Communication Techniques for Patients with Sensory Needs & Nursing Care Guidelines, Exams of Nursing

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Chapter 1: The Vista of Nursing

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. An LPN nursing student is reviewing requirements related to nurse practice acts. Which statement provides the most accurate description of individual state nurse practice acts?
2. Nurse practice acts are regulated by the federal government.
3. Nurse practice acts have identical role regulations for LPNs and RNs.
4. Differences exist between scope of practice and/or educational requirements.
5. State governments provide the content for each nurse practice act.
6. Which priority information should the nurse review in the state nurse practice act in order to deliver care within the scope of practice? 1. Verify educational background. 2. Confirm length of licensure. 3. Review principles of delegation. 4. Note members of the board of nursing (BON).
7. A nurse is discussing how evidence-based practice (EBP) can help improve delivery of care to patients. Which statement best describes EBP? 1. EBP requires that the nurse use government databases to obtain information. 2. EBP focuses on long-term results to improve outcomes. 3. EBP research does not have to be peer reviewed. 4. EBP establishes a methodological approach to improve outcomes.
8. The LPN/LVN nurse is interested in being able to function as an advanced nurse practitioner. Which educational plan best describes a pathway to advanced nursing practice? 1. Working in a long-term facility while going back to school to get a diploma in BSN program 2. Continuing to work in an acute care facility and applying to a PVN to ADN program 3. Applying to a university to a BSN program after one year of clinical practice 4. Continuing to work as an LPN/LVN for a few years and then reassess interest
9. A student nurse is reviewing characteristics associated with the nursing profession. Which option best represents Watson’s theory of nursing as it relates to nursing characteristics? 1. Individualization of care 2. Coordinating care 3. Integration of information 4. Admit one’s mistakes
10. A student nurse is being evaluated by a nursing instructor. Which situation warrants immediate action?
    1. The student nurse has come back from a break a few minutes late.
    2. The student nurse is asking the patient when family members will arrive.
    3. The student nurse forgot to bring a stethoscope to clinical.
    4. The student nurse is using a personal cell phone while in the clinical environment.
11. Which statement best addresses the core concepts of QSEN as they relate to knowledge, skills, and attitude (KSA)? 1. Awareness of cultural diversity leads to bias. 2. Coordination of care is based on effective communication. 3. Quality care is based on patient preference. 4. Application of generalized nursing care plans leads to improved practice.

8. A student nurse is looking to incorporate cultural diversity in the plan of care for a group of patients. Which nursing theorist should the student nurse research? 1. Imogene King 2. Madeleine Leininger 3. Jean Watson 4. Betty Neuman
9. A student nurse is preparing to sit for National Council Licensure Examination for Practical Nursing. Which statement indicates that additional teaching is needed as it relates to NCLEX-PN? 1. The test includes a clinical component. 2. The test is delivered online. 3. Results of the test are shared with each state board of nursing. 4. The test is based on a specific detailed test plan.
10. A high school graduate plans to attend a one-plus-one program. How should this student explain the program to her friends?
11. “I can have my LPN courses applied to a baccalaureate degree.”
12. “My courses from the LPN program will be placed toward an associate degree.”
13. “I can apply to a master of science in nursing degree program after two years.”
14. “I’ll become an LPN first and then take another year of classes while I work as a nurse.”
15. A licensed practical nurse (LPN) has applied and completed an associate degree program in nursing and passed RN licensure. Which statement indicates that additional information is needed as it relates to graduate studies in nursing?
16. The nurse will not have to take additional licensure exams in nursing.
17. The nurse needs to continue completing professional education activities.
18. The nurse can continue to work while pursuing graduate studies.
19. The nurse does not have to submit paperwork related to licensure.
20. While providing medications, a nurse realizes that an incorrect dose was given to a patient. Which characteristic does the nurse demonstrate when reporting the error to the manager?
21. Being caring
22. Being honest
23. Being organized
24. Being responsible
25. A nurse notes that a patient’s blood pressure has dropped. The patient has nausea, dizziness, and abdominal pain. Which characteristic does the nurse demonstrate when the health-care provider (HCP) is notified of the patient’s condition?
26. Being caring
27. Being honest
28. Being organized
29. Being responsible
30. A nurse provides care and meets the needs of a patient until the patient is able to resume self-care. Which nursing theory is this nurse implementing?
31. Levine
32. Johnson
33. Neuman
34. Henderson
35. A nurse is working with a patient who is considered to be a high fall risk. Which priority action should the nurse implement?

1. Secure a bed alarm.
2. Assist the patient to the bathroom as needed.
3. Place the call bell in reach.
4. Place one side rail while the patient is in bed.
5. A nurse reviews a new medication prescribed for a patient and contacts the pharmacy to ask questions about the prescribed dose and route. Which behavior does the nurse demonstrate in this situation?
6. Safety
7. Quality
8. Teamwork
9. Collaboration Multiple Response Identify one or more choices that best complete the statement or answer the question.
10. A manager reviews the organizational policy about unprofessional conduct. Which actions should the manager describe that would lead to revoking or suspending a nursing license? Select all that apply.
11. Accidentally causing a skin tear on a frail elderly patient
12. Conduct that violates the nurse practice act
13. Documenting patient care at the end of the shift
14. The use of drugs or alcohol while on duty
15. Failure to supervise nursing assistants and unlicensed assistive personnel
16. The Quality and Safety Education for Nurses (QSEN) project was established to equip the next generation of nurses to help make needed changes in health care. Which are included in the six prelicensure knowledge, skills, and attitudes (KSAs) for nursing and graduate students? Select all that apply.
17. Patient-centered care
18. Appearance
19. Leadership
20. Teamwork and collaboration
21. Evidence-based practice
22. A group of nursing students are discussing methods to improve clinical judgment. Which activities may help support the development of clinical judgment? Select all that apply.
23. Performing clinical skill in a rote manner
24. Incorporating experience into future practice
25. Maintaining time management schedule
26. Answering call bells promptly
27. Trending results of patient lab data
28. A manager is preparing an annual performance review for a new nurse. Which behaviors indicate that the nurse is demonstrating professional behaviors? Select all that apply.
29. Arrives to work on time
30. Identifies the mistakes of others
31. Asks for help when appropriate
32. Covers patient care assignments for other nurses
33. Adheres to the required length of time for breaks
34. A nurse is receiving an evaluation from the nurse manager related to professional behaviors. Which observations warrant immediate action? Select all that apply.
35. Wears the same uniform to work several days in a row
36. Leaves late when staffing demands are increased

3. Forgets to bring stethoscope to work frequently
4. Participates in team activities
5. Takes extended breaks during the shift
6. A nurse wants to use evidence-based practice (EBP) to improve nursing care. What actions should the nurse include to improve health outcomes based on EBP? Select all that apply.
7. Review appropriate clinical research
8. Rely on personal experience
9. Keep current with protocols
10. Rely on health-care provider (HCP) for direction
11. Use a scientific approach to problem solving

Chapter 1: The Vista of Nursing

Answer Section

MULTIPLE CHOICE

1. ANS: 3

Chapter: Chapter 1, The Vista of Nursing Objective: 8. Define the scope of practice. Page: 4 Heading: Nurse Practice Acts and Scope of Practice Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Moderate

Feedback

(^1) This is incorrect. Nurse practice acts are regulated by individual state governments, not at the federal level. (^2) This is incorrect. Nurse practice acts can vary from state to state; therefore, they are not identical in scope of practice. (^3) This is correct. Nurse practice acts specify requirements for scope of practice and educational background, which can differ among individual states. (^4) This is incorrect. The board of nursing in each state determines and enforces the nurse practice act in each state. PTS: 1 CON: Professionalism

2. ANS: 3 Chapter: Chapter 1, The Vista of Nursing Objective: 15. Discuss information found in the Connection features in this chapter. Page: 8 Heading: Supervision/Delegation Connection Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Moderate

Feedback

(^1) This is incorrect. Although the nurse practice act provides information about the educational requirements for defined nursing roles, this is not the priority information to be reviewed at this time. (^2) This is incorrect. Confirming the length of a nursing license is not the priority information to be reviewed at this time. (^3) This is correct. Principles of delegation should be reviewed by the nurse because they will directly affect level of practice and delivery of care. (^4) This is incorrect. Knowing the composition of the BON is not the priority at this time. PTS: 1 CON: Professionalism

3. ANS: 4

Chapter: Chapter 1, The Vista of Nursing Objective: 1. Define various terms associated with nursing practice. Page: 9 Heading: Trends in Nursing Practice > Evidence-Based Practice Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Evidence-Based Practice Difficulty: Moderate

Feedback

(^1) This is incorrect. EBP is based on databases and Web sites that are professionally reviewed and organized. It is not limited to government databases. (^2) This is incorrect. EBP methodology is not based on long-term results but rather looks at the analysis of both short-term and long-term data. (^3) This is incorrect. EBP focuses on research data that has been peer reviewed and analyzed based on organized hierarchy of evidence. (^4) This is correct. EBP uses research as a problem-solving approach to help deliver health care and improve patient outcomes. PTS: 1 CON: Evidence-Based Practice

4. ANS: 2 Chapter: Chapter 1, The Vista of Nursing Objective: 5. Describe the four pathways for nursing education. Page: 4 Heading: Advancing Your Career Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Moderate

Feedback

(^1) This is incorrect. To become an advanced practice nurse, one must complete a graduate degree. Pursuing a diploma to BSN degree would not be the best approach because there are few diploma programs available at this time. (^2) This is correct. Continuing to work in an acute care facility will add to clinical background, and applying to a bridge/transition program will build on prior LPN/LVN knowledge and skill. (^3) This is incorrect. The LPN/LVN can both attend school and continue to work in order to build on clinical experience. Additional coursework may be needed to apply to a BSN in a university setting, which may further extend the timeline. (^4) This is incorrect. This option extends the timeline and suggests that the nurse’s interest may change over time. PTS: 1 CON: Professionalism

5. ANS: 1 Chapter: Chapter 1, The Vista of Nursing

Objective: 9. Describe four characteristics of nurses. Page: 6 Heading: Characteristics of Nurses >Being Caring Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Caring Difficulty: Moderate

Feedback

(^1) This is correct. Watson’s theory of nursing is based on caring, which is one of the four characteristics associated with nursing. Individualization of care demonstrates a caring approach. (^2) This is incorrect. Coordinating care is related to being responsible, which is one of the four characteristics associated with nursing. (^3) This is incorrect. Integration of information relates to being organized, which is another of the four characteristics associated with nursing. (^4) This is incorrect. Admitting one’s mistakes relates to being honest, which is another of the four characteristics associated with nursing. PTS: 1 CON: Professionalism

6. ANS: 4 Chapter: Chapter 1, The Vista of Nursing Objective: 15. Discuss information found in the Connection features in this chapter. Page: 7 Heading: Professional Appearance and Behavior Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Professionalism Difficulty: Easy

Feedback

(^1) This is incorrect. Although the student nurse should come back on time from a break, being a few minutes late does not warrant immediate action. (^2) This is incorrect. This communication does not warrant immediate action because it represents a therapeutic exchange between the student nurse and patient. (^3) This is incorrect. Bringing equipment is a responsibility of the student nurse but it does not require immediate action at this time and can be discussed later. (^4) This is correct. The student nurse should not use a personal cell phone while in the clinical setting. This finding requires immediate action. PTS: 1 CON: Professionalism

7. ANS: 2 Chapter: Chapter 1, The Vista of Nursing Objective: 17. Describe trends in nursing practice, including evidence-based practice & QSEN. Page: 10

Heading: Quality and Safety Education for Nurses Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Professionalism Difficulty: Moderate

Feedback

(^1) This is incorrect. Awareness of cultural diversity does not lead to bias but can help to resolve underlying issues and improve delivery of patient-centered care. (^2) This is correct. Coordination of care based on effective communication is an example of teamwork and collaboration, which leads to improved health outcomes. (^3) This is incorrect. Although patient preference is recognized as a factor in the delivery of patient-centered care, quality care improvement focuses on continued review and evaluation of data collection. (^4) This is incorrect. Patient-centered care focuses on the use of individualized care plans to help improve patient outcomes. PTS: 1 CON: Professionalism

8. ANS: 2 Chapter: Chapter 1, The Vista of Nursing Objective: 13. Discuss selected nursing theories and theorists. Page: 9 - 10 Heading: Nursing Theories and Theorists Integrated Processes: Teaching and Learning Client Need: Culture and Spirituality Cognitive Level: Comprehension [Understanding] Concept: Self Difficulty: Easy

Feedback

(^1) This is incorrect. Imogene King’s theory is based on goal attainment. (^2) This is correct. Madeleine Leininger’s theory includes cultural diversity and universality. (^3) This is incorrect. Jean Watson’s theory is based on caring. (^4) This is incorrect. Betty Neuman’s theory is based on general systems theory. PTS: 1 CON: Self

9. ANS: 1 Chapter: Chapter 1, The Vista of Nursing Objective: 5. Differentiate four pathways for entering nursing education. Page: 3 Heading: Licensed Practical/Vocational Nurse Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Moderate

Feedback

(^1) This is correct. There is no clinical component on the NCLEX-PN test but rather required clinical hours and classes that must be completed prior to being eligible to sit for licensure. (^2) This is incorrect. The NCLEX-PN test is delivered online. (^3) This is incorrect. The results of the NCLEX-PN test are shared with each state board of nursing. (^4) This is incorrect. The NCLEX-PN is a specific detailed test plan based on patient needs and integrated processes of nursing. PTS: 1 CON: Professionalism

10. ANS: 4 Chapter: Chapter 1, The Vista of Nursing Objective: 6. Discuss career ladders and specialization in nursing. Page: 4 Heading: Advancing Your Career Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Moderate

Feedback

(^1) This is incorrect. The LPN courses can be applied to a PN to BSN program. (^2) This is incorrect. The LPN courses can be applied to a PN to ADN program. (^3) This is incorrect. The LPN would need to achieve a baccalaureate degree before applying to an MSN program. (^4) This is correct. The one-plus-one program is offered at community and state colleges. In this program the student becomes an LPN in the first year and can work as a nurse while taking courses in preparation to take the NCLEX-RN exam as a registered nurse. PTS: 1 CON: Professionalism

11. ANS: 4 Chapter: Chapter 1, The Vista of Nursing Objective: 6. Discuss career ladders and specialization in nursing. Page: 5 Heading: Being a Lifelong Learner Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Moderate

Feedback

(^1) This is incorrect. The RN license is the highest nursing license for a registered nurse. (^2) This is incorrect. The nurse must continue lifelong learning activities while holding a nursing license to meet requirements of continued licensure. (^3) This is incorrect. The nurse can continue to work while enrolled in graduate studies based on individual preference.

(^4) This is correct. The nurse must continue to submit up-to-date paperwork related to current nursing licensure while pursuing graduate studies. PTS: 1 CON: Professionalism

12. ANS: 2 Chapter: Chapter 1, The Vista of Nursing Objective: 9. Describe four characteristics of nurses. Page: 6- 7 Heading: Characteristics of Nurses Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate

Feedback

(^1) This is incorrect. When caring, nurses respond to patients in a way that confirms their individuality, emotions, and needs. (^2) This is correct. Being honest means admitting when a mistake is made and following up with appropriate actions. (^3) This is incorrect. Being organized means keeping track of all of the information and needs for assigned patients. (^4) This is incorrect. Being responsible means caring for patients’ needs, helping families, and noticing changes in the patient’s condition. PTS: 1 CON: Safety

13. ANS: 4 Chapter: Chapter 1, The Vista of Nursing Objective: 9. Describe four characteristics of nurses. Page: 6- 7 Heading: Characteristics of Nurses Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Collaboration Difficulty: Moderate

Feedback

(^1) This is incorrect. When caring, nurses respond to patients in a way that confirms their individuality, emotions, and needs. (^2) This is incorrect. Being honest means admitting when a mistake is made and following up with appropriate actions. (^3) This is incorrect. Being organized means keeping track of all of the information and needs for assigned patients. (^4) This is correct. Being responsible means caring for patients’ needs, helping families, and noticing changes in the patient’s condition. PTS: 1 CON: Collaboration

14. ANS: 4

Chapter: Chapter 1, The Vista of Nursing Objective: 13. Discuss selected nursing theories and theorists. Page: 9 Heading: Nursing Theories and Theorists Integrated Processes: Caring Client Need: Basic Care and Comfort Cognitive Level: Application [Applying] Concept: Patient-Centered Care Difficulty: Moderate

Feedback

(^1) This is incorrect. Myra Levine’s theory is a conservation model, which is designed to promote adaptation of the person while maintaining wholeness or health. (^2) This is incorrect. Dorothy Johnson developed the behavioral system model, which incorporates five principles of systems thinking to establish a balance or equilibrium in the person. (^3) This is incorrect. Betty Neuman’s systems model is based on general systems theory and reflects the nature of living organisms as open systems. (^4) This is correct. Virginia Henderson’s theory is built on 14 basic needs addressed by nursing care and defines nursing as doing for patients what they cannot do for themselves. PTS: 1 CON: Patient-Centered Care

15. ANS: 1 Chapter: Chapter 1, The Vista of Nursing Objective: 16. Identify specific safety information. Page: 4 Heading: Nurse Practice Acts and Scope of Practice Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Safety Difficulty: Difficult

Feedback

(^1) This is correct. As the patient has been assessed as a fall risk, the nurse should obtain a bed alarm to prevent possible falls and assist in notification of a potential problem. (^2) This is incorrect. The nurse should assist the patient to the bathroom each time, not as needed, if the patient is assessed as a fall risk. (^3) This is incorrect. Although the call bell should be given to the patient, it is not the priority because it will not affect patient mobility and thus the patient can still be at risk for a fall. (^4) This is incorrect. Placing one side rail up is an example of a restraint and, as such, that should not be implemented without further assessment and documentation. PTS: 1 CON: Safety

16. ANS: 1 Chapter: Chapter 1, The Vista of Nursing Objective: 17. Describe trends in nursing practice, including evidence-based practice & QSEN. Page: 10- 11

Heading: Trends in Nursing Practice >Quality and Safety Education for Nurses Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Physiological Integrity: Pharmacological Therapies Cognitive Level: Application [Applying] Concept: Clinical Judgment Difficulty: Moderate

Feedback

(^1) This is correct. Preventing risk and harm to patients demonstrates safety. (^2) This is incorrect. Quality requires a review and evaluation of care provided to improve processes. (^3) This is incorrect. Teamwork requires functioning effectively within the nursing team and with other professionals. (^4) This is incorrect. Collaboration requires functioning effectively within the nursing team and with other professionals. PTS: 1 CON: Clinical Judgment MULTIPLE RESPONSE

17. ANS: 2, 4, 5 Chapter: Chapter 1, The Vista of Nursing Objective: 12. Discuss unprofessional conduct and its consequences. Page: 8 Heading: Box 1.4 Professional Appearance and Behavior Integrated Processes: N/A Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Addiction | Professionalism Difficulty: Moderate Feedback (^1) This is incorrect. Some examples of unprofessional conduct that could result in the loss of nursing license are use of drugs or alcohol in a way that could endanger patients, diversion of drugs from prescribed patient to personal use, and failure to adequately care for patients or conform to minimum standards of nursing practice. 2 This is correct. Some examples of unprofessional conduct that could result in the loss of nursing license are use of drugs or alcohol in a way that could endanger patients, diversion of drugs from prescribed patient to personal use, failure to supervise nursing assistants and unlicensed assistive personnel adequately, and failure to adequately care for patients or conform to minimum standards of nursing practice. 3 This is incorrect. Unprofessional conduct that could result in the loss of nursing license includes failure to supervise nursing assistants and unlicensed assistive personnel adequately and failure to adequately care for patients or conform to minimum standards of nursing practice. 4 This is correct. One example of unprofessional conduct that could result in the loss of nursing license is use of drugs or alcohol in a way that could endanger patients. 5 This is correct. Failure to supervise nursing assistants and unlicensed assistive personnel adequately is an example of unprofessional conduct that could result in loss of nursing license.

PTS: 1 CON: Addiction | Professionalism

18. ANS: 1, 4, 5 Chapter: Chapter 1, The Vista of Nursing Objective: 17. Describe trends in nursing practice, including evidence-based practice and QSEN. Page: 10- 11 Heading: Trends in Nursing Practice > Quality and Safety Education for Nurses Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Knowledge [Remembering] Concept: Professionalism Difficulty: Easy Feedback 1 This^ is^ correct.^ QSEN focuses^ on^ these^ six^ prelicensure^ KSAs,^ which^ include^ patient- centered care. 2 This^ is^ incorrect. QSEN^ focuses^ on these^ six^ prelicensure^ KSAs,^ but appearance is^ not included in these KSAs. 3 This^ is^ incorrect.^ QSEN^ focuses^ on^ these^ six^ prelicensure^ KSAs;^ however,^ leadership is not included in these KSAs. 4 This^ is^ correct.^ QSEN^ focuses^ on^ these^ six^ prelicensure^ KSAs.^ One^ of^ these^ includes teamwork and collaboration. 5 This is correct. QSEN focuses on these six prelicensure KSAs, including evidence-based practice. PTS: 1 CON: Professionalism
19. ANS: 2, 5 Chapter: Chapter 1, The Vista of Nursing Objective: 15. Discuss information found in the Connection features in this chapter. Page: 11 Heading: Clinical Judgment in Action Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Clinical Judgment Difficulty: Difficult Feedback 1 This is incorrect. Performing clinical skills in a rote manner does not allow the nurse to assess and interpret information and improvement of outcomes. 2 This is correct. By incorporating information obtained from clinical experience, the nurse will be able to improve future practice. 3 This is incorrect. Maintaining time management schedules does not directly relate to the development of clinical judgment but does correlate with development of organization. 4 This is incorrect. Answering call bells promptly does not relate to the development of clinical judgment. 5 This is correct. Trending patient lab data helps the nurse to interpret and analyze information leading to the development of clinical judgment.

PTS: 1 CON: Clinical Judgment

20. ANS: 1, 3, 4, 5 Chapter: Chapter 1, The Vista of Nursing Objective: 10. Evaluate professional appearance and behavior. Page: 8 Heading: Box 1.4 Professional Appearance and Behavior Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Moderate PTS: 1 CON: Professionalism
21. ANS: 1, 3, 5 Chapter: Chapter 1, The Vista of Nursing Objective: 10. Evaluate professional appearance and behavior. Page: 8 Heading: Box 1.4 Professional Appearance and Behavior Integrated Processes: Clinical Problem-Solving Process: Nursing Process Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Moderate Feedback 1 This is correct. This warrants immediate action because hygiene should be maintained. 2 This is incorrect. This does not warrant immediate action. 3 This^ is^ correct.^ This^ requires^ immediate^ action^ because^ the^ nurse^ should^ make^ sure^ they have required items for performing patient care, such as a stethoscope and a watch. 4 This is incorrect. This does not warrant immediate action. 5 This is correct. This requires immediate action because the nurse should take breaks on time and return on time so that others can go at their assigned times. PTS: 1 CON: Professionalism Feedback 1 This is correct. Arriving to work on time is an example of professional behavior. 2 This is incorrect. Criticizing others is not a professional behavior. 3 This is correct. Asking for help and offering to help others are professional behaviors. 4 This is correct. Assuming the responsibility for others’ assignments is a professional behavior. 5 This is correct. Taking breaks and lunch on time and returning on time are professional behaviors.

22. ANS: 1, 3, 5

Chapter: Chapter 1, The Vista of Nursing Objective: 15. Discuss information found in the Connection features in this chapter. Page: 9 Heading: Evidence-Based Practice Integrated Processes: Clinical Problem-Solving Process: Nursing Process Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Evidence-Based Practice Difficulty: Moderate Feedback 1 This is correct. Nurses use evidence-based practice (EBP) as a problem-solving approach to delivering health care. This approach uses the best evidence from nursing research studies and patient care data; it also considers the patient’s preferences and values. In other words, research is very important in determining what care is appropriate for certain situations; however, making the care fit a patient’s preferences and values is just as important. 2 This is incorrect. Although personal experience can be helpful, EBP does rely on the analysis of clinical research data. 3 This is correct. The nurse should keep current with protocols. 4 This is incorrect. The nurse should not rely solely on the HCP for direction related to EBP practice. (^5) This is correct. Nurses use evidence-based practice (EBP) as a problem-solving approach to delivering health care. This approach uses the best evidence from nursing research studies and patient care data; it also considers the patient’s preferences and values. In other words, research is very important in determining what care is appropriate for certain situations; however, making the care fit a patient’s preferences and values is just as important. PTS: 1 CON: Evidence-Based Practice

Chapter 2: Health-Care Delivery, Settings, and Economics

Multiple Choice Identify the choice that best completes the statement or answers the question.

1. In an inpatient setting a patient has had a surgical repair of a superficial laceration incurred during a motor vehicle accident. Insurance has been filed and the claim has been rejected. The patient asks the nurse why the claim was not accepted. What is the best nursing response? 1. Documentation was insufficient. 2. Patient care setting was not appropriate. 3. Procedure was not considered medically necessary. 4. It was not a covered service on the patient’s plan.
2. A health-care organization uses a system of health-care delivery aimed at managing the cost and quality of access to health care. Which type of delivery system should the nurse review prior to arriving for an interview for a position? 1. Medicaid 2. Medicare

3. Managed care
4. Private insurance
5. A nurse reviews the purpose and functions of a skilled nursing facility (SNF) with a new nurse colleague. Which statement by the new nurse indicates that additional teaching about an SNF is required?
6. “Medicare will most likely pay for my patient’s care at the SNF.”
7. “I hope that my patient gets to return home after going to the SNF.”
8. “My patient will never get to go home again if he’s transferred to an SNF.”
9. “My patient will receive skilled nursing care, such as physical therapy as needed.”
10. A nurse is preparing to transfer a patient to a skilled nursing facility (SNF). For which reason will this patient’s Medicare policy pay for the care at the SNF?
11. The patient stays longer than 100 days per year.
12. The patient enters the SNF within 60 days of a hospitalization.
13. The patient has been hospitalized for at least 1 day before admission.
14. The patient makes regular progress as documented by medical professionals.
15. A charge nurse observes a staff nurse prepare to transfer a patient to a rehabilitation facility. For which statement should the charge nurse intervene when hearing the staff member explain about this type of care setting?
16. “You will receive intensive therapy services while you’re here.”
17. “You must participate in at least 6 hours of therapy each day.”
18. “You will be seen by a physician who specializes in rehabilitation.”
19. “If you get sick while you’re here, we can transfer you to the hospital.”
20. An adult patient requires a laparoscopic cholecystectomy to be performed. Which clinical facility would be best suited for the procedure?
21. Acute care facility
22. Outpatient clinic setting
23. Physician’s office
24. Ambulatory surgery center
25. A patient has been referred to cardiac rehabilitation post-cardiac event. Which essential service would be provided to the patient?
26. Dietary counseling
27. Echocardiogram
28. Laboratory testing for cardiac enzymes
29. Occupational therapy
30. A patient wants to remain at home yet still receive health-care services for an ulceration of the left foot. Which option should the nurse suggest to the patient based on stated concern?
31. Arrange for the patient to go to the local health department.
32. Arrange for the patient to be placed temporarily in rehab.
33. Obtain a referral for home health services.
34. Continue to keep office appointments with health-care provider (HCP).
35. A nurse is reviewing requests from multiple patients for hospice care. Which factor would alert the nurse that hospice care is not indicated for a patient?
36. Patient is admitted for acute appendectomy after rupture of the appendix.
37. Patient has received a terminal medical diagnosis.
38. Patient is seeking palliative care.
39. Patient does not require any additional surgical or medical treatment for cure.

10. A nursing medical unit has 20 beds and the following staffing: 1 RN, 2 LPNs, and 2 CNAs. Which type of nursing delivery system is best utilized to provide services?
    1. Primary care nursing
    2. Patient-centered care
    3. Team nursing
    4. Triage
11. A group of nurses assigned to a unit are discussing methods of nursing supervision. Which option represents best practice?
    1. Use of a formal approach
    2. Limiting conversation
    3. Maintaining strict control
    4. Providing positive direction
12. A nurse is reviewing a family’s health insurance, which is provided under the Affordable Care Act (ACA). Which statement is correct as it relates to ACA?
    1. The son, age 25, is covered.
    2. Vaccinations are not covered services.
    3. Preexisting conditions are not covered.
    4. Mammograms are not covered services.
13. A patient is admitted to the hospital for an appendectomy identified by a diagnosis-related group (DRG). What information does the DRG provide?
    1. Economic reimbursement to the hospital for costs associated with DRG
    2. Specifics of cost of nursing care related to the DRG
    3. Types of procedures that are allowed for an inpatient stay related to that DRG
    4. List of complications that can occur based on the DRG
14. A patient calls the family clinic stating that he has Medicaid coverage, is visiting his family, lives out of state, and needs to see a health-care provider (HCP). Which information should the nurse provide to the patient related to insurance coverage?
    1. Preapproval is needed.
    2. Amount of benefit may vary.
    3. Copay is required for all services.
    4. Go to the emergency room.
15. A nurse manager is reviewing risk management data collected for the care area after the staff attended an educational program on health-care collaboration. Which outcome indicates that this program has been successful?
    1. Number of patient falls were reduced by 85%.
    2. Two patients were readmitted for wound infections.
    3. There were the same number of medication errors as in previous month.
    4. Five patients were delayed discharge because of catheter-related infections.
16. The department of nursing in a large hospital implements Team STEPPS on all of the care areas. Which is an expected outcome from this program?
    1. Reports of incivility
    2. Enhanced teamwork
    3. Increased absenteeism
    4. Inappropriate delegation
17. A patient asks the nurse why they must get a referral from their health-care provider (HCP) to see another physician for treatment of an eye problem. What is the best response by the nurse?

1. “HMO plans require preapproval authorization.”
2. “Switch over to another HMO.”
3. “Let your primary care doctor handle the issue.”
4. “Capitation costs limit the number of referrals the HCP can make.”
5. A patient is concerned that the health insurance plan will not cover a diagnostic test. Which information should the nurse explain about medical necessity?
6. “The insurer will cover the test if they like the physician.”
7. “Most tests are covered even if they have no connection to the health problem.”
8. “If the test is found reasonable and necessary for your illness, it will be covered.”
9. “There is no guarantee that any test will be covered. It depends on the reviewer.”
10. An older patient is being released from the hospital after treatment for a deep vein thrombosis (DVT). The patient lives alone and intends to return to the prior dwelling but needs additional care. Which type of facility does the nurse expect the patient to be transferred to?
11. Independent living facility
12. Skilled nursing unit
13. Memory care unit
14. Long-term care unit
15. A patient has had an endoscopy as an outpatient in a hospital setting and requires additional observation after the procedure. Which type of order would the nurse expect the health-care provider to write?
16. Admit for observation.
17. Admit to the hospital as an inpatient.
18. Transfer to the emergency room.
19. Arrange for home health visits. Multiple Response Identify one or more choices that best complete the statement or answer the question.
20. A nurse manager is reviewing the unit budget to determine the number of new positions needed for the next fiscal year. Which would the manager use to help guide decisions about patient care? Select all that apply.
21. Appropriate level of care
22. Type of health insurance
23. Medical necessity
24. Location of the facility
25. Education of the staff
26. A patient no longer needs care in an acute care facility. What should be considered to ensure this patient continues to receive the most appropriate level of care? Select all that apply.
27. Cost
28. Safety
29. Location
30. Activities
31. Effectiveness
32. A nurse manager is looking at delegation procedures on the nursing unit. Which actions would serve as best- practice methods of delegation? Select all that apply.
33. Maintain strict control over individuals.
34. Offer praise as warranted.
35. Use respect as a core principle.

4. Emphasize that the nursing staff is there is help one another.
5. Correct each minor variance.
6. A nurse is taking care of a patient who has Medicare A and D. What type of benefits does the patient have? Select all that apply.
7. Prescription services
8. HMO provider
9. Hospitalization coverage
10. Supplemental insurance
11. Hospice coverage

Chapter 2: Health-Care Delivery, Settings, and Economics

Answer Section

MULTIPLE CHOICE

1. ANS: 2

Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective:1. Define various terms associated with health-care delivery and economics. Page: 17 Heading: Determining the Delivery of Effective Care Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care Policy | Health-Care System Difficulty: Difficult

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(^1) This is incorrect. There is insufficient evidence to support this response from the nurse. (^2) This is correct. Because the surgical repair was based on a superficial laceration, the selection of an inpatient setting is not an appropriate environment to provide the service. (^3) This is incorrect. Surgical repair of a laceration is considered a medically necessary treatment. (^4) This is incorrect. There is insufficient evidence to support this response from the nurse. PTS: 1 CON: Health-Care Policy | Health-Care System

2. ANS: 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 10. Describe various types of private health insurance. Page: 17 Heading: Determining the Delivery of Effective Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System Difficulty: Moderate

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(^1) This is incorrect. Medicaid is a federal-state program in which the federal government helps states pay for the health care of those with an income below the poverty level, as well as certain other individuals. (^2) This is incorrect. Medicare is the federal government’s health insurance program for people older than 65 years or those with certain disabilities or conditions. (^3) This is correct. Managed care is defined as a system of health-care delivery aimed at managing the cost and quality of access to health care. (^4) This is incorrect. Private insurance is insurance that is provided by a number of companies and purchased by the individual or his or her employer. PTS: 1 CON: Health-Care System

3. ANS: 3

Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 5. Describe inpatient health-care settings and their services. Page: 18 Heading: Determining the Delivery of Effective Care > Skilled Nursing Facility Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System Difficulty: Moderate

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(^1) This is incorrect. An SNF level of care is usually covered by Medicare and most private insurances. (^2) This is incorrect. Patients may stay in an SNF for a few days or as long as 100 days, but they eventually move to a rehabilitation facility, nursing home, or home setting. (^3) This is correct. The patient will eventually move to a rehabilitation facility, nursing home, or home setting after the required number of days, up to 100. (^4) This is incorrect. SNF care consists of skilled nursing care and physical, occupational, and speech therapy as needed. PTS: 1 CON: Health-Care System

4. ANS: 4 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 5. Describe inpatient health-care settings and their services. Page: 18 Heading: Determining the Delivery of Effective Care > Skilled Nursing Facility Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System Difficulty: Moderate

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(^1) This is incorrect. An SNF level of care is usually covered by Medicare and most private insurances, but there are certain requirements. There is a 100-day stay maximum per year related to any one hospitalization and diagnosis. (^2) This is incorrect. An SNF level of care is usually covered by Medicare and most private insurances, but there are certain requirements. The patient must enter the nursing home within 30 days of a hospitalization. (^3) This is incorrect. Medicare will pay for SNF care if the patient was hospitalized for at least 3 days prior to admission. (^4) This is correct. An SNF level of care is usually covered by Medicare and most private insurances, but there are certain requirements. The patient must be making regular progress as documented by medical professionals. PTS: 1 CON: Health-Care System

5. ANS: 2

Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 7. Explain two types of rehabilitation services. Page: 18 Heading: Determining the Delivery of Effective Care > Rehabilitation Facility Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System Difficulty: Moderate

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(^1) This is incorrect. Rehabilitation is a level of care in which the patient can receive intense physical, occupational, and speech therapy services. (^2) This is correct. As a rule of thumb, the patient must be capable of participating in at least 3 hours of therapy a day to be admitted to a rehabilitation facility. (^3) This is incorrect. A physician specialist in physical medicine and rehabilitation oversees the patient’s care during his or her stay. (^4) This is incorrect. If the patient becomes ill or has other medical problems while in rehabilitation, the patient will be transferred back to an acute care hospital. PTS: 1 CON: Health-Care System

6. ANS: 4 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 6. Describe outpatient health-care settings and their services. Page: 19 Heading: Determining the Delivery of Effective Care > Outpatient Care > Hospital Outpatient Department Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Health-Care System Difficulty: Moderate

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(^1) This is incorrect. A laparoscopic cholecystectomy does not have to be performed in an acute care setting. (^2) This is incorrect. A laparoscopic cholecystectomy is not performed in an outpatient clinic setting. (^3) This is incorrect. A laparoscopic cholecystectomy is not performed in a physician’s office. (^4) This is correct. A laparoscopic cholecystectomy can be performed in an ambulatory surgical center that is specifically designed to provide surgical care services. PTS: 1 CON: Health-Care System

7. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 7. Explain two types of rehabilitation services. Page: 20 Heading: Cardiac Rehabilitation Integrated Processes: Teaching and Learning

Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health Promotion | Difficulty: Moderate

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(^1) This is correct. Nutrition (dietary) counseling is a critical part of cardiac rehabilitation. (^2) This is incorrect. An echocardiogram is a diagnostic test that is not included in the cardiac rehabilitation process. (^3) This is incorrect. Laboratory testing of cardiac enzymes is not included in the cardiac rehabilitation process. (^4) This is incorrect. Exercise, nutrition (dietary) modification, medication, and disease counseling are essential elements of cardiac rehabilitation process. PTS: 1 CON: Health Promotion | Teaching and Learning

8. ANS: 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 6. Describe outpatient health-care settings and their services. Page: 20 Heading: Home Health Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Clinical Judgment | Health-Care System Difficulty: Moderate

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(^1) This is incorrect. This response does not address the patient’s primary concern of wanting to receive treatment at home. (^2) This is incorrect. This response does not address the patient’s primary concern of wanting to receive treatment at home. (^3) This is correct. This response focuses on the patient’s primary concern and allows for nursing care to be provided in the home setting. (^4) This is incorrect. This response does not address the patient’s primary concern of wanting to receive treatment at home. PTS: 1 CON: Clinical Judgment | Health-Care System

9. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 8. Distinguish between types of nursing care delivery systems. Page: 21 Heading: Hospice Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System Difficulty: Moderate

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(^1) This is correct. Hospice services are for those individuals who have received a terminal diagnosis (6 months or less to live), are seeking palliative care, want to remain pain free, and/or are no longer seeking treatment to cure or treat the disease. This patient has had a surgical intervention for an acute disease process. (^2) This is incorrect. Hospice services are for those individuals who have received a terminal diagnosis (6 months or less to live), are seeking palliative care, want to remain pain free, and/or are no longer seeking treatment to cure or treat the disease. (^3) This is incorrect. Hospice services are for those individuals who have received a terminal diagnosis (6 months or less to live), are seeking palliative care, want to remain pain free, and/or are no longer seeking treatment to cure or treat the disease. (^4) This is incorrect. Hospice services are for those individuals who have received a terminal diagnosis (6 months or less to live), are seeking palliative care, want to remain pain free, and/or are no longer seeking treatment to cure or treat the disease. PTS: 1 CON: Health-Care System

10. ANS: 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 8. Distinguish between types of nursing care delivery systems. Page: 21- 22 Heading: Delivery of Nursing Care >Team Nursing Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System Difficulty: Difficult

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(^1) This is incorrect. In primary care nursing, one nurse is responsible for all aspects of nursing care. Based on the available staffing mix, there are insufficient nurses to be able to implement this type of care. (^2) This is incorrect. In patient-centered care, the interactions are focused on limiting the number of staff that come in direct contact with more acute care patients. (^3) This is correct. Based on the available staffing mix, a team nursing approach would represent the best delivery of services to the patients on this unit. (^4) This is incorrect. Triage is a medical system used to assess and evaluate patients for treatment based on acuity. It is used in emergent care situations. PTS: 1 CON: Health-Care System

11. ANS: 4 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 11. Discussion information found in the Connection features of the chapter. Page: 23 Heading: Supervision/Delegation Connection >The Secret to Good Supervision Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Leadership and Management Difficulty: Moderate

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(^1) This is incorrect. Best supervision requires both formal and informal approaches to promote a good working environment. (^2) This is incorrect. Limiting conversation will lead to poor supervision because it will affect communication. (^3) This is incorrect. Maintaining strict control will lead to a poor working environment. (^4) This is correct. Providing positive direction will help promote a positive working environment. PTS: 1 CON: Leadership and Management

12. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 1. Define various terms associated with health-care delivery and economics. Page: 23 - 24 Heading: Health-Care Economics > Affordable Care Act Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System Difficulty: Moderate

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(^1) This is correct. Under the ACA, children up to age 26 are covered under their parents’ insurance. (^2) This is incorrect. Under the ACA, vaccinations are covered services. (^3) This is incorrect. Under the ACA, preexisting conditions are covered. (^4) This is incorrect. Under the ACA, mammograms are covered services because they are considered to be preventive measures. PTS: 1 CON: Health-Care System

13. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 1. Define various terms associated with health-care delivery and economics. Page: 24 Heading: Public Health Insurance Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System Difficulty: Moderate

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(^1) This is correct. DRG provides the economic reimbursement to the hospital of allowed costs for a specific medical diagnosis. (^2) This is incorrect. DRG does not specify the nursing cost but rather includes all nursing care, tests, treatment, and teaching associated with a specific medical diagnosis.