Cherry Chap. 22

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A current trend is for students to be evaluated to determine whether they demonstrate competence in the actual client care environment or with a standardized patient. This process occurs in addition to or instead of traditional pencil-and-paper evaluations. This type of evaluation is referred to as: a. core practice competencies. b. continuing competence. c. distance learning. d. performance-based assessment. ANS: D Performance-based assessment is the evaluation of abilities based on an objective demonstration of specific required competencies. This may include performance in actual or simulated situations. Core practice competencies consist of the abilities and skills currently required for program completion and nursing practice. Continuing competence is required in many states for relicensure and recertification. Distant learning occurs when courses are delivered through some electronic format such as a Web-based course. The course may be presented a great distance from the student, who is never required to attend a class at a physical location.
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One of the major trends that currently influences nursing education and practice is: a. increased technology in the field of critical care. b. a narrowing scope of practice for nurses. c. incivility or disregard of others’ rights in social interactions. d. a decrease in ethnicity due to international programs allowing students to study from a distance. ANS: C Incivility has escalated with the use of text-messaging during class and academic dishonesty. Critical care is not the only area in which technology is increasing, and this has no direct effect as a major trend influencing nursing education. The scope of practice is becoming broader, including community and global settings. The number of diverse ethnic minorities and illegal immigrants is increasing.
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Although the use of technology and the Internet provides nursing faculty and students with unlimited resources and current information, an outcome associated with this trend is that: a. users of electronic resources spend a disproportionate amount of time looking for pertinent content. b. additional time is available to study and revise curricula because special skills are not needed to access information via the Internet. c. immediate results and outcomes are expected from students and faculty, thus enhancing time management. d. skills that require problem solving and reflective abilities are developed. ANS: A Students can easily become distracted by pursuit of the intriguing web of links they encounter while they search websites to complete assignments or find pertinent content. Students must learn to become computer literate and competent. Success in nursing courses and practice depends on these skills. With unlimited information available to them, students may actually take more time to navigate Web-based resources than is needed for review of traditional print-based resources. Learning from the Internet helps students develop skills in analytic thinking, decision making, and reflective judgment.
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The new trend in nursing education that is consistent with real-world practice is focused on: a. outcomes. b. objectives. c. goals. d. subjective appraisals. ANS: A Outcomes and criteria establish real expectations for clinical practice and have a powerful influence on nursing education and practice at all levels. Outcomes are used in all areas of nursing in the nursing process. Objectives refer to knowledge that the student is expected to attain. Goals are client focused. Subjective appraisals are not used in real-world practice.
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The practice of nurses, nursing students, and faculty is affected by demographic changes due to: a. the growing percentage of adults ages 50 to 65 years. b. increasing numbers of obese children and adults. c. changes by which families are becoming more nuclear. d. social programs that are essentially eliminating poverty. ANS: B The United States is experiencing an epidemic of obesity with major consequences for health and the health care system. The percentage of adults ages 50 to 65 years is not increasing. The number of very old adults is increasing. Even the definition of family has changed radically, as evidenced by single individuals living with other single individuals, single-parent households, and same-sex couples (with and without children). The number of families who remain uninsured, jobless, homeless, and surviving in poverty is increasing.
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The first university to offer nursing graduates a baccalaureate degree was: a. Columbia Teachers College. b. Yale University. c. Harvard University. d. the New York Regents Program. ANS: B In 1924 Yale University offered the first separate Department of Nursing, whose graduates earned a baccalaureate degree. Columbia Teachers College was the first to offer a doctor of education degree. Harvard University does not offer a baccalaureate program in nursing. The New York Regents Program is a distance mobility program.
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The nursing model that is referred to as the “class without walls” is which model? a. Articulation b. Career ladder (2 + 2) c. External degree d. Second degree ANS: C An external degree does not require attendance and provides no course classes; it enrolls thousands and is accessible regardless of geographic location. Articulation is the format of a program, or refers to what the student must do to complete the program. The 2 + 2 option is for LPN or RN students to continue their education to RN or BSN, respectively. A second degree is a degree that is pursued after the first degree has been obtained.
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In preparing students for professional nursing practice in the twenty-first century, where should the emphasis be placed? a. Care coordination, direct care for complex clients, and outcomes evaluation b. Chemistry, biostatistics, and computer programming c. Illness care, hospice, and ethics d. Psychomotor skills, obstetrics, and epidemiology ANS: A Caring for complexities in practice, coordinating care, and focusing on outcomes evaluation are the tasks that reflect the direction in which nursing is heading. As supplemental courses to nursing, these are essential but they do not represent an area of emphasis for professional nursing. Illness care, hospice, and ethics are currently components in programs that are preparing students for professional nursing. Psychomotor skills, obstetrics, and epidemiology are limited in scope.
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A standardized means of determining initial proficiency at the entry level into nursing is: a. certification in medical-surgical nursing. b. the National Certification Licensure Examination (NCLEX®). c. instructor-constructed examinations that are comprehensive in nature. d. the ability of the student to answer questions related to the care provided to a patient during the senior nursing courses. ANS: B NCLEX is the national licensure examination that is based on the minimal level of safety required for a nurse to enter practice. Certification in medical-surgical nursing is attained through a specialty examination for AACN certification that can be taken only by registered nurses. Instructor-constructed examinations are based on instructors’ knowledge and experience and are not used for entry into practice. The ability of the student to answer questions related to the care provided to a patient during the senior nursing courses describes a nonstandardized means of determining initial proficiency.
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Which trend is an effect of the nursing shortage on nursing education? a. Only devoted qualified nurses are continuing to provide bedside nursing because of the complexity of care required, resulting in excellent preceptorships for students. b. The number of applicants to nursing programs has risen but enrollment is limited because of a decrease in the number of available scholarships and grants. c. With an increase in the number of nurses who are entering graduate school to escape bedside nursing, students can soon enjoy a lower faculty/student ratio. d. Students may be assigned to preceptors who have not yet developed expertise in the field of interest. ANS: D Qualified preceptors are few. There is a shortage of nurses qualified at the bedside who are available to serve as preceptors for students. Nursing enrollments are limited because of a shortage of faculty. Nurses are not entering graduate school to escape bedside nursing, but to pursue advanced practice degrees.
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The NCLEX examination is created and administered by the: a. American Association of Colleges of Nursing (AACN). b. American Nurses Association (ANA). c. National Council of State Boards of Nursing (NCSBN). d. National League for Nursing (NLN). ANS: C The NCSBN coordinates licensure activities on a national level and creates and administers the licensure examination (NCLEX). The AACN is an organization of deans and directors of baccalaureate and higher degree nursing programs that establishes standards for programs and is concerned with legislative issues that pertain to professional nursing education. The ANA is the major national nursing organization concerned with broad scope practice issues, standards of practice, scope of practice, ethics, legal issues, and employment; it consists of a federation of state nurse associations. The NLN is a national organization of nurse educators that has a long-standing commitment to four types of basic programs: LPN, diploma, ADN, and BSN.
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A potential nursing student is visiting the website of some nursing programs and notes that the school states, “The curriculum is built on the Essentials of Baccalaureate Education to ensure that this nursing program meets the standards set for educating nurses at the baccalaureate level.” Which organization oversees professional nursing programs and establishes these essentials? a. American Association of Colleges of Nursing (AACN) b. American Nurses Association (ANA) c. National Council of State Boards of Nursing (NCSBN) d. National League for Nursing (NLN) ANS: A The AACN publishes the Journal of Professional Nursing, The Essentials of Baccalaureate Education, and other related documents pertaining to the BSN and higher degree education. The ANA is the major national organization that is concerned with a broad scope of practice issues. The NCSBN is the organization of all state boards of nursing that coordinates licensure activities at the national level. The NLN is the national organization of nurse educators that has a long-standing commitment to four types of basic programs: LPN, diploma, ADN, and BSN.
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A student is planning to enroll in prerequisite courses after graduating from high school and is researching options for nursing programs. During a career fair the student compares different types of nursing education programs and discovers that: a. diploma programs focus on family and community, with an emphasis on health promotion. b. most practicing RNs graduated from diploma programs because this was the first type of RN program. c. baccalaureate programs focus on technical and hands-on nursing skills in diverse community settings. d. master’s programs such as that for the clinical nurse leader provide entry into practice with a focus on interdisciplinary and bedside nursing care for complex client populations. ANS: D A clinical nurse leader oversees the care coordination of groups of clients and actively provides direct client care in complex situations, evaluates client outcomes, and has the decision-making authority to change care plans when necessary. Diploma programs do not focus on community, with an emphasis on health promotion, although baccalaureate programs do have this focus. Most of today’s practicing RNs graduated from ADN programs. BSN programs focus on the care of clients, with greater emphasis on the family and community and on health promotion and illness prevention.
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When preparing to complete a competency exam involving a neurologic assessment in a simulation laboratory, the nurse reviews the critical elements, which consist of: a. those steps that result in life or death of a client. b. required criteria that must be incorporated into the assessment for the desired outcome. c. fundamental strategies unique to complex dynamic care environments. d. objective data that can be used to determine the likelihood that the client will recover. ANS: B Critical elements include the application of mandatory principles that must be used according to established practice standards. Critical elements work to achieve desired outcomes for the client. Critical elements are not strategies. Critical elements are based on the application of mandatory principles, not on objective data, to determine the likelihood that the client will recover.
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An RN with a diploma preparation wants to participate in decisions about health care and decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering self-scheduling and self-paced curriculum. This nurse is taking advantage of: a. educational mobility. b. a traditional nursing program. c. training for advanced practice nursing. d. credit by examination. ANS: A Education mobility is the progressive movement from one level or type of education to another, in this instance, diploma to BSN. Programs are aimed to make the transition possible through creative flexible scheduling. Traditional nursing programs have set schedules, often face-to-face lectures offered in a full-time format; although some programs are web-assisted, the majority require the student to be on campus for most learning experiences. A BSN is not an advanced practice degree. Although credit by examination may be a part of a nontraditional nursing program, it is only a portion and does not characterize the type of learning.
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A nursing student scores 95% on the written examination for the adult health course. To be successful in this course, this same student must then perform an indwelling catheter insertion and wound care in a simulated environment meeting core competencies. The student asks, “What are core competencies?” The nursing instructor replies, “Core competencies are: a. a trend used in nursing education to reduce attrition in prelicensure students.” b. those skills necessary for safe competent nursing practice.” c. educational opportunities that provide remediation when student is unable to perform psychomotor skills correctly.” d. critical thinking exercises aimed to improve reading and math skills.” ANS: B Core competencies are those skills and elements that are fundamental and essential for safe competent practice. The aim is not to reduce attrition but to ensure students have skills needed to provide safe care in today’s dynamic healthcare environment. Critical elements are the components of any skill required to produce safe competent care. The aim is not to improve reading and math skills rather critical thinking related to the practice of nursing.
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A nurse realizes that a recent health care concern related to globalization was: a. the emergence of epidemic hepatitis A. b. the pandemic of H1N1 “swine flu.” c. reemergence of polio. d. an increase in chronic illnesses. ANS: B There was a pandemic of H1N1 on every continent Hepatitis A is not related to globalization; rather the most common cause is lack of simple handwashing. Polio has been almost nonexistent in the United States since the 1960s. Globalization does not affect chronic illness.
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The purpose of recent research conducted jointly with nurses and physicians participating in the Advisory Council on Nursing Education and Practice and the Council on Graduate Medical Education was: a. to reduce medical costs by eliminated unnecessary diagnostic tests. b. improved interdisciplinary efforts between nurses and physicians to improve client safety and reduce errors. c. globalization of health care to Third World countries. d. ways to ensure confidentiality when sharing client data between nurses and physicians in today’s technology-driven health care. ANS: B Collaborative education is key to ensuring client safety. This study was conducted jointly with nurses and physicians to improve safety and reduce errors. The aim was not a reducing cost rather improving safety and reducing errors. The aim was not toward globalization. This study focused on interdisciplinary collaboration and safety rather than technology and concerns such as confidentiality. MULTIPLE RESPONSE
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A nurse is concerned that the policy of using povidone-iodine (Betadine) to clean foot ulcers may lead to unwarranted allergic reactions and drying of surrounding tissue. A literature review is performed to determine the “best practice” related to care of foot ulcers. This nurse: (Select all that apply.) a. is applying evidence-based practice to the clinical setting. b. is using critical thinking to change procedures performed in the care of foot ulcers. c. is minimally educated at the master’s level and participating in research to provide cost-effective care (soap is less expensive than povidone-iodine). d. lacks clinical competence in health assessment and in application of theory to the clinical setting. e. is using information to problem-solve and ensure safe, competent care. ANS: A, B, E Critical thinking is an essential part of applying evidence-based practice that is using research findings to guide actual practice. Evidence-based research, not cost, should be used to guide actual practice. The nurse is demonstrating clinical competence by using assessment skills and by noting the effects of povidone-iodine and applying evidence-based practice to change procedures performed in the care of foot ulcers.
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When planning health care, the nurse should be mindful that members of the Asian culture tend to: a. miss appointments because they are present oriented and time is viewed as flexible. b. look to their ancestors for guidance. c. plan ahead and be future oriented. d. arrive early because they have no concept of time. ANS: A In Asian culture, individuals tend to be present oriented and time is viewed as being more flexible than in the Western culture; being on time for appointments is not seen as a priority. The people of the Asian culture usually have close, extended family ties, and emphasis is on family needs rather than individual needs; all members participate in health care decisions. The Asian culture is present oriented. The Asian culture is present oriented and Asian individuals are often late for appointments because they are less concerned with planning ahead.
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A nurse is admitting a Mexican-American child, and the mother comments that the child was exposed to vista fuerte. The nurse should expect to find which symptom associated with this exposure? a. Fever b. Constipation c. Bruising d. Somnolence ANS: A The child has what is referred to as mal ojo, which can lead to diarrhea, fever, and even death. A child said to have been exposed to vista fuerte would experience diarrhea. Bruising is associated with cupping, a common practice among Southeast Asians. The child is having restless sleep rather than feeling drowsy.
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A Mexican-American patient is attacked and beaten. This patient is at risk for “fright disease,” which is known as: a. susto. b. empacho. c. bilis. d. mal ojo. ANS: A Susto is an emotion-based illness that is common among Mexicans. An unexpected fall, a barking dog, or a car accident could cause susto. Symptoms include colic, diarrhea, high temperature, and vomiting. Empacho is a disease that can affect children or adults and is caused by food particles that become lodged in the intestinal tract, causing sharp pains. Bilis is a disease that is brought on by anger. It primarily affects adults and commonly occurs a day or two after a fit of rage. Mal ojo is associated with “evil eye,” which causes fever, diarrhea, and restlessness.
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A priority action for the nurse who works with culturally diverse clients is completion of a: a. sign language course. b. cultural self-assessment. c. cultural client assessment. d. continuing education course on how to speak Spanish. ANS: B The first step to becoming a culturally sensitive and competent health provider is to conduct a cultural self-assessment. Through identification of health-related attitudes, values, beliefs, and practices, the nurse can better understand the cultural aspects of health care from the client’s perspective. A sign language course is not a priority because interpreters are usually available. The nurse should always perform a cultural self-assessment first, before performing the patient’s cultural assessment. Taking a Spanish class is not a priority action and would be helpful only with patients who speak Spanish; the nurse may encounter many other patients with different language needs.
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A nurse is caring for a recent Asian immigrant client and is overheard making the following comment, “These rituals you believe in are false. You live in America now and must believe in realistic health practices, like Americans do.” The nurse is exhibiting: a. stereotyping. b. ethnocentrism. c. cultural accommodation. d. empathy. ANS: B Ethnocentrism is the belief that one’s own ethnic group, culture, or nation is best. Stereotyping is defined as assigning certain beliefs and behaviors to groups without recognizing individuality. Cultural accommodation involves making adjustments or adaptations for the beliefs of others. Empathy is mentally identifying with a person’s situation or character.
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The nurse is preparing a plan of care for an African-American patient who has had a change of bowel habits from being constipated and having only two firm stools weekly to having three or more loose stools daily. Which comment is related to cultural variation for health information? a. The individual states, “I will need to discuss health care options with my grandmother.” b. The eldest male member of the family will make all health care decisions. c. The patient has high respect for the nurse and nods approvingly, although she has no intention of complying with instructions or plan of care. d. The individual speaks very quietly and gently reaches to hold the nurse’s hand for support. ANS: A In the African-American culture, women, especially “Granny,” play a key role in health care decisions. Males often make decisions in Asian cultures. In the Asian culture it is important for an individual to agree with those in authority and to appear compliant, even if there is no intention of complying with instructions or plan of care. A low tone of voice is consistent with the American Indian culture, and touching another’s hand is not common among Asians or American Indians.
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A nurse is submitting a grant application to improve access to health care and mortality for minority groups. The grant focuses on the six causes of death that are identified as priorities for minorities, which include: a. chronic obstructive pulmonary disease. b. malnutrition. c. cirrhosis of the liver. d. cancer. ANS: D Cancer is identified as the cause of excessive death among minority group members. The six leading causes are cancer, cardiovascular disease and stroke, chemical dependency, diabetes, homicides/accidents, and infant mortality. Chronic obstructive pulmonary disease is not identified as one of the six leading causes of death among minority groups. Malnutrition is not identified as one of the six leading causes of death among minority groups. Cirrhosis of the liver is not identified as one of the six leading causes of death among minority groups.
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A nurse is given a referral to make a home visit to a Russian immigrant. The nurse knows very little about the health beliefs of this ethnic group. To research this group, she can use an Internet search engine and enter the term “Russian cultures” or “Russian health beliefs.” To obtain more generalized information, she could also search under: a. federally recognized minorities. b. marginalized populations. c. Asian/Pacific Islander cultures. d. Latino cultures. ANS: B Marginalized populations include recently arrived immigrants. Their lives and health care needs often are kept secret and are understood only by them. Russian immigrants are not federally recognized minorities. A search for Asian/Pacific Islander cultures would not provide any information on Russian Immigrants. A search for Latino cultures would not provide any information on Russian immigrants.
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Which statement is true regarding health care for minorities? a. Federal legislation that provides free health insurance for minorities has resulted in fewer minorities than members of the general population who lack health insurance. b. Higher costs of health care coupled with lower wages for minorities have prevented most minorities from seeking health care. c. Because many Mexican-Americans are highly skilled workers with comparable wages, they have the lowest uninsured rate. d. Asians, because of their quiet demeanor and unwillingness to challenge the health care system, have the highest rate of uninsured people. ANS: B Most families with racially or ethnically diverse backgrounds have a lower socioeconomic status than is observed in the population at large. Dramatic changes in technology and specialization in the health care field have caused health care costs to skyrocket. Therefore, not everyone can afford health care services. More minorities than general population members lack health insurance. At 40%, Mexican-Americans have one of the highest uninsured rates. African-Americans, Hispanics, and Native Americans have much higher rates of poverty than do non-Hispanic whites, and Asians. The median family income of Asians is slightly higher than that of non-Hispanic whites; because their income is higher, Asians have better access to health care.
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While completing a nursing degree in Virginia, a student who is interested in teaching in Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of Mexican-Americans live there. This nursing student values: a. cultural competence. b. ethnocentrism. c. prejudice. d. stereotyping. ANS: A Cultural competence is the responsibility of all nurses to become knowledgeable about the values, beliefs, and health care practices of the culturally diverse groups that are dominant in the nurse’s particular practice area. Ethnocentrism is the belief that one’s own ethnic group, culture, or nation is best. Prejudice is a preconceived, deeply held, usually negative judgment that has been formed about other groups. Stereotyping is defined as assigning particular beliefs and behaviors to specific groups without recognition of individuality.
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A Southeast Asian woman brings her baby into the clinic because the baby is lethargic. The nurse determines that the baby has had diarrhea and vomiting for several days, resulting in dehydration. Physical examination reveals small, round burns on the abdomen. These burns probably are the result of cigarettes or burning cotton used to: a. try to quiet the child and is considered child abuse. b. bring out toxic wind from the body. c. balance heat loss from the body. d. brush the body with ruda to allow spirits to return. ANS: C In the Southeast Asian culture, touching a burning cigarette or piece of cotton to the skin, usually the abdomen, is done to compensate for “heat” lost through diarrhea. This type of burning is a common part of self-care. Quieting a child by burning his or her skin is not a practice of Southeast Asian culture. Using burns to bring out toxic wind from the body is not a practice of Southeast Asian culture. Brushing the body with ruda to allow spirits to return is not a practice of Southeast Asian culture.
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A cultural phenomenon that is based on biologic variation would include: a. belief that exposure of a pregnant woman to an eclipse can result in cleft lip. b. denser bones in African-Americans result in less morbidity associated with osteoporosis. c. the grandmother who determines that her grandchild has scoliosis and should seek treatment, then informs the parents of her decision. d. family participates in feasts prepared to celebrate and make decisions ANS: B Biologic variations include denser bones in African-Americans. Biologic variations such as body build and structure, genetic variations, skin characteristics, susceptibility to disease, and nutritional variations exist among different cultures. Other common variations include skin color, eye shape, hair texture, and adipose tissue deposits. The belief that exposure of a pregnant woman to an eclipse can result in cleft lip is an example of environmental control. A grandmother who has a lot of say in health care decisions is an example of ways that social organization affects cultural beliefs Family feasts to celebrate and make decisions and Vietnamese immigrants gather at an altar into which the names of ancestors have been carved are examples of ways that social organization affects cultural beliefs
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A nurse plans to move to an area that is rich in immigrants from several countries and is concerned about respecting others’ cultural beliefs. The nurse’s first step to ensure cultural competence and sensitivity is to: a. enroll in a nursing theories course to increase knowledge about transcultural practices. b. become immersed in nursing literature about culturally diverse clients. c. participate in continuing education that focuses on health assessment variations among cultural groups. d. conduct a cultural self-assessment. ANS: D A cultural self-assessment allows the nurse to identify attitudes about individuals from different cultures. To gain maximum benefit, the nurse must first identify his own attitudes before enrolling in a nursing theories course. To gain maximum benefit, the nurse must first identify his own attitudes before immersing himself in nursing literature about culturally diverse clients. To gain maximum benefit, the nurse must first identify his own attitudes before participating in continuing education that focuses on health assessment variations among cultural groups.
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A nurse is preparing discharge teaching for an Asian American woman with a fractured hip. The nurse reviews the client’s diet history while hospitalized and is concerned that the patient refused milk and yogurt placing her at risk for osteoporosis. What cultural variation is the nurse overlooking? Asian Americans: a. have denser bones that other ethnic groups. b. consume diets rich in pork bone and shells reducing the risk of osteoporosis. c. would participate in the practice of burning to compensate for this injury. d. would consult a curandero for dietary consultation. ANS: B Pork bones and shells are rich in calcium, reducing the risk of osteoporosis. African-Americans have denser bones than other ethnic groups. Although Southeast Asians participate in burning, it is used to compensate for heat loss such as with diarrhea. Hispanic clients consult with curanderos, whereas Asian clients would seek an acupuncturist or bone setter. MULTIPLE RESPONSE
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Six cultural phenomena that vary among cultural groups are known to affect health care. The influence of the consequences of these phenomena can be seen in: (Select all that apply.) a. Asians and American Indians end to be nonadherent with medications because they believe that the environment has no control over their fate. b. Some cancers such as stomach cancer occur less frequently among African-Americans. c. African-Americans and American Indians often resist direct eye contact. d. Mexican-Americans are more likely to stand close and touch health care providers. e. Whites are often late for health care appointments. ANS: C, D The use of eye contact is a cultural communication phenomenon. Cultures such as African-American and American Indian may view direct eye contact as rude behavior. Space and touch are cultural phenomena factors. In some cultures, touching strangers is inappropriate. On the other hand, Mexican-Americans tend to be comfortable with less space because they like to touch persons with whom they are talking. Asians and American Indian believe that illness represents a disharmony with nature. The occurrence of stomach cancer is twice as high among African-American men than among white men. Whites represent Western culture, in which punctuality and “watching the clock” are part of the cultural phenomena.
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When an RN is asked to accept an assignment that he or she may not be qualified to perform, the nurse should: a. accept the assignment as appropriate if assigned by a legitimate power. b. be primarily concerned with the number of patients being assigned. c. ask how other nurses have handled the assignment in the past. d. determine whether he or she is familiar with the types of patients being assigned. ANS: D Nurses should always think critically about assignments so they can communicate what makes them uncomfortable about a particular assignment. If nurses do not have the knowledge or experience required for particular patient assignments, then modification of the assignments is in order to ensure patient safety. Even if the person who makes the assignment has legitimate power, he or she may not be aware of the nurse’s work experience and training. The nurse should not respond on the basis of the actual number of patients assigned but should consider the needs of each patient, his or her age and condition, other factors that contribute to special needs, and the resources available to meet those needs. Each nurse possesses individual expertise. Basing decisions on the actions and capabilities of others is incorrect and is potentially unsafe for the patient.
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One workplace issue—the nursing shortage—is caused by several complex issues, including: a. movement of nurses into acute care settings. b. the use of unlicensed assistive personnel to replace RNs. c. a mass of baby-boomers who have chosen nursing as a career. d. an aging nursing workforce. ANS: D Research validates that an aging population and an aging nursing workforce are significant contributors to the nursing shortage issue. Movement of nurses into acute care settings would actually be beneficial in terms of the nursing shortage. As patient care technology increases, the number of nurses needed in acute care settings is increasing. Unlicensed assistive personnel cannot be used to replace RNs, although they can be placed in positions that allow them to assist RNs in providing patient care. There has not been a mass of baby-boomers who have chosen nursing as a career.
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Studies conducted to determine why enrollment in nursing schools has declined found: a. that a greater number of individuals chose nursing as a career but could not meet entrance requirements. b. fewer young individuals are available to enter the workforce. c. fewer career opportunities exist for women outside of nursing. d. men have dominated the profession, and women feel that they have experienced discrimination. ANS: B Younger birth cohorts (those born after 1955) are smaller in population size resulting in fewer potential nursing profession candidates. Many qualified nursing candidates are turned away because of limited enrollment in nursing schools. The shortage of nursing school faculty limits the number of applicants that can be accepted for admission. Job opportunities are actually more numerous than ever for women. Men remain a minority in the nursing profession.
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Along with the shortage of enrollment reported in nursing schools is a shortage of faculty, which is attributed to several factors, including: a. the burden of research leads to burnout. b. that faculty choose employment where work hours are more flexible. c. increased enrollment in doctoral programs but only in the areas of research and clinical practice, not in the specialty of education. d. increasing job competition from higher-paying clinical sites. ANS: D Academic institutions, especially those faced with budget cuts, generally cannot compete with nonacademic employers. Faculty salaries continue to be a major contributor to the nursing shortage. Faculty salaries are not substantial, and research is not a job requirement in many nursing faculty positions. The educational setting is so desperate for nursing faculty that scheduling flexibility usually is not an issue. Most nursing faculty members actually have greater flexibility with regard to weekend and holiday scheduling than do clinical nurses. Enrollment in doctoral programs has not increased in any specialty area because of the faculty shortage.
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The key to organizational success for health care facilities is: a. hiring younger, more energetic nurses. b. offering incentives such as sign-on bonuses. c. hiring highly qualified advanced practice nurses. d. retaining professional nurses. ANS: D Past nursing shortages have proved that retention of professional nurses is the key to any organization’s success. Nurses want to work in an environment that supports decision making and effective nurse-physician relationships. The ability of an organization to retain nurses primarily depends on the creation of an environment that is conducive to professional autonomy. Younger nurses want flexible hours and considerable autonomy in the work environment. These options are limited in the current health care environment, where round-the-clock patient care, including on weekends and holidays, is mandatory. Offering sign-on bonuses actually results in considerable expenditure by the health care organization. Many believe that these recruitment-related costs could be better spent by increasing basic compensation levels of professional nurses. Hiring highly qualified advanced practice nurses does help to improve patient outcomes but does not provide the staffing needed for direct patient care.
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Magnet hospitals are those work environments that: a. attract physicians but repel nurses. b. lack appreciation for nursing certification. c. not only attract but also retain professional nurses. d. discourage nurses from advancing their current level of education. ANS: C Magnet hospitals are those that have been identified as both attracting and retaining professional nurses. A study conducted in 1983 identified workplace factors such as management style, nursing autonomy, quality of leadership, organizational structure, professional practice, career development, and quality of patient care as influencing nurse job satisfaction and turnover rates (i.e., higher retention). Magnet hospital nurses have higher levels of autonomy, greater control over the practice setting, and better relationships with physicians. Magnet hospitals actually attract both physicians and nurses. Magnet hospitals actually recruit and reward professional nurses with specialty certification. Magnet hospitals have programs that support nurses in advancing their education.
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Which situation would be considered a workforce advocacy issue that is reportable to the state nurses association or the Center for American Nurses if it is not resolved at the local level? a. Nurses prefer to wear navy blue scrubs but the institution requires burgundy scrubs, which interferes with autonomy. b. The cafeteria often serves fried vegetables rather than healthier baked vegetables, causing the potential for hyperlipidemia. c. The hospital pharmacy does not fill employee prescriptions upon receiving them; instead, they fill employee prescriptions after all inpatient prescriptions have been filled. d. The key needed to change the sharps container is locked in the supervisor’s office after 3 PM on weekdays and all day on weekends, which prevents changing of the container when needed and places nurses at risk for needlesticks. ANS: D A safe work environment is imperative for the safety of both nurses and patients. Correcting this work environment issue promotes job satisfaction and patient outcomes. Dress codes do not affect nurse safety or patient outcomes; therefore advocacy intervention is not appropriate. Food choices in the cafeteria do not affect nurse safety or patient outcomes; therefore, advocacy intervention is not appropriate. Waiting to fill employee prescriptions until after inpatient prescriptions have been filled does not affect nurse safety or patient outcomes; therefore, advocacy intervention is not appropriate.
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8.
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A newly hired nurse is asked to serve on a committee formed to recruit and retain nurses. At the committee meeting, the nurse learns that: a. older nurses are being encouraged to retire, so that younger, more efficient nurses can practice. b. Magnet hospitals are able to attract nurses with sign-on bonuses and flexible work hours but fail to retain nurses because insufficient autonomy over professional practice is provided. c. multitasking is seldom desired by the younger generation of nurses. d. many younger workers are less concerned with longevity and are willing to change institutions to achieve professional advancement and flexible work hours. ANS: D The emerging workforce, ages 18 to 35 years, has compensation expectations that differ from those of previous generations. This younger generation prefers to work in an outcomes-based environment, where pay is based on achievement or merit, not on longevity. Older nurses are actually being recruited to stay in the employment arena to improve patient outcomes. Research advancements in ergonomics and workload have made early retirement less appealing. Magnet hospitals definitely retain nurses by offering professional practice autonomy. The younger generation is very adept at multitasking and at using technology.
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9.
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Hospitals surveyed nurses who terminated their employment to determine why they chose to leave. One of the most common reasons for leaving was: a. decreased pay for alternative shifts. b. that the nurse/patient ratio prevents safe care. c. that most facilities are choosing an all-RN staff, which decreases opportunities for advancement. d. that agency and foreign nurses are favored by administration over full-time nursing staff. ANS: B A number of studies in the late 1990s focused on the work environment as a significant contributor to the difficulties involved in recruiting and retaining RNs. One of the primary factors for the increasing nurse turnover rate was identified as workload and staffing patterns. A more recent study by Aiken (2002) reported higher rates of patient complications and increased death rates when fewer nurses are assigned per patient. Substantial monetary compensation is provided for alternative shifts. An all-RN staff would not limit advancement opportunities. Use of agency and foreign nurses results in considerable expenditures by health care organizations. Many believe that these recruitment-related costs would be better spent by increasing the basic compensation levels of professional nurses.
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A staff nurse serves on a shared governance council that has been given the authority to decide issues related to “self-scheduling” and “use of unlicensed assistive personnel.” Council chairs make all final decisions regarding nurse/patient ratios and use of agency nurses. This phase of shared governance is phase: a. 1. b. 2. c. 3. d. 4. ANS: C In the third developmental phase of shared governance, staff nurse representatives serve on councils that are assigned authority to handle specific functions. At this level, council chairs make up the management committee that is charged with making all final operational decisions. Phase 1 includes staff nurse representatives who have the authority to address designated practice issues and some authority to determine roles, functions, and processes. Managers are responsible for facilitating practice through resource management and allocation. The executive committee accepts recommendations from staff nurses and managers. The chief nurse executive retains final decision-making authority. In phase 2, staff nurse representatives serve on committees that are designated for specific management and/or clinical functions. Managers serve on the same committees with staff nurses. Committee chairs are appointed by the chief nurse executive, and the nursing cabinet makes final decisions on the basis of recommendations received from the committees. Shared governance has passed through only three developmental phases.
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A nurse is concerned about safe staffing levels at her facility and observes that several units have no RN coverage but instead have RNs who float among several units. In determining whether this staffing concern should be reported to an outside agency, the nurse understands that with whistle blowing: a. reporting unsafe staffing levels to The Joint Commission provides protection from the employer. b. keeping copies of inappropriate staffing patterns in the nurse’s personal file is illegal. c. when observing inappropriate staffing, the nurse should record her personal thoughts concerning the outcomes. d. one should seek guidance from a trusted individual who can provide an objective point of view. ANS: D One of the many guidelines of whistle blowing specifies that one should seek counsel from a trusted individual outside the situation to gain an objective perspective. Private groups such as The Joint Commission do not confer protection in whistle-blowing situations; a nurse must report to a state or national regulator. Keeping copies of inappropriate staffing patterns in a personal file is not illegal. The nurse should record objective information, not personal thoughts or interpretations.
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12.
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The occupational health and safety nurse would like to develop programs designed to decrease mortality and morbidity among the workforce. When considering factors related to mortality among female workers, the nurse should focus her efforts on prevention of: a. suicide. b. homicide. c. blood-borne disease. d. ergonomic hazards. ANS: B Workplace violence has become a major societal issue. Its most extreme form, homicide, is the fourth leading cause of fatal occupational injury in the United States, with 551 workplace homicides reported in 2004 out of a total of 5703 fatal work injuries (OSHA, 2006b). Suicide is not a strong mortality issue in the workforce. Mortality due to blood-borne pathogen exposure has decreased since the Needlestick Safety and Prevention Act was implemented. Ergonomic hazards have decreased since safe patient handling educational programs were implemented.
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According to the Needlestick Safety and Prevention Act (1991): a. employers must mandate policies for nonmanagerial employees to prevent patients from being exposed to used needles. b. employers are not responsible when employees fail to follow Universal Precautions, resulting in a needlestick. c. each state must determine the degree of input sought from employees to determine safe workplace policies involving protection from sharps injuries. d. employers are required to document how and where a sharps injury occurred, including the brand of device that was involved. ANS: D The Needlestick Safety and Prevention Act, passed at the federal level, requires the use of safer needle devices to protect from sharps injuries; the law requires employers to maintain a sharps injury log that contains, at a minimum, the brand of device involved in the incident, the department or work area where the exposure incident occurred, and an explanation of how the incident occurred. The law requires employers to solicit the input of nonmanagerial employees responsible for direct patient care who are potentially exposed to sharps injuries in the identification, evaluation, and selection of effective engineering and work practice controls. Employers are responsible for the identification, evaluation, and selection of effective engineering and work practice controls to prevent needlesticks. The Needlestick Safety and Prevention Act is a federal law, and all states are held to this statute.
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A nurse is concerned because novice nurses are having their orientation period shortened and are being placed in charge nurse positions. The nurse has documented unsafe care and decisions by these novice nurses. To be protected from retaliation by the employer, this nurse must “blow the whistle” by: a. holding a public forum in the agency cafeteria to discuss concerns. b. reporting concerns to state and/or national agencies regulating the agency. c. calling coworkers outside the workplace to informally discuss wrongdoing. d. contacting The Joint Commission to report unsafe conditions. ANS: B The whistle blower is not protected until concerns are reported to the state or national regulatory agency. Holding a public forum does not in any way offer protection. Reporting to state-national agencies that regulate the employer is the method to ensure whistle blower protection, and it is recommended that complaints be in writing. Neither The Joint Commission nor the National Committee for Quality Assurance grants protection. MULTIPLE RESPONSE
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1.
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Managers at an acute care facility value the contributions of their aging nursing workforce. Using Hatcher’s (2006) recommendations for an aging nursing workforce, they institute which of the following changes? (Select all that apply.) a. Supplies such as dressing change and Foley catheter kits are placed on the nursing unit. b. Novice nurses will be mentored by peers who graduated within the last 2 years. c. Continuing education requirements are waived for nurses within 2 years of anticipated retirement. d. Monthly newsletter will focus on the contribution of all nurses. e. A work-design consultant is hired to redesign the nursing unit to reduce wasted motion. ANS: A, D, E Placing supplies in a decentralized area prevents fatigue from securing items from a distant location. Nurses are integral to quality and their contributions should be noticed. Ill-designed units contribute to fatigue and inability of aging nurses to perform efficiently. Mentoring is one way to acknowledge skills of the aging workforce. Aging nurses want and need information related to technology and practice.
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1.
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Nurses in a unionized hospital are paid “compensatory pay” when working holidays equal to the number of hours worked with no extra compensation. Although they have suggested changes during the annual survey of employee satisfaction, management refuses to consider another system for compensatory pay. A trained member listened to both nurses and management to make recommendations that were not legally binding. This type of settlement is termed: a. picketing. b. binding arbitration. c. mediation. d. grievance. ANS: C Mediation enlists the help of a trained person to listen to both sides; however, recommendations are not legally binding. Picketing is a group of striking employees who congregate outside the workplace to draw attention or discourage others from entering the workplace. Although binding arbitrations involve talks between all parties, the recommendations are compulsory. A grievance is usually a single employee who feels he or she has been treated differently or unfairly than other employees.
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A nurse has been asked to serve as the charge nurse on the evening shift. The agency where the nurse is employed is considering unionization. If the charge nurse position is accepted, this nurse: a. can be represented by the union because charge nurses are not considered part of the management team. b. is part of the management team so union participation would be a conflict of interest. c. can file a grievance that automatically will be arbitrated by the union. d. is ineligible for collective bargaining activities that deal with unfair labor practices. ANS: A Serving as charge nurse is part of a nurse’s professional role and not management. The duty of assigning clients and coordination of care is not a management function. A grievance deals with allegations by an employee that he or she has been treated unfairly. This nurse is eligible for representation through collective bargaining.
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A nurse has heard rumors that other nurses are interested in unionizing but knows little about the purpose of unions. The nurse’s first action is to: a. contact an arbitrator who has worked with other nurses in unions. b. picket the agency where employed to gain inside information as to why unionization is sought. c. sign the dual-purpose union authorization card. d. review the United American Nurses (UAN) website for collective bargaining information. ANS: D The UAN website gives information about collective bargaining for nurses. An arbitrator is the person who negotiates for both sides and may provide information. However, to gain a foundation of understanding it is important that a nurse first contact either the UAN or the National Labor Relations Board. Picketing the agency places the nurse in a position to join the union, and those picketing may resent having someone who does not truly support their cause as a representative. Signing the dual-purpose union authorization card is a request for an election and indicates the nurse is applying for union membership, which without information may not be the best choice.
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Nurses in a nonprofit hospital have expressed an interest in forming a union to secure fair wages and ensure client safety. To form a support group of nurses, the union organizer conducts meetings: a. away from the worksite with a group of managers to learn both sides of the situation. b. at the worksite with staff nurses. c. in homes or local businesses with staff nurses. d. within 24 hours of initial contact to conduct an official election. ANS: C The union representative meets with laborers (staff nurses) at a nonwork setting to gather information about grievances. When initiating union efforts, meetings take place at nonwork settings with laborers to gather information about grievances. Meetings are initially conducted at nonwork settings. Several weeks prior to holding an election, union representatives meet with laborers to determine interest and grievances.
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Mandatory overtime and reduction in RN staff has resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. A nurse is approached to sign a single-purpose union authorization card and if signed, the card: a. simply asks the nurse’s employment status to garner statistics of number of eligible RNs employed. b. indicates that the person is requesting union election. c. indicates the nurse is applying for union membership. d. gives permission for union dues to be deducted from pay. ANS: A A single-purpose card is seeking information such as number and job position of potential union members. The dual-purpose authorization card indicates that the nurse is requesting union election. The single-purpose authorization card does not indicate this. The dual-purpose authorization card indicates that the nurse is applying for union membership. The single-purpose authorization card does not indicate this. The single-purpose authorization card only attempts to determine if enough interest in a union exists and does not establish a union nor dues collection.
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6.
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A group of RNs wish to seek union representation that would protect all workers in the agency including nonlicensed assistive personnel and non-nursing employees such as nutritionists and dietary workers. The type of union being sought is the strongest collective group known as a(n): a. occupational unionism. b. industrial unionism. c. union shop. d. right-to-work bargaining. ANS: B Industrial unionism is single union for all workers in the agency. An occupational unionism has separate unions for each occupation. A union shop is a worksite that requires all new employees within a work group to join the union. Right-to-work statutes prohibit requirement of union member dues as part of employment.
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7.
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Physical therapists are represented by a union, nurses are represented by a separate union, and pharmacists have yet another union within a single agency. This type of union representation is known as: a. occupational unionism. b. industrial unionisms. c. union shop. d. power sharing. ANS: A Occupational unionism indicates separate unions for each occupation in an agency. Industrial unionism is a single union for all workers in the agency. A union shop is a worksite that requires all new employees within a work group to join the union. Power sharing refers to the right of employees to share in decision making.
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8.
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Historically, what movement most influenced unionization in American health care agencies/hospitals? a. Immigration laws protected foreign employees from discrimination in hiring or discharge on the basis of national origin and citizenship status. b. Women entered the workforce, gaining voice to support unions. c. The industrial revolution led to poor working conditions and the need to protect workers. d. Nurses were exposed to communicable diseases, which led to death and disability. ANS: C The industrial revolution led to people working in factories where poor and unsafe working conditions were widespread. Immigration laws protected workers rather than addressing unfair work practices. Although women did enter the workforce during wartime, gender was not a reason to unionize. Although unions provide for safe work environments, unionization was not directly related to communicable diseases.
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9.
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In recent Gallop Polls, nurses were voted as the most honest with the highest ethical standards of all professions. How does this degree of professionalism affect nurses’ desire to participate in organized strikes? a. Nurses most often turn to collective bargaining strategies such as strikes to emphasize client safety initiatives. b. Nurses use evidence-based studies that reflect both management and labor views to support participation in unionization. c. Nurses often find union activities such as strikes in conflict with the need to serve and protect clients and their profession. d. Nurses who strike can be legally punished for abandonment and negligence, considered to be professional misconduct. ANS: C Nurses are client advocates and promotion of professionalism is valued as evidenced by the public’s opinion related to honesty and professionalism. Nurses may feel a conflict with collective bargaining activities such as strikes. There are limited resources, especially evidence-based resources, that provide a thorough discussion of benefits and concerns with unionization for professional nurses. A 10-day notice of intent to strike is required allowing client care to be covered, thus negligence and abandonment is avoided.
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10.
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A concern that nurses were being asked to perform tasks that went beyond the state’s nurse practice act was brought to the union’s attention. Nurses were informed that either mediation or binding arbitration will be used to resolve the issue. A novice nurse asks about the difference between these techniques and was informed that: a. mediation is sanctioned by the National Labor Relations Board (NLRB) to formally discuss concerns with management and labor. b. binding arbitration is a formal discussion between labor and management in which the arbitrator’s recommendations are compulsory. c. mediation uses a trained person to negotiate a legally binding plan. d. binding arbitration requires both labor and management to participate in discussions on the least destructive approach to allow self-governance by employees. ANS: B Binding arbitration requires that both parties meet in formal talks, and all parties must obey the arbitrator’s recommendations. Arbitration, not mediation, is sanctioned by the NLRB. Mediation is not legally binding. Binding arbitration focuses on more than self-governance.
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11.
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A large corporation employs nurses all over the United States. Nurses in one agency learned that fellow nurses in another agency are striking because they are required to work 16-hour shifts to cover for nurses who have left due to unsafe staffing practices. The union of the nonstriking agency nurses decides to stop work to support the nurses who are striking; thus, this union: a. is placing nurses at risk for a lawsuit because their direct employer did not cause the strike. b. must be an industry union representing both parties. c. is participating in a sympathy strike, which, if done correctly, is legal. d. must pay for any losses incurred by the agency during the strike. ANS: C A sympathy strike occurs when a union stops work to support the strike of another union. Sympathy strikes are legal and policies are in place to protect clients. Sympathy strikes can be in support of another union. Policies are put in place to limit losses and ensure client safety prior to a strike. MULTIPLE RESPONSE
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1.
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A hospital is seeking a 2.5% wage reduction for all nurses as part of a new balanced budget plan; however, the plan provides for raises for upper-level management. This plan resulted in a call for a union to protect the nurses. When the union representative arrives, what questions should the nurses ask? (Select all that apply.) a. Will the dues be used to support charity care when clients are unable to pay? b. How effective has the union been in representing nurses’ best interest? c. What percent of dues pays union personnel salaries? d. Are dues used to promote research for terminally ill clients? e. If arbitration is unsuccessful and a strike occurs, will nurse receive compensation during the strike? ANS: B, C, E Laborers (staff nurses) want a union with a successful track record of improving wages and benefits. Union dues are used to support union personnel and the amount varies among different union groups; the higher percentage to pay union personnel salaries means less money to support members. Employers are not obligated to pay laborers during a strike and unions may choose to pay employees while striking. Unions are not involved in philanthropic activities. Union dues are used to support activities to better laborers, not to support research activities.
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2.
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Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. A nurse is approached to sign a dual-purpose union authorization card. The purpose of this card is to: (Select all that apply.) a. ask the nurse’s employment status to garner statistics of number of eligible RNs employed. b. indicate that this person is requesting a union election. c. determine if the nurse wishes to apply for union membership. d. determine willingness to picket or strike if requested by union representative. e. obtain name, address, and signature of person interested in a union. ANS: A, B, C, E A dual-purpose card is seeking information such as number and job description of potential union members. Indicating a desire to hold a union election is a function of the dual-purpose authorization card and not part of the single-purpose authorization card. Indicating a desire to apply for union membership is part of the dual-purpose authorization card but not part of the single-purpose authorization card. Obtaining signatures and information from of people interested in forming a union allows union representatives to contact potential members. The dual-purpose authorization card only attempts to determine if enough interest in a union exists and does not seek to determine willingness to strike or picket the employer.
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3.
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A hospital refused to purchase a better grade of utility gloves even after learning that the cheaper utility gloves are easily punctured during routine use. This unsafe situation led nurses to seek unionization. During the preelection phase for unionization, which actions by union representatives are prohibited by the National Labor Relations Board? (Select all that apply.) a. Scheduling a meeting in the agency’s cafeteria to determine employees’ interest in unionization. b. Distributing nondocumented information that female nurses receive lower annual performance evaluations than do male nurses. c. Distributing information about the benefits of unionization and grievances in a public parking garage located across from the hospital. d. Suggesting to workers the likelihood of job loss should the union not win the election. e. Signing authorization cards for employees who are on leave. ANS: A, B, D, E Union representatives must meet in nonwork areas. Union representatives must not incite rumors of prejudices. Neither the union nor employers can spread falsehood about potential job loss or repercussion in the event of unionization. Union representatives cannot sign cards for employees. Union materials including information about grievances can be distributed on public property.
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4.
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It is important to realize that nurses may seek unionization if: (Select all that apply.) a. physicians rotate on-call coverage among group members for complicated long-term clients. b. scheduling is presented that provides adequate staffing on holidays by rotation of time off for holidays among nurses. c. incident report trends indicate medication errors are caused by shift reports being taped and heard after nurses from the prior shift have left the unit. d. physicians, nurses, nutritionists, and physical therapists visit concurrently with clients to plan care. e. staff development activities are planned daily at 8 AM for 2 consecutive days to educate staff on new cardiac monitoring procedures while following normal staffing patterns. ANS: C, E Policies where shift reports are taped and heard after a prior shift has left have proved to lead to errors and unsafe care. Staff development activities should be scheduled to allow nurses to attend, and normal staffing patterns or time of training must coincide with nurses’ availability and ability to listen to and retain information (such as at the beginning or end of the shift while others provide coverage). Coverage is provided, and communication about client conditions can be shared. Client care is ensured, and nurses have the opportunity to have time off on holidays shared among staff. Such reports, commonly known as walking rounds or interdisciplinary rounds, allow a team approach to plan care.
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1.
answer

Nurses and community officials are working together to ensure that churches and schools have needed supplies to provide shelter for large numbers of individuals in the event of a natural or manmade disaster. These activities represent which stage of a disaster scale? a. Preimpact b. Impact c. Postimpact d. Rehabilitation ANS: A Every disaster begins as a local event known as the preimpact stage, which consists of planning, preparedness, prevention, and warning. At the impact stage all efforts are directed to responding to the disaster, initiating the emergency management system, and limiting the effects of the hazard. During the postimpact stage the focus is on recovery, rehabilitation, and reconstruction; this occurs about 72 hours after the disaster and not before. Evaluation of the disaster plan is a major part of the postimpact phase. Rehabilitation is part of the postimpact stage.
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2.
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A nurse at a school notices that several students have “blisters” on their bodies. Further investigation reveals that a terrorist incident has occurred, causing smallpox. If the chemical, biologic, radiologic, nuclear, and explosive (CBRNE) agent categories are used, this incident would be classified as: a. chemical. b. biologic. c. radiologic. d. nuclear. ANS: B The biologic category refers to diseases such as plague or smallpox. The chemical category includes diseases that are easily spread through the air and require decontamination. Radioactive dirty bombs result in burns and poisoning. The nuclear category consists of thermal burns due to nuclear blasts.
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3.
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The Metropolitan Medical Response System (MMRS): a. is totally financed by the federal government national disaster fund. b. consists of responders who have obtained specialized training and equipment to deal with mass casualty events. c. has a storehouse of medications and antidotes to be used during response in times of national emergencies. d. arranges for patient admissions to federal hospitals. ANS: B The MMRS responds to disaster with trained individuals who have expertise in this type of situation and who have the equipment required to be effective. The MMRS is funded by local and state governments until funds are exhausted; then federal funds are contributed. The Strategic National Stockpile, a national repository, supplies antibiotics, chemical antidotes, antitoxins, IV administrations, airway supplies, and other medical-surgical items as needed to replenish supplies of local and state agencies during a time of emergency. The National Disaster Medical System arranges for the use of federal hospitals.
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4.
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A community in the New Madrid fault zone experiences an earthquake resulting in injuries from propelled objects and abrasions for many victims. The local supply of antibiotics is quickly exhausted. Local authorities would contact the: a. Commissioned Corps Readiness Force. b. Strategic National Stockpile. c. Department of Homeland Security. d. local Young Men’s Christian Association (YMCA). ANS: B The Strategic National Stockpile provides antibiotics, antidotes, and medical and surgical items when local and state supplies have been exhausted. The Commissioned Corps Readiness Force is a group of health care professionals who can be deployed to respond to a disaster, as a large group or in small numbers. The Department of Homeland Security is the agency responsible for coordinating efforts to protect the United States against terrorism. The local YMCA is a large nonprofit community organization that meets the health and human needs of the community through established programs but would not provide the means to obtain medications and supplies.
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5.
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During the impact phase of a disaster resulting from a “dirty bomb”: a. treatment for burns and poisoning is provided for victims. b. emergency plans are coordinated between agencies. c. reconstruction of destroyed facilities and homes begins. d. food stores are collected for potential victims. ANS: A During the impact phase of a disaster, emergency responders provide assistance to victims and stabilize the scene; with a dirty bomb, radioactive material causes burns and poisoning. Planning between agencies occurs in the preimpact phase. Recovery or reconstruction of businesses and residential areas occurs during the postimpact phase. Preparedness occurs in the preimpact phase, before the disaster occurs.
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6.
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A novice nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at the scene, the nurse knows that: a. the response of local hospitals will be dictated by the federal government. b. the same ground rules practiced in other settings and during smaller crises will be applicable. c. the least experienced nurses will be assigned to triage low-risk victims and victims who have no chance of survival. d. multiple incident commanders ensure a quick, effective response. ANS: B The fundamentals of nursing applied to other settings and situations can be used in a disaster. Local hospitals design their own centers to deal with disaster victims. Trained responders triage care, so those who have the greatest chance of survival are given priority. Only one incident commander is used so as to minimize confusion about who is managing the incident.
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7.
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Nurses caring for the victims of a mass casualty incident: a. determine the common terminology to be used by hospitals and participating agencies. b. take charge of communicating with the news media. c. determine whether there is a credible threat of a terrorist attack. d. give priority for care to those with the greatest chance of survival rather than those most critically ill. ANS: D Care is shifted from categorizing patients at low, intermediate, and critical risk to using resources to serve those with the greatest likelihood of survival. The Hospital Incident Command System has responsibility for determining common terminology. The facility information officer determines the effect of the incident and communicates honestly to calm and reassure staff and consumers of the facility and the news media. The Federal Bureau of Investigation determines whether a credible threat is present.
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8.
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During a community health fair the disaster medical assistance team (DMAT) informs participants that every community must be ready to provide disaster care. A participant asks, “In a disaster, the local community cannot possibly be effective, so why not have a plan to call federal agencies immediately to provide relief?” The correct response by the DMAT is: a. “Unless known terrorist activities involving mass destruction occur, the federal government does not become involved.” b. “The community is essentially the ‘first responder’ to any disaster.” c. “The preimpact phase of a disaster is the responsibility of the community, the impact phase is assigned to state agencies, and the postimpact stage is the responsibility of federal agencies.” d. “Unless local health care facilities are incapacitated, state and federal agencies will withhold assistance.” ANS: B Each disaster begins locally, and each community responds first and receives assistance from state and federal agencies when local resources are not adequate for the situation. The federal government becomes involved in any disaster when local and state resources are exhausted or overwhelmed. Local, state, and federal agencies may be involved at each stage, depending on the local resources. State and federal agencies do respond when other resources are exhausted or when help is needed with containment efforts.
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9.
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A nurse who is conducting a staff in-service on the stages of a disaster continuum teaches participants that during the impact stage, activities focus on: a. community awareness in anticipation of a terrorist attack or natural disaster. b. determining the effectiveness of the disaster medical assistance team (DMAT). c. the use of an all hazards approach. d. initiating response activities. ANS: D Response activities during the impact stage consist of immediate actions to save lives and meet basic human needs Community awareness occurs during the preimpact planning stage. Evaluation of the DMAT occurs during the postimpact stage. The all-hazards approach is part of the preimpact stage.
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10.
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Following a terrorist attack, victims are exhibiting posttraumatic stress syndrome, and care providers are exhibiting compassion fatigue. Which federal response system should be initiated? a. Strategic National Stockpile b. Metropolitan Medical Response System (MMRS) c. Commissioned Corps Readiness Force d. National Disaster Medical System ANS: B The MMRS is concerned with deploying trained responders who are able to provide mental health care for victims and health care providers. The Strategic National Stockpile has a national storehouse of medications and medical supplies for use during a disaster. The Commissioned Corps Readiness Force is an initiative led by the surgeon general that consists of trained health care professionals who can be deployed to support the DMAT. The National Disaster Medical System is the lead federal agency for medical response under the National Response Plan; this system provides supplies and equipment, assists with evacuation, and arranges for hospitalization in federal and voluntary nonfederal acute care facilities.
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11.
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The crisis communication officer may first inform the public or health care facility of a disaster or an act of terrorism. This representative has the responsibility to: a. contain the facts to within the administration group. b. incite the public to quickly take cover and obtain emergency supplies. c. provide understandable and straightforward facts about the event within the facility and possibly to the news media. d. inform the public that no information can be released until it has been confirmed by state and federal agencies. ANS: C The crisis communication officer is the first contact for patients, families, and employees within the facility or news media, so they may better understand the situation and know how to react and protect themselves. The crisis communication officer communicates with the news media, as well as with individuals who work at or are consumers of the health care facility. The crisis communication officer must calm the public and consumers of the facility. The crisis communication officer is the voice to the public that supplies known facts.
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12.
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The disaster medical assistance team works quickly to contain contaminants from a chemical plant explosion. Afterward, personnel undergo a special process to remove harmful chemicals from equipment and supplies. This removal process is known as: a. containment. b. decontamination. c. triage. d. scene assessment. ANS: B Decontamination is the physical process of removing harmful substances from personnel, equipment, and supplies. Containment is limiting the emergency situation within a well-defined area. Triage is the process of prioritizing the order in which patients are treated. Scene assessment is the review of the location of an event to search of information to guide treatment options.
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13.
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A group of local volunteers respond to a tornado. Volunteers have completed an emergency response course and are able to assist with triage of injured citizens. They also participate in local health fairs to teach residents how to react during tornadoes. The responders are members of the: a. Medical Reserve Corps (MRC). b. Metropolitan Medical Response System (MMRS). c. National Disaster Medical System (NDMS). d. Commissioned Corps Readiness Force (CCRF). ANS: A The MRC are local volunteers trained to respond to local emergencies. The MMRS is an area- and state-wide emergency system that expands hospital based care including transportation and mass fatalities. The NDMS is a federal emergency system for major emergency and federally declared emergencies. The CCRF emergency teams are led by the Office of the Surgeon General when emergencies exceed the capability of the local and state services. MULTIPLE RESPONSE
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1.
answer

Health care professionals have been activated to respond to a disaster, and the registered nurse who is coordinating the effort realizes that: (Select all that apply.) a. in the event of a mass casualty incident, care is prioritized to those who have the greatest chance of surviving. b. communities should use their own resources first to attempt to stabilize and organize the response. c. state assistance occurs any time a disaster occurs, regardless of the community’s resources. d. the emergency operating plan developed by one central agency rather than individual facilities should be put into operation. e. strict protocols regarding the use of resources must be followed. ANS: A, B Care is shifted to doing the most good for the most people. Efforts begin at the local level. Assistance from state and federal levels is provided only when the local system is unable to provide the necessary level of care. Each local agency should have a well-developed emergency operating plan that includes its duties, chain of command, and a plan for interaction with other community agencies. Resources are often scarce, and creative strategies may be needed.
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When teaching community preparedness for a community group, the nurse explains that components of the National Disaster Medical System (NDMS) provide for: (Select all that apply.) a. a nationwide bomb disposal squad team for the rapid removal of explosive devices. b. teams of health care providers who are experts and have specialized supplies and equipment. c. structures for patient evacuation from the disaster area to an unaffected area. d. arrangements for hospitalization in federal and volunteer nonfederal acute care hospitals. e. providing mental health care for the community, for victims, and for health care providers. ANS: B, C, D The NDMS provides specially trained teams of people along with equipment designed for disaster relief. The NDMS is responsible for removing patients from unsafe to safe areas. The NDMS coordinates efforts to evacuate victims to federal or nonfederal volunteer hospitals that can care for disaster victims. Many individuals are trained to detonate bombs, and they may be called on in the event of a disaster. Provision of mental health services is the responsibility of the Metropolitan Medical Response System.
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MULTIPLE CHOICE
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1. “Ninety-five percent of all patients presenting to the emergency department with chest pain will receive aspirin 80 mg within 15 minutes of arrival unless contraindicated.” Top hospital emergency departments use this standard to eliminated sudden death related to chest pain. Hospitals desiring to replicate these results establish compliance rates known as: a. competencies. b. benchmarks. c. driving force. d. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). ANS: B A benchmark is a standard for other providers or institutions to replicate. A competency is the ability to practice safely based on knowledge, skills, and attitudes for a certain role. Driving forces promote change and in this example may be a desire to be a magnet hospital or simply to be recognized as a safe place to receive care. TeamSTEPPS is a team training and communication approach that enhances patient safety.
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Which of the following occurrences would be classified as a sentinel event? a. A postpartum patient who elects to breastfeed only twice daily develops mastitis. b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator. c. A nurse assisting with the delivery of twins places the “Twin 1” name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin. d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin subcutaneously that resulted in a drop in the patient’s serum glucose from 160 to 100 mg while retaining stable vital signs. ANS: C Any procedure performed on a wrong person or organ constitutes a sentinel event. The infection was not due to negligence of provider. The patient chose the site and, although not the one indicated by the nurse, it was an appropriate site. Although a medication error occurred, the death or permanent loss of function did not occur.
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A patient is ordered a low-protein, low-calorie diet but the patient’s family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. This situation would represent: a. a sentinel event. b. an adverse event. c. patient-centered care. d. the communication technique of “call-out.” ANS: C The nurse and dietitian are respecting patient values, preferences, and expressed needs. Death or permanent loss of function did not occur. No injury occurred due to medical care. “Call out” occurs during critical situations so all members anticipate next steps in care.
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During resuscitation efforts, a provider states, “I need to give a 1.5 mg/kg bolus of lidocaine because the patient is in ventricular tachycardia.” The nurse responds, “I have a lidocaine bolus equal to 1.5 mg/kg.” This communication model is known as: a. situation background assessment recommendation (SBAR). b. check-back. c. hand-off check. d. critical-language. ANS: B SBAR shares information during patient hand-offs. Check-back is the process of repeating what was heard. No checklist was used and no hand-off or transfer of care is occurring. No problem was identified and the language would have included terms such as “I need some clarity.”
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Following a complicated surgery, a patient who was received in the recovery room suddenly loses consciousness and become unstable. The nurse that arrives at the scene performs assessments and makes the following comments, “The patient is nonresponsive to verbal stimuli,” “The patient is not initiating any spontaneous respiration,” and “I am unable to palpate a femoral pulse,” and other members of the health care team react to the comments. The team is using the mental model for communication known as: a. critical language. b. call-out. c. check-back. d. hand-off. ANS: B The nurse is providing critical information so the team can anticipate what is needed next for the patient. There is no indication to stop and there was no evidence of language such as “I am concerned” to indicate a concern. Members of the team were not repeating what was heard. The patient is not being transferred to another unit or provider at this time.
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When planning a program to reduce the number of sentinel events in an organization, the program planner should focus on the leading cause of sentinel events, which is related to a problem with: a. leadership or management. b. staffing patterns. c. environmental safety. d. communication. ANS: D Approximately 65% of sentinel events are related to failed communication or problems with communication. More than 10% but less than 20% are related to problems with leadership. More than 20% but less than 30% are related to problems with staffing. Less than 20% are related to environmental safety.
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Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on their area of expertise but also recognize other members’ strengths. Which of the QSEN competencies are being demonstrated? a. Quality improvement b. Evidence-based practice c. Teamwork and collaboration d. Patient-centered care ANS: C An interdisciplinary team is working to prevent hand-off errors on discharge. The focus is on the functioning and coordination of team efforts to support care of the patient across the continuum rather than on data and improvement methods, although a well-functioning team does contribute to quality care. Best practices” based on current evidence are not the focus. This scenario is not considering patient preferences or incorporating the family into care.
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Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct? a. Each competency is mutually exclusive. b. The competencies focus on individual efforts to reduce errors. c. Physicians lead the team to achieve each competency. d. The competencies address both individual and system approaches to transform care. ANS: D Errors and cost of health care result from both health care workers and the system in which they deliver care. Each concept overlaps, and what affects one competency often impacts other competencies. Competencies focus on team efforts as well as individual members of the team. Nurses have key roles in transforming health care through the IOM competencies.
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Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies? a. Patient-centered care b. Informatics c. Teamwork d. Quality improvement ANS: B Technology (PDA) is used to aid decision making and reduce errors. Patient-centered care considers values and diversity of patients and their families. The emphasis is on the use of technology to ensure quality care. The use of technology does continue to improve quality but not analyze data or processes for improvement.
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A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency? a. Safety b. Timely c. Equitable d. Patient-centered care. ANS: A Standardization contributes to safety and improves individual performance of care providers. The focus of the team was on standardization rather than timeliness and timeliness is not an IOM competency. The focus is not on providing care that is impartial and equitable is not an IOM competency. The focus is on safety rather than cultural or patient preferences.
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During team rounds, a member states, “Ms. Jones has a positive tuberculin skin test and is scheduled for sputum cultures.” The nurse notices that the antibiotic infusing has the wrong patient name and the patient is allergic to this particular medication. The nurse tells the team, “I need some clarity” to alert the team: a. that they have breached patient confidentiality. b. the patient is not aware of the diagnosis of tuberculosis. c. that the patient is contagious. d. that there is a safety concern. ANS: D The phrase “I need some clarity” is used to alert the team that there is a problem. All members are involved in patient care and privileged to patient information. The phrase “I need some clarity” is not used to alert the team to a lack of knowledge by the patient. The phrase “I need some clarity” is not used to indicate the risk of contracting a contagious disease.
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The ability to clearly demonstrate the knowledge, skills, attitudes, and professional judgment required to practice safely and ethically in a designated role and setting is termed: a. human factors. b. competency. c. evidence-based practice. d. workarounds ANS: B Competency is having the skill set to provide safe care within the scope of practice and context. Human factors is the cognitive ability and social influences that affect practices. Evidence-based practice is the use of scientific information to inform practice. Workarounds are nonstandard work processes used by nurses and other healthcare professionals when standard work is blocked by dysfunctional processes such as unavailability of supplies or lack of information. MULTIPLE RESPONSE
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A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals which include: (Select all that apply.) a. advanced health assessment techniques. b. patient-centered care. c. prescriptive pharmacology content. d. quality improvement. e. safety. ANS: B, D, E Patient-centered care is a recommended competency, along with teamwork and collaboration, evidence-based practice, and informatics. Quality improvement is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. Safety is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. Although it is important to know correct health assessment skills, advanced techniques are not an IOM competency. Although a comprehensive pharmacology foundation is needed to administer and evaluate pharmacologic treatments, the IOM does not address prescriptive content.
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What are some of the driving forces for change to improve the quality and safety competencies for nursing in the United States? (Select all that apply.) a. The U.S. health care system is one of the world’s least technically advanced systems. b. Health care has led other industries in establishing quality and safety standards. c. System failures occur regularly. d. The U.S. public has confidence in its system to reduce morbidity and mortality rates. e. Outcomes are unpredictable and costly. ANS: C, E Although the U.S. system has the advantage of technologic advancement, system errors are not unusual. Outcomes of care fail to follow predicted outcomes, resulting in extended stays and increased death and illness. The U.S. health care system is one of the world’s most technically advanced systems. Aviation, business, and nuclear power industries have outpaced health care in setting and achieving quality and safety standards. The public has increased knowledge about morbidity and mortality related to health care errors resulting in a loss of confidence in the U.S. health care system.

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