can take to prevent lawsuits. Paramount among these is maintaining a high standard of care. Insurance does not necessarily prevent claims, but rather mitigates the consequences of these claims. It is normally unnecessary to avoid one-on-one interaction with patients and clients and

continuing competence requirements do not necessarily prevent lawsuits.

Chapter 8: Ethical Concerns in Nursing Practice Multiple Choice

1. A mother and a daughter are taken to the emergency room for injuries suffered in a car accident. When the mother is taken to surgery, the nurse tells her that her

daughter will be fine, even though she does not know the exact extent of the daughters injuries. This nurses actions may have been guided by which of the following ethical theories? A) Social equity and justice B) Natural law C) Deontology D) Utilitarianism Ans: D Client Needs: C




Objective: 2

Page and Header: 297, Table 8.2 Feedback: A central premise of utilitarianism is that an act is right when it is useful in bringing about a desirable or good end. In this case, instilling hope in the mother may alleviate her stress before surgery. A deontological view would condemn the nurses

actions, since deontology proposes that ethical decision-making is based on moral rules and unchanging principles (i.e. that lying is categorically wrong). Social equity and natural law are not reflected in the nurses decision to temporarily deceive the

patient.

2. A client has advance directives for a DNR code (do not resuscitate). When the nurse is caring for this client, the clients wife asks him to do everything in your power to keep my husband alive. This nurse is most likely to experience which of the following moral challenges? A) Values clarification B) Ethical dilemma C) Values conflict D)

Nonmaleficence Ans: B Client Needs: C




Page and Header: 289, Understanding the Concept of Ethics Feedback: An ethical dilemma is any situation in which guiding moral principles cannot determine which course of action is right or wrong. In this case, there is a

conflict between the clients wishes and that of his wife, a situation that causes duress for the nurse. Values clarification, values conflict, and nonmaleficence are not at the root of the situation the nurse faces. 3. Which of the following statements accurately reflects one of the primary provisions of the ANA Code for Nurses? A) The administrators of the healthcare facility are responsible and accountable for individual nursing practice. B) The physician determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care. C) The nurses primary commitment is to the employing agency. D) The nurse owes the same duties to self as to others. Ans: D

Client Needs: A-1




Objective: 3

Page and Header: 302, Display 8.1 Feedback: The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. The Code does not place primary ethical responsibility with administrators or physicians nor does it claim that the nurses main commitment is to the employer.

4. A nurse helps a client work through an ethical dilemma by using an ethical decision-making framework. Which of the following statements describes a component of this process? A) The steps of this process are distinctly different from those of the nursing process. B) Most ethical problems have one possible solution. C) The nurse uses the framework of his or her own values to assist the clients to make a decision. D) The facts of a situation make a difference in the options that are possible. Ans: D Client Needs: A-1




Page and Header: 311, Gather Factual Data Feedback: When attempting to make ethical decisions, it is important to have as much information about the unique situation as possible because the facts of the situation make a difference in what options are possible. The steps in ethical decision-making mimic those of the nursing process. The nurse should not impose his or her values on

clients and most ethical problems have more than one potential solution. 5. Which of the following is an accurate guideline for reporting the chemical dependency of a colleague? A) Confront the person you suspect, and offer assistance in obtaining treatment. B) Be sure beyond any doubt that a problem exists. C) Rely on an informed supervisor to assume responsibility for the problem. D) Be aware that help and rehabilitation are only offered to the person need it following disciplinary proceedings. Ans: C

Client Needs: A-1




Objective: 7

Page and Header: 325, Reporting the Chemically Impaired Colleague Feedback: Usually, once you have notified your supervisor, he or she will assume responsibility for the problem. When planning to report, you do not have to be sure beyond any doubt that a problem exists. Confrontation is often ill-advised and rehabilitation may accompany or precede discipline. 6. A nurse on a palliative care unit has attended an educational inservice on ethics. Which of the following statements most accurately describes the concept of ethics? A) Ethics offers a process that can be used to guide behavior.

B) Ethics is the expression of social and culture values, priorities, and norms.

C) Ethics is the basis for evaluating personal character. D) Ethics is the tangible application of religious and spiritual truths.

Ans: A

Client Needs: C


Difficulty: Easy


Objective: 1

Page and Header: 289, Understanding the Concept of Ethics

Feedback: Ethics offers a formal process for answering the question about what one ought to do in a given situation. Ethics is not considered to be simply an expression of cultural or religious principles and it does not specify criteria for evaluating an individuals character.

7. Nursing involves close interaction between nurses and patients, a situation which can create the potential for boundary violations. Which of the following situations most clearly constitutes a boundaries violation? A) A community health nurse continues weekly visits to a former client despite the fact that the client is no longer receiving care. B) A nurse states that she is willing to advocate to the patients employer than the patient was genuinely ill and not feigning health complaints to gain time off work. C) A nurse attends a family meeting at the hospital in which the patient and his family discuss the patients code status. D) A nurse contacts a social worker without the patients knowledge because of admissions the patient has made about her substandard living conditions. Ans: A

Client Needs: C




Objective: 8

Page and Header: 326, Boundary Violations Feedback: Continuing contact with a patient outside of the domain of care is a boundaries violation. Informing an employer that a patient was ill is not likely a boundaries violation, since the nurse is reporting facts with the patients permission. Nurses often participate in family meetings and referrals made without a patients

knowledge are not a violation of boundaries. 8. A few weeks ago, a nurse worked a shift with a colleague during which three oxycodone tablets went missing from the narcotic cupboard. As well, the nurse has noted that the colleague has sometimes documented the administration of oxycodone to patients only to have the patients continue to complain of pain. The nurse suspects

that the colleague is taking the oxycodone from the unit for personal use. How should the nurse best follow up these suspicions?

A) Organize coworkers and the colleagues family members to carry out an intervention B) Contact representatives from the state board of nursing

C) Report these suspicions to the unit supervisor

D) Confront the colleague with these suspicions

Ans: C

Client Needs: C




Objective: 7

Page and Header: 325, Reporting the Chemically Impaired Colleague

Feedback: Reasonable suspicions of chemical abuse should be reported to a nurses

immediate supervisor. Confrontation, either face-to-face or in a group setting, should

normally be avoided. It would be premature to contact the state board of nursing.

9. Mr. Bains is a 70-year-old man who has been recently diagnosed with colon cancer. Mr. Bains is adamant that he does not want to undergo chemotherapy or radiotherapy,

citing the unpleasant side effects and the absence of a guaranteed cure. His wife, however, is distraught that he would give up so quickly and begs the nurse to convince him to pursue treatment. Which of the following ethical principles would

underlie the nurses decision to respect Mr. Bains informed choice? A) Beneficence B) Nonmaleficence

C) Fidelity D) Autonomy Ans: D Client Needs: C Cognitive Level: Application



Objective: 1

Page and Header: 291, Autonomy Feedback: Autonomy involves the right of self-determination or choice, independence, and freedom. As such, an expression of autonomy would involve respecting the patients wishes even if they are unusual or opposed by family members. Beneficence

and nonmaleficence denote doing good and avoiding harm. Fidelity refers to the obligation to be faithful to the agreements and commitments. 10. An obstetrical-gynecological nurse has moved to a new region and is seeking employment. The nurse opposes the ethics of elective abortion and refuses to

participate in the procedures. However, the only hospital in the immediate area is the site of numerous elective abortions. How should the nurse account for this fact when seeking employment?

A) Ask the hospital administrators to exempt her from participating in any aspect of abortion. B) Consider applying for a nursing position that will not involve abortion.

C) Begin working at the hospital and attempt to change the hospital politically. D) Accept a position at the hospital and then make her position known to supervisors. Ans: B Client Needs: C




Page and Header: 308, Seeking Employment Feedback: Nurses have a responsibility to avoid situations that they know would be

personally problematic for ethical reasons. It would be unreasonable to accept a position and expect special treatment. As well, it would be disingenuous for the nurse to accept a position without disclosing her stance or to accept a position with the

intent of enacting a change. 11. A patient with a long-standing diagnosis of renal failure has declared her intention to stop hemodialysis. Because of the ethical ramifications of this, the care team has begun the process of making an ethical decision. This process should begin by

A) eliciting input from impartial individuals from outside the hospital setting. B) explaining the major concepts of ethics to the patient and her family.

C) clearly identifying the essential elements of the ethical problem. D) confirming the patients cultural and religious background. Ans: C Client Needs: A-1




Objective: 5

Page and Header: 311, Identify and Clarify the Ethical Problem Feedback: A process for ethical decision-making begins with the clear identification of the situation at hand. This should precede the involvement of other individuals or an exploration of the patients culture and religion. It would not likely be helpful to explain ethical concepts to the patient. 12. The care providers and administrators of a hospital have struggled to find an appropriate response to a patient who has a long history of being admitted to hospital and then leaving against medical advice. Under the direction of the hospital ethics

committee, a plan was created and implemented. What action should the care providers and the ethics committee take after the plan has been implemented?

A) Continue to implement the plan when necessary

B) Assess the outcomes of applying the plan

C) Seek input from the hospitals risk manager D) Report to the state board of nursing about the manner in which the situation was handled Ans: B

Client Needs: A-1




Objective: 5 Page and Header: 312, Act and Assess Feedback: Implementation of an ethical decision should always be followed by

evaluation and appraisal of the course of action that was chosen. Involvement of the hospitals risk manager should take place during the planning phase. It would not normally be necessary to involve the state board of nursing in this decision-making

process. 13. A nurse is working a shift with a colleague who has a nursing student participating

in the care of the colleagues patients. The nurse notices that the colleague has spent much of the morning on the computer at the nurses station and is allowing the student to perform every aspect of the patients care. How should the nurse best respond to this colleague? A) Speak directly to the colleague about these observations. B) Ask the nursing student if she feels like the colleagues patients are receiving good care. C) Report the colleague to the supervisor of the unit. D) Create a written report recording the facts of the morning. Ans: D Client Needs: A-2




Objective: 7 Page and Header: 319, Addressing Substandard Care Feedback: Lapses in the quality of care are best addressed by speaking directly and privately to the person involved. The individuals response to this discussion would determine whether involvement by supervisors is necessary. It would be

inappropriate to involve the nursing student in this matter, given the power differential that exists between the nurse and the student.

14. Tom is a nurse who provides care on a busy medical unit. One of Toms colleagues has just confided in him that she erroneously gave her patient 16 mg of immediate-

release hydromorphone instead of 16 mg of extended-release hydromorphone. She tells Tom that she does not want to report the incident and so she plans to simply monitor the patients level of consciousness and respiratory status closely for the next

several hours. Which of the following statements best describes Toms required response to this situation? A) Tom has a professional and legal responsibility to report this. B) Tom should strongly encourage his colleague to document this error. C) Tom is obliged to assist his colleague with follow-up assessments. D) Tom has no legal obligation to respond, but he should take advantage of this teaching opportunity. Ans: A Client Needs: A-2




Objective: 7

Page and Header: 320, A Basic Pattern for Action Feedback: Incidents that have the potential for patient harm create a legal and moral obligation for the nurse to report. Simply encouraging the colleague to document this matter or helping with assessments are insufficient responses. 15. After working for several months on a geriatric subacute medicine unit, a nurse

has come to the conclusion that substandard care has become accepted as the norm by the majority of nurses as well as their immediate supervisors. The nurses attempts to discuss and address some significant and persistent lapses in care have been rebuffed by nurses and supervisors alike. What should the nurse do next? A) Enlist the support of current and previous patients B) Resign from the unit C) Contact media outlets D) Further discuss the benefits of practice improvements with the nurses Ans: B Client Needs: A-2


Difficulty: Moderate Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 320, Alternative Approaches for Action Feedback: A final alternative to a workplace problem may be to resign. It is normally inappropriate to involve patients. Further discussions with the nurses are unlikely to

be beneficial, given the systemic nature of problems on this unit. Contacting the media is rare and appropriate response.

Chapter 9: Bioethical Issues in Healthcare

Multiple Choice

1. A doctor performs an abortion on a woman who is unable to carry a fetus to term because of a severe risk to her health. What is the term for this type of abortion? A) Spontaneous abortion

B) Elective abortion C) Therapeutic abortion D) Legal abortion Ans: C Client Needs: A-1




Objective: 2

Page and Header: 338, Abortion Feedback: A therapeutic abortion is performed for medical reasons while elective abortion is undertaken for personal reasons. Both are legal under legally appropriate circumstances. A spontaneous abortion results from natural causes. 2. Which of the following statements accurately describes a characteristic of the stem cell? A) Stem cells are not able to renew themselves. B) Stem cells give way to specialized cells. C) Stem cells are committed to conduct a specific function. D) Pluripotent stem cells are derived from the patients own DNA. Ans: B Client Needs: D-4


Difficulty: Easy


Objective: 11

Page and Header: 363, Stem Cell Research Feedback: A stem cell is a special kind of cell that is able to renew itself and give rise to specialized cell types. These cells, unlike most other cells in the body, such as those

of the heart or skin, are not committed to conduct a specific function. The cell remains uncommitted until it receives a signal to develop into a specialized cell. Pluripotent cells have the ability to differentiate into any type of cell found in the body; they are not directly derived from DNA.

3. A nurse is asked to obtain informed consent for a procedure to be performed on a patient who has not yet been told her cancer is terminal. Which of the following is an issue surrounding guidelines to the amount of information that should be given to this patient? A) Under a paternalistic model of care, the locus of decision-making resides with the patients family, who are responsible for informing the patient. B) Physicians basically agree on the amount and nature of the information that should be provided to the patient, but disagree on its delivery. C) It is the responsibility of the nurse to inform the patient of matters that have not been discussed with the physician. D) In some cultures, both physicians and families strongly believe that those who are ill should be protected from bad news. Ans: D Client Needs: C




Objective: 7

Page and Header: 364, Truth Telling and Healthcare Providers Feedback: In some cultures, both physicians and families strongly believe that those who are ill should be protected from bad news. A paternalistic model of care

denigrates the role of the patients family. The nurse is not always obliged to compensate for missing information and there is controversy surrounding the appropriate nature of information to provide to patients and/or families. 4. Which of the following guidelines supports current practice when using behavior control on a client? A) Methods of influence that decrease a persons ability to think rationally should only be used when a client is not acting in his or her own best interest. B) In many cases, the use of psychosurgery to effect a permanent change is recommended over drug therapy. C) Methods of influence that keep relevant facts from a client should only be used with the consent of the clients significant others. D) Methods that work through the cognitive and affective structure of a person are preferred treatment. Ans: D Client Needs: A-1




Objective: 12

Page and Header: 366, Ethical Concerns and Behavior Control

Feedback: Although there are widely varying opinions regarding the appropriate application of behavior control in clients with mental illness, it is generally agreed that

nonsurgical options are preferred over surgical interventions. Family consent does not necessarily warrant the withholding of information from clients. Interventions do not have the goal of reducing a persons ability to think rationally.

5. Which of the following best describes the term rationing of healthcare? A) Providing healthcare only to those who can afford it. B) Providing a planned approach to the use of limited resources. C) Asking consumers to prioritize their use of healthcare resources. D) Requiring consumers to carry private insurance to cover healthcare not covered by the public sector. Ans: B

Client Needs: A-1 Cognitive Level: Comprehension



Objective: 13

Page and Header: 367, Rationing of Healthcare Feedback: Most consider rationing to be a planned, thoughtful approach to a limited

supply. This does not involve mandatory insurance or restricting care to those who can

afford it. Individual preferences should be considered, but the philosophy of rationing

does not require consumers to prioritize their own use of resources. 6. During the various clinical placements that a nursing student has had during a baccalaureate program, the student has become increasingly aware of how significant

bioethical issues are in the delivery of healthcare. Which of the following factors has contributed most significantly to the importance of bioethical issues in healthcare? A) Increased health literacy among healthcare consumers B) The development of new healthcare technologies C) The politics of proposed universal healthcare in the United States D) Increased incidence and prevalence of chronic health problems Ans: B

Client Needs: A-1




Page and Header: 332, Introduction Feedback: Bioethical issues have always been present, but their importance has grown alongside changes in technology. The phenomena of increased health literacy, chronic diseases, and politics are not among the primary factors that have increased the

visibility of bioethics.

7. The history of family planning in the United States has been characterized by controversies, many of which continue to the present day. Which of the following statements most accurately conveys an aspect of these controversies? A) Protestant Christianity advocates a careful and deliberate control of the size of a population. B) The Church of Jesus Christ of Latter Day Saints (Mormons) teach that only nonhormonal contraceptive methods may be used. C) The Roman Catholic church states that the purpose of all sexual activity is the creation of new life. D) Judaism teaches that family planning should be the exclusive domain of wives. Ans: C Client Needs: C

Cognitive Level: Analysis Difficulty: Moderate


Objective: 2

Page and Header: 335, Family Planning Feedback: The Roman Catholic Church has strongly advocated that the natural purpose of sexual activity is to create new life and nothing should try to interfere with that potential. The members of the Church of Jesus Christ of Latter Day Saints

(Mormons) do not differentiate between the hormonal and nonhormonal methods of contraception. Some conservative Protestant Christians and conservative Muslims also advocate allowing God to plan families and do not use birth control methods.

Judaism does not explicitly teach about family planning. 8. In vitro fertilization (IVF) is an example of assisted reproductive technology (ART)

that has become more common in recent decades. However, IVF is not without

controversy. Which of the following aspects of IVF is most often contentious? A) The number of fertilized ova normally exceeds the number of children that a woman desires. B) The success or failure of IVF rests on the genetic characteristics of sperm that comes from a man unknown to the woman undergoing the procedure. C) IVF is most common among women who have a history of elective abortion. D) IVF is often undertaken without the consent of a womans partner. Ans: A

Client Needs: A-1 Cognitive Level: Application



Objective: 3

Page and Header: 344, Assisted Reproductive Technology (ART)

Feedback: In IVF, several fertilized ova are usually returned to the uterus to ensure that at least one will survive. If more than one implants successfully, it is possible for

the mother to have multiple births. The alternative to this potential is the abortion of one of more of the implanted ova, a practice that is controversial. IVF may or may not use sperm from an anonymous donor and is not normally performed without the

awareness or consent of the womans partner. IVF is not normally necessitated by prior elective abortions.

9. The advent of technology has made it increasingly difficult to define the exact point at which death occurs. Which of the following is currently the most commonly-accepted criterion for death? A) The cessation of blood circulation B) The inability to perform respiration spontaneously C) Persistent lack of interaction with outside stimuli D) The cessation of brain activity

Ans: D

Client Needs: A-1


Difficulty: Easy


Objective: 4

Page and Header: 350, Death Defined Feedback: Brain activity, with few exceptions, is said to be nonexistent when flat electroencephalographic tracings are obtained over a given period, often 48 hours.

After this point, the person may be considered dead, although machines may be supporting the vital functions of respiration and circulation. Many institutions now accept this definition of cerebral death and use it as a basis for turning off respirators and stopping other treatments. It is also used as a basis for determining death when

there is a desire to recover organs from the patient. 10. After several rounds of unsuccessful in vitro fertilization (IVF), a couple has chosen to explore the use of a surrogate mother. In most states, this would involve A) a civil court case in which a judge grants permission for the couple to proceed with surrogacy. B) the use of a surrogate who is selected from a state-recognized list of approved surrogates. C) the drafting of a detailed contract between the surrogate mother and the couple. D) a covert and illegal arrangement between the couple and the potential surrogate mother.

Ans: C

Client Needs: A-1




Objective: 3

Page and Header: 347, Surrogate Mothers

Feedback: A formal, contractual relationship is usually established. The couple who wishes to have the child agrees to pay all expenses associated with the pregnancy, and to pay the surrogate mother an agreed sum for her time and involvement In a few

states, however, such arrangements are illegal. A court case is not required and approval of a particular surrogate mother is not the jurisdiction of the state.

11. A nurse is aware that there are numerous bioethical issues involved in the practice or euthanasia. Which of the following events most clearly constitutes active euthanasia? A) A woman chooses not to phone 911 when her elderly husband become unconscious in the home. B) At his and his wifes request, a doctor provides a man with a fatal dose of phenytoin. C) A nurse withholds cardiopulmonary resuscitation (CPR) from a patient in light of the patients DNR order. D) A family decides against treating their mothers sepsis because of her low potential for recovery. Ans: B

Client Needs: C




Objective: 5 Page and Header: 353, Positive Euthanasia Feedback: Negative, or passive, euthanasia refers to a situation in which no extraordinary or heroic measures are undertaken to sustain life. This includes applying DNR orders, opting not to phone 911, or choosing to withhold treatment of an acute illness. Active euthanasia, however, occurs in a situation in which the

physician prescribes, supplies, or administers an agent that results in death. 12. There are differing viewpoints surrounding the withholding and withdrawal of treatment. Which of the following situations constitutes the most acceptable application of the withholding and/or withdrawal of treatment? A) A competent patient expresses a desire that hydration and nutrition be discontinued. B) The potential benefits of a patients antibiotic therapy exceed the likely risks. C) A patients family will be forced to pay out-of-pocket for the patients life support due to a lack of insurance coverage. D) A patients children wish to discontinue the patients treatment because they have lost faith in the care team. Ans: A

Client Needs: A-1




Objective: 6


Feedback: Most healthcare organizations and institutions agree that a competent

patient has the right to withdraw or withhold treatment, especially when such

treatment is unlikely to result in positive outcomes. When benefits exceed risks,

treatment is normally undertaken. Financial concerns and interpersonal disputes

should ideally not form the basis of such life-and-death decisions.

13. The practice or organ transplantation is associated with several important bioethical issues. The ethics of transplantation primarily surround the fact that A) organ transplantation does not guarantee positive outcomes. B) only a small number of the organs in the body are amenable to transplantation. C) transplantation is a treatment of last resort. D) the demand for organs greatly exceeds the available supply. Ans: D Client Needs: A-1




Objective: 8

Page and Header: 357, Organ and Tissue Transplantation Feedback: Ethical issues in organ transplantation most often surround the fact that there is a very finite supply of available organs and a larger number of potential

recipients. As a result, difficult decisions must be made around the allocation of a valuable and scarce resource. The fact that transplantation is a measure of last resort is less salient. The facts that transplantation does not guarantee recovery and that only

certain organs may be transplanted are not central to these difficult decisions. 14. The Human Genome Project (HGP) has been the subject of extensive attention, both in the healthcare community and in the public at large. Which of the following bioethical issues is most applicable to the HGP? A) The HGP was conducted with little participation from developing countries. B) The HGP did not result in the number or quality of medical applications that were originally hoped. C) The HGP provides information that has the potential to influence the selection of behavioral attributes. D) The HGP calls into question many of the practices that have been accepted in Western medicine. Ans: C

Client Needs: C




Objective: 9

Page and Header: 361, The Human Genome Project

Feedback: The ethical and bioethical concerns that can evolve from the HGP are many and varied. Among them are the issues of access to and use of new genetic

information and technology to improve health, the research that would involve human participants, and the implications of the discovery of genetic contributions related to diseases, non-disease attributes, and various behavioral traits such as cognition,

mental illness, diurnal rhythms, and aging for how we understand health and illness. The project did not discount common medical practices or fail to produce useful applications. The Western focus of the project was not widely criticized.

15. Gene therapy has been touted as one of the most promising therapies for healthcare in the 21st century. At present, gene therapy is primarily limited by A) the dynamic nature of the human genome. B) objections to gene therapy that are posed by religious groups. C)

the difficulty in producing safe, consistent therapeutic results. D) the fact that only around a dozen known human diseases have a genetic basis. Ans: C Client Needs: C




Page and Header: 362, Gene Therapy Feedback: Although gene therapy is a promising treatment option for a number of diseases (including inherited disorders, some types of cancer, and certain viral infections), the technique remains risky and is still under study to ensure its safety

and effectiveness. The human genome is essentially consistent between individuals. Hundreds of diseases have a genetic basis and opposition from organized groups has not been the primary brake on the development of gene therapy.

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