Chapter 1. Evolution of Nursing Thought & Action

MULTIPLE CHOICE

	1.	Which of the following is an example of an illness prevention activity?
a.	Encouraging the use of a food diary	
b.	Joining a cancer support group	
c.	Administering immunization for HPV	
d.	Teaching a diabetic patient about his diet	

ANS:	C
Administering immunization for HPV is an example of illness prevention. Although cancer is a disease, it is assumed that a person joining a support group would already have the disease; therefore, it would be treatment and not disease prevention. Illness prevention activities focus on avoiding a specific disease. A food diary is a health promotion activity. Teaching a diabetic patient about diet is a treatment for diabetes; the patient already has diabetes, so the teaching cannot prevent diabetes.

Difficulty: Moderate
Client Need: Health Promotion and Maintenance
Cognitive Level: Application
Page 15

PTS:	1

	2.	Which organization can require nurses to take continuing education courses as a condition of licensure renewal?
a.	American Nurses Association	
b.	National League for Nursing	
c.	Sigma Theta Tau	
d.	State Board of Nursing	

ANS:	D
Continuing education is a professional strategy designed to ensure that nurses remain current in their clinical knowledge. Many states require nurses to engage in a certain number of continuing-education requirements to renew their license. The knowledge gained in the nursing curriculum is sufficient for nursing school graduates to obtain their initial license. Requirements for renewal of a nurse’s license can be found in the state’s nurse practice act (state board of nursing).

Difficulty: Difficult 
Cognitive Level: Analysis
Client Need: Health Promotion and Maintenance
Cognitive Level: Application
Page 11

PTS:	1

	3.	An experienced seasoned nurse uses her knowledge of patient medical conditions and intuition to identify patient problems. She is often the resource for other nurses on the unit. What stage of proficiency has this nurse achieved?
a.	Novice	
b.	Advanced beginner	
c.	Competent	
d.	Expert	

ANS:	D
The nurse who has reached the expert stage of proficiency has a deep understanding of the clinical situation based on knowledge and experience. The nurse often senses a potential problem in the absence of classic signs and symptoms. The novice nurse is inexperienced and relies on rules and processes. The advanced beginner focuses on aspects of a situation and is unable to see the comprehensive perspective. A nurse functioning at the competent level is able to prioritize to meet the patient needs but does not fully grasp the total situation. 

Difficulty: Moderate
Cognitive Level: Comprehension
Pages 11-12

PTS:	1

	4.	Which of the following best explains the importance of standards of practice?
a.	Nurses and other healthcare providers have the same standards of practice.	
b.	Standard of practice only apply to nurses who work in hospital settings.	
c.	Standards of practice identify the knowledge, skills, and attitudes nurses need to provide safe care.	
d.	Standards of practice differ among registered nurses because the roles are different based on the population they serve.	

ANS:	C
Standards of practice are authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. Standards are derived from several sources, including professional organizations and healthcare facilities’ policies and procedures.

Difficulty: Moderate
Cognitive Level: Application
Pages 12-13

PTS:	1

	5.	What is the primary goal of the National League for Nursing?
a.	Advocate for the needs of registered nurses to promote patient safety	
b.	Establish and maintain standards for nursing education	
c.	Support global health policies and improve health worldwide	
d.	Foster nursing scholarship, leadership, and service to improve health worldwide	

ANS:	B
The National League for Nursing (NLN) was founded to establish and maintain a universal standard of nursing education. The NLN focuses on faculty development in nursing education programs and is the voice for nursing education.

Difficulty: Moderate
Cognitive Level: Application
Page 14

PTS:	1

	6.	A patient who requires long-term rehabilitation needs which type of care?
a.	Primary care	
b.	Secondary care	
c.	Tertiary care	
d.	Preventive care	

ANS:	C
Tertiary care is required for individuals who need long-term care or for those who are dying. 

Difficulty: Easy
Cognitive Level: Knowledge
Page 18

PTS:	1

	7.	An elderly patient is covered under Medicare. She is scheduled for discharge and tells the nursing student that several therapists will come to her home to help her regain functional abilities. The patient then asks, “Why can’t I just stay in the hospital and receive this type of care?” What is the nursing student’s best response?
a.	“You should be able to stay in the hospital. I will ask the nurse to call your doctor.”	
b.	“Once you have reached your reimbursable length of stay and your condition is stable, it is more cost effective to provide you with home healthcare.”	
c.	“Medicare is a type of managed care, which mean that you are only allowed to stay in the hospital for a certain number of days before being discharged, regardless of your condition.”	
d.	“You should be glad to be in your own home. You will recover in no time.”	

ANS:	B
Home healthcare services are provided to patients who still require skilled care but are discharged from the hospital because the reimbursable length-of-stay has expired. The patient is stable and can receive provider services at home. It would be incorrect and misleading to tell the patient she “should be able to stay in the hospital.” It would be incorrect to tell the patient she is allowed only “a certain number of days before being discharged,” because the patient’s condition is a factor in determining whether the patient can be discharged from the hospital. Telling the patient that she should be glad to be going home is a form of closed communication and does not address her question. 

Difficulty: Moderate
Cognitive Level: Application
Pages 15-17

PTS:	1

	8.	Which of the following is the most important reason to develop a definition of nursing?
a.	Recruit more informed people into the nursing profession	
b.	Evaluate the degree of role satisfaction	
c.	Dispel the stereotypical images of nurses and nursing	
d.	Differentiate nursing activities from those of other health professionals	

ANS:	D
Nursing organization leaders think it is important to develop a definition of nursing to bring value and understanding to the profession, differentiate nursing activities from those of other health professionals, and help student nurses understand what is expected of them. A definition of nursing likely would not increase the number of informed people recruited into nursing. A definition of nursing would do little to improve the nurse’s role satisfaction. Although a definition of nursing might contribute to fighting stereotypes of nursing, other, more powerful influences (e.g., media portrayals), exist to counteract it.

Difficulty: Easy
Cognitive Level: Knowledge
Page 8

PTS:	1

	9.	Which of the following provides evidence-based support for the contribution that advanced practice nurses (APNs) make within healthcare?
a.	Reduced usage of diagnostics using advanced technology	
b.	Decreased number of unnecessary visits to the emergency department	
c.	Improved patient compliance with prescribed treatments	
d.	Increased usage of complementary and alternative therapies	

ANS:	C
Studies demonstrate that APNs have improved patient outcomes over those of physicians, including increased patient understanding and cooperation with treatments and decreased need for hospitalizations. No well-known, scientific studies support APNs’ effect on the use of advanced technology. No well-known, scientific studies support APNs’ effect on the frequency of emergency department visits. No well-known, scientific studies support APNs’ effect on the use of alternative therapies.

Difficulty: Moderate
Cognitive Level: Knowledge
Page 28

PTS:	1

	10.	Which of the following is an example of a complementary and alternative form of treatment or medicine?
a.	Herbal medicines	
b.	Sterile dressing changes	
c.	Pain medications	
d.	Influenza (flu) vaccine	

ANS:	A
Complementary and alternative medicine (CAM) includes those treatments outside of traditional medicine. Sterile dressings, pain medications, and influenza vaccines are traditional treatments. The use of herbs and spices are common CAM treatments. 

Difficulty: Moderate
Cognitive Level: Comprehension
Page 27

PTS:	1

	11.	A nurse working in a rehabilitation facility has a physician’s prescription to contact other therapists as required by patient need. A patient has started to have difficulty with bathing and grooming. Which therapist should the nurse contact to assist the patient to regain these skills?
a.	Physical therapist	
b.	Occupational therapist	
c.	Speech-language pathologist	
d.	Respiratory therapist	

ANS:	B
Occupational therapists help patients to regain and maintain function and independence with activities of daily living, such as dressing, bathing, and grooming.

Difficulty: Moderate
Cognitive Level: Application
Page 19

PTS:	1

	12.	An older adult has type 1 diabetes. He can perform self-care activities but needs help with shopping and meal preparation as well as with blood glucose monitoring and insulin administration. Which type of healthcare facility would be most appropriate for him?
a.	Acute care facility	
b.	Ambulatory care facility	
c.	Extended care facility	
d.	Assisted living facility	

ANS:	D
Assisted living facilities are intended for those who are able to perform self-care activities but who require assistance with meals, housekeeping, or medications. Acute care facilities focus on preventing illnesses and treating acute problems. These facilities include physicians’ offices, clinics, and diagnostic centers. Ambulatory care facilities provide outpatient care. Clients live at home or in nonhospital settings and come to the site for care. Ambulatory care facilities include private health and medical offices, clinics, surgery centers, and outpatient therapy centers. Extended care facilities typically provide long-term care, rehabilitation, wound care, and ongoing monitoring of patient conditions.

Difficulty: Easy
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Application
Pages 15-17

PTS:	1

	13.	The nurse in the intensive care unit is providing care for only one patient, who was admitted in septic shock. Based on this information, which care delivery model can you infer that this nurse is following?
a.	Functional	
b.	Primary	
c.	Case method	
d.	Team	

ANS:	C
The nurse is following the case method model of nursing care. In this model, one nurse cares for one patient during a single shift. When the functional nursing model is employed, care is compartmentalized, and each task is assigned to a staff member with the appropriate knowledge and skills. In primary nursing, one nurse plans the care for a group of patients around the clock. The primary nurse assesses the patient and develops the plan of care. When he or she is working, he or she provides care for those patients for whom he or she is responsible. In his or her absence, the associate nurses deliver care. Although the nurse in this case could possibly be a primary nurse, there are not enough data to confidently infer that. If the team nursing approach is employed, a licensed nurse (RN or LVN) is paired with a nursing assistant. The pair is then assigned to a group of patients.

Difficulty: Moderate
Nursing Process: Implementation
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Analysis
Page 15

PTS:	1

	14.	Which healthcare worker should the nurse consult to counsel a patient about financial and family stressors impacting healthcare?
a.	Social worker	
b.	Occupational therapist	
c.	Physician’s assistant	
d.	Technologist	

ANS:	A
The social worker coordinates services and counsels patients about financial, housing, marital, and family issues impacting healthcare. The occupational therapist helps patients regain function and independence for activities of daily living. Physician’s assistants work under the physician’s direction to diagnose certain diseases and injuries. Technologists provide a variety of specific functions in hospitals, diagnostic centers, and emergency care. For example, laboratory technologists aid in the diagnosis and treatment of patients by examining blood, urine, tissue, and body fluids. Radiology technologists perform x-rays and other diagnostic testing.

Difficulty: Moderate
Nursing Process: Planning
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Comprehension
Pages 18-19

PTS:	1

	15.	Which type of managed care allows patients the greatest choice of providers, medications, and medical devices?
a.	Health maintenance organization	
b.	Integrated delivery network	
c.	Preferred provider organization	
d.	Employment-based private insurance	

ANS:	C
Preferred provider organizations are a form of managed care that allows the patient a greater choice of providers, medications, and medical devices within the designated list. Health maintenance organizations allow the patient to choose a primary care provider within the organization to coordinate his care. This type of program will only reimburse medical care when the patient has first obtained a referral from the primary provider. Integrated delivery networks combine providers, healthcare facilities, pharmaceuticals, and services into one system, and the patient must remain within the system to receive care. Employment-based private insurance is not a managed care organization.

Difficulty: Easy	
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Analysis
Pages 23-24

PTS:	1

	16.	The registered nurse is discharging a patient to an assisted living facility. Which instruction below is most appropriate for the patient?
a.	“Therapists will be working with you daily to ensure that you regain functional abilities.”	
b.	“You will have 24-hour nursing care for the next 6 weeks.”	
c.	“You will have assistance with meals and housekeeping tasks.”	
d.	“A nurse will come to your home and provide you with nursing care.”	

ANS:	C
Assisted living facilities are designed to bridge the gap between independence and institutionalization for persons who have a decline in health status. The assistance available will vary based on the facility but commonly involves meals and housekeeping tasks. Hospitals provide 24-hour nursing care. Rehabilitation centers have a team of therapists who work with patients to help them achieve their optimal functional status.

Difficulty: Moderate
Nursing Process: Planning
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Application
Page 17

PTS:	1

	17.	Which member of the healthcare team typically serves as the case manager?
a.	Occupational therapist	
b.	Physician	
c.	Physician’s assistant	
d.	Registered nurse	

ANS:	D
Typically, registered nurses serve as case managers for patients with specific diagnoses. Their role is coordinator of care across the healthcare system. The occupational therapist, physician, and physician’s assistant all serve on the healthcare team and take direction from the case manager.

Difficulty: Easy	
Client Need: Safe and Effective Nursing Care
Cognitive Level: Knowledge
Page 24

PTS:	1

	18.	Which of the following is considered a primary care service?
a.	Providing wound care	
b.	Administering childhood immunizations	
c.	Providing drug rehabilitation	
d.	Providing outpatient hernia repair	

ANS:	B
Primary care services focus on health promotion and disease prevention; administering childhood immunizations is one such service. Providing wound care and drug rehabilitation are examples of tertiary care services. Outpatient hernia repair surgery is an example of a secondary care service.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Application
Page 18

PTS:	1

	19.	An 80-year-old patient fell and fractured her hip and is now in the hospital. Before the fall, she lived at home with her husband and managed their activities of daily living very well. The goal is for the patient to recover from the injury and return to her home. The hospital is ready to discharge her because she has exceeded the recommended length of stay in a hospital. However, she cannot walk or care for herself yet, and she will require lengthy physical therapy and further monitoring of her medications and her physical and mental status. To which type of facility should she be transferred?
a.	Nursing home	
b.	Rehabilitation center	
c.	An outpatient therapy center	
d.	None of these; she should receive home healthcare	

ANS:	B
A skilled nursing facility (e.g., a rehabilitation center) primarily provides skilled nursing care for patients who can be expected to improve with treatment. For example, a patient who no longer needs hospitalization may transfer to a skilled nursing facility to receive skilled care until she is able to return home. A nursing home provides custodial care for people who cannot live on their own but who are not sick enough to require hospitalization. It provides a room, custodial care, and opportunity for recreation. This patient cannot ambulate or perform activities of daily living, so outpatient therapy and home care would not be appropriate.

Difficulty: Moderate
Nursing Process: Implementation
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Application
Pages 15-17

PTS:	1

	20.	Which of the following best describes the legal definition of a nurse? Assume all education programs are accredited.
a.	Graduate of a nursing education program and has passed the National Council Licensure Exam	
b.	Person with advanced training and certified to administer medications in most healthcare settings	
c.	Graduate licensed to practice in an acute care setting or a home care environment	
d.	Graduate with advanced education licensed to practice under the direct supervision of a physician	

ANS:	A
The best legal description of the nurse is one who has graduated from an accredited nursing education program and has passed the NCLEX exam. Persons certified to administer medications may be certified medication technicians and not necessarily nurses. Additionally, nurses can practice in a vast array of areas, not exclusively in an acute care setting or in home care. Practicing under the direct supervision of a physician is descriptive of a physician’s assistant.

Difficulty: Easy
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Knowledge
Page 9

PTS:	1

	21.	A nurse who has been practicing for 3 years in an acute care facility is caring for a post–hip surgery patient. The nurse observes an abnormal change in vital signs and associates these changes with a postoperative bleeding problem. The nurse is demonstrating which proficiency level?
a.	Advanced beginner	
b.	Competent	
c.	Proficient	
d.	Expert	

ANS:	B
The nurse is demonstrating competency (competent) level as evidenced by associating abnormal changes in vital signs with postoperative bleeding. Additionally, this nurse has been practicing for 3 years, which is within the range needed for the competency proficiency level. The advanced beginner can distinguish abnormal findings but cannot readily understand their significance. The proficient nurse recognizes problems but will immediately gather resources to initiate treatment; there is no evidence in the scenario that the nurse took any actions. The expert can often recognize a problem in the absence of signs and symptoms.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Comprehension
Page 11

PTS:	1

	22.	In the United States, each state enacts its own nurse practice acts. Which agency is responsible for nurse practice acts?
a.	The American Nurses Association	
b.	Institute of Medicine	
c.	State Board of Nursing	
d.	National League for Nursing	

ANS:	C
Each state board of nursing is responsible for enacting and enforcing the nurse practice act of its state. The American Nurses Association is a professional organization responsible for guiding and improving nursing practice, usually by setting standards of practice and establishing a nursing code of ethics. The Institute of Medicine provides information and advice concerning health and science policy, for example, its involvement in the project Quality and Safety Education for Nurses (QSEN). The National League for Nursing sets standards for all nursing education.

Difficulty: Easy
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Knowledge
Page 12

PTS:	1

	23.	A nurse is recently hired at an acute care facility. During orientation to her unit, she is given a role chart describing each person’s role on the unit. The chart reflects that the registered nurses are responsible for all admission and discharge assessments and patient treatments. The licensed practical nurses are responsible for administering all medications and the certified nursing assistants obtain all vital signs and administer baths. The nurse recognizes this practice as which model of care?
a.	Case method	
b.	Team	
c.	Primary	
d.	Functional	

ANS:	D
The nurse recognizes this practice as the functional model of care in which care is compartmentalized and each employee is assigned specific tasks and roles with the associating knowledge and skill. In the case method model, one nurse cares for one patient during a single shift. In the team model, a nurse is paired with an LPN or a CNA; then the team is assigned to a specific group of patients.

Difficulty: Difficult
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Analysis
Pages 15-17

PTS:	1

	24.	The nurse is working at a hospice organization in her area. Which of the following best describes the patients for whom she will be caring?
a.	Patients who are terminally ill and their family members	
b.	Patients who require long-term rehabilitation	
c.	Patients who are unable to independently meet hygiene and nutrition needs	
d.	Patients who have undergone a complex surgical procedure	

ANS:	A
Hospice organizations work with dying individuals and family members to focus specifically on the needs of the terminally ill. Activities for the dying are designed to promote comfort, maintain quality of life, provide spiritual care, and ease the emotional burden of death. Long-term rehabilitation facilities provide activities to restore a patient to a previous state (e.g., after a knee or hip surgery). Although providing hygiene and nutrition for someone unable to do so independently may be an activity provided by hospice, it is not exclusive to the hospice setting. Care provided to patients after any surgical procedure does not indicate that the patient is dying.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Comprehension
Page 18

PTS:	1

	25.	The patient post–total knee replacement is preparing to be discharged. The patient tells the case manager, “I feel pretty good, but I am having a hard time getting in and out of the bathroom.” What is the case manager’s most appropriate response?
a.	“I’ll be sure to teach your family how to help you with this.”	
b.	“Once you are home for a while, it will get easier.”	
c.	“I can have a recreational therapist help you take your mind off your concerns.”	
d.	“An occupational therapist can be ordered to assist you in this area.”	

ANS:	D
The patient is expressing a concern for managing toileting at home. Upon discharge, the therapy focusing most closely on activities of daily living is occupational therapy. Teaching the family how to assist with toileting is not typically the role of the case manager. Additionally, this does not assist the patient with the immediate concern of toileting. Reassurance is important and positive, but the patient first needs assistance with toileting. Recreational therapists promote patient physical, social, and emotional well-being through the use of leisure activities. There is no indication that this patient is in need of a recreational therapist.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Application
Page 19

PTS:	1

	26.	The 75-year-old patient is preparing for discharge and tells the case manager, “I don’t know what I am going to do when I get home. I cannot afford the medications the doctor has ordered for me.” What is the case manager’s most appropriate response?
a.	“We can have a social worker see you when you get home.”	
b.	“Medications are expensive, but you will need to take them.”	
c.	“I can speak with your doctor about discontinuing some of the medications.”	
d.	“The home health nurse will address this when she sees you.”	

ANS:	A
Social workers counsel patients on financial, housing, marital, and family issues affecting healthcare. Owing to rising healthcare costs and diminished access to healthcare, particularly for aging populations, social workers are increasingly used to help move clients through the health system. Acknowledging the rising costs of medications does not assist the patient in solving the problem of his ability to pay for medications. The case manager cannot make any assumption that to alleviate the patient’s concern for affording medications, it might be appropriate to have some medications discontinued. The home health nurse typically coordinates the care and services but is not typically the healthcare provider addressing financial concerns.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Application
Page 20

PTS:	1

	27.	The patient in the ambulatory clinic asks the nurse in the billing office, “Why do I have to pay $10.00 for this visit when I have insurance?” What is the nurse’s most appropriate response?
a.	“I don’t know how your insurance works. You need to pay this and follow up with your insurance company.”	
b.	“This a co-payment you are required to pay per clinic visit as described in your insurance plan.”	
c.	“Healthcare is expensive and insurance companies can’t pay all of the costs.”	
d.	“This is part of your insurance premium that you pay monthly.”	

ANS:	B
Those who have insurance or government-financed insurance bear some of the expenses of healthcare through cost sharing. Typical cost sharing can be in the form of co-pays, deductibles, paying a portion of one’s insurance premium, or paying costs above a fixed payment amount. Patients do not always understand cost-sharing methods and may need an explanation at the time of the visit. The best response is for the nurse to explain what a co-payment is. Most facilities have access to the coverage plan and can answer immediate questions until the patient is able to follow up with his or her insurance company. Stating that healthcare is expensive is merely stating the obvious; it may also be perceived as defensive rather than supportive. Co-payments are typically not part of an insurance premium and are only collected at the time of a service.

Difficulty: Moderate
Client Need: 
Cognitive Level: Application
Page 21

PTS:	1

	28.	The nursing staff on the surgical unit complains to the manager that they do not have enough time to complete all wound care and dressing changes. What is the manager’s most appropriate action to take?
a.	Decrease the patient-to-nurse ratio within budget limits	
b.	Offer an in-service session on time-management strategies	
c.	Suggest a continuing quality improvement committee to assess the issue	
d.	Report the complaints to the director of nurses at the next management meeting	

ANS:	C
The most appropriate action by the nurse manager is to assess the issue through establishing some quality improvement/quality care activities. There may be a need to look at nurse-patient ratios and there may be a need to provide an in-service session on time management. However, these are not known until some assessment is completed and data are obtained. Totally Quality Management (TQM) or Continuous Quality Improvement (CQI) projects assist in looking at all aspects of quality and safe care practices. Reporting the complaint to the director of nurses may be indicated, but this will not immediately address the concerns of the staff.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Application
Page 25

PTS:	1

MULTIPLE RESPONSE

	1.	Which of the following nursing activities represent direct care? Select all that apply.
a.	Bathing a patient	
b.	Administering a medication	
c.	Teaching a patient how to change a wound dressing	
d.	Making work assignments for the shift	

ANS:	B, C
Direct care involves personal interaction between the nurse and clients (e.g., bathing a patient, giving medications, dressing a wound, or teaching a client about medicines or care). Nurses deliver indirect care when they work on behalf of an individual, group, family, or community to improve their health status (e.g., restocking the code blue cart [an emergency cart], ordering unit supplies, or arranging unit staffing).

Difficulty: Easy
Nursing Process: Implementation
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Comprehension
Page 14

PTS:	1

	2.	Which actions by the nurse are considered “skilled nursing care”? Select all that apply.
a.	Changing a wound dressing	
b.	Assisting with bathing and grooming	
c.	Monitoring an IV antibiotic	
d.	Teaching a patient how to use a blood glucose monitor	
e.	Helping a patient to get dressed	

ANS:	A, C, D
Skilled care includes services offered by trained (usually licensed) healthcare professionals who have received the education and are licensed to provide the services. 

Difficulty: Moderate
Cognitive Level: Application
Page 16

PTS:	1

	3.	To reflect the changes in healthcare and nurses’ expanded roles, the International Council of Nurses revised the definition of nursing. Which statements are consistent with the revised definition of nursing?
a.	Nursing encompasses the autonomous and collaborative care of others.	
b.	Nursing includes the care of ill, disabled, and dying people.	
c.	Participation in shaping health policy is a nursing role.	
d.	Registered nurses use the nursing process to plan and individualize care.	

ANS:	A, B, C
The ICN definition of nursing includes the autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. In addition to caring for ill, disabled, and dying persons, nurses are expected to promote health and prevent illness. Key nursing roles include advocacy, education, research, promotion of a safe environment, and participation in shaping health policy and in health systems management. The ICN definition does not mention that registered nurses use the nursing process to plan and individualize care.

Difficulty: Moderate
Cognitive Level: Application
Page 7

PTS:	1

	4.	According to the American Nurses Association (ANA), which statements best describe the characteristics of registered nursing? Select all that apply.
a.	Nursing practice is individualized.	
b.	Nursing practice is similar to medical practice.	
c.	Caring is central to the practice of the registered nurse.	
d.	Nurses coordinate care by establishing partnerships.	

ANS:	A, C, D
In 2010, the ANA acknowledged five characteristics of the registered nurse: Nursing practice is individualized, nurses coordinate care by establishing partnerships with others, caring is central to the practice of the registered nurse, nurses use the nursing process and acknowledge there is a strong link between the professional work environment and the nurse’s ability to provide quality healthcare.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Application
Page 7

PTS:	1

	5.	Strategies to improve the status of nursing include which of the following? Select all that apply.
a.	Standardizing the educational requirements for entry into practice	
b.	Enacting uniform continuing education requirements	
c.	Guaranteeing that all nurses will obtain employment upon graduation	
d.	Encouraging participation in professional organizations	

ANS:	A, B, D
Rather than continuing to develop arguments to prove that nursing is a profession, it may be beneficial to follow actions to improve the status of nursing. Some suggestions include the following: standardizing educational requirements for entry to practice, enacting uniform continuing education requirements, encouraging participation of more nurses in professional organizations, and educating the public about the true nature of nursing practice. There are no regulating bodies or professional organizations that equate guaranteeing employment with improving the status of nursing, nor is it likely it would be possible to do that.

Difficulty: Moderate 
Client Need: Safe and Effective Nursing Care 
Cognitive Level: Knowledge
Page 8

PTS:	1

	6.	Each U.S. state has its own state board of nursing responsible for protecting the health, safety, and welfare of the general public. The state board of nursing meets these responsibilities by performing which of the following functions? Select all that apply.
a.	Advocating for nursing student issues	
b.	Determining the nurse’s scope of practice	
c.	Enforcing the rules that govern nursing	
d.	Writing the laws that regulate nursing	

ANS:	B, C
State boards of nursing are responsible for determining scope of practice and enforcing the rules that govern nursing. They do not advocate for nursing student issues. This is usually addressed through the National Student Nurses Association. State boards of nursing do not write the laws that regulate nursing; rather, they enforce them.

Difficulty: Moderate 
Client Need: Safe and Effective Nursing Care
Cognitive Level: Analysis
Page 12

PTS:	1

	7.	The nursing student is preparing a presentation on health promotion. Which of the following activities are included in the presentation? Select all that apply.
a.	Teaching a group of 75-year-old adults about the influenza vaccine	
b.	Administering a pain medication to a patient after surgery	
c.	Developing a list of stress-management strategies	
d.	Identifying calorie counts on all food choices in restaurants	

ANS:	C, D
Health promotion activities foster the highest state of well-being of the recipient of the activities. These activities are applied to individuals, groups, and communities and at the societal level. Stress-management strategies foster well-being related to mind and body. Calorie counts allow patients to make healthier food choices. Teaching related to vaccinations is a useful strategy in illness prevention. Administering pain medication is restorative care.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care
Cognitive Level: Application
Page 18

PTS:	1

COMPLETION

	1.	____________________ is a health program, administered by the state and funded by federal and state governments, to provide care for low-income people.

ANS:	
Medicaid 
Medicaid is a health program run by the state and funded by the federal and state governments. It is intended to provide preventive and acute healthcare for individuals who are unable to pay for services, in particular pregnant women and children.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care
Cognitive Level: Knowledge
Page 21

PTS:	1

	2.	____________________ is a federal insurance program designed to fund healthcare for people aged 65 years and older, the disabled, and those with end-stage renal disease.

ANS:	
Medicare
Medicare is a federal insurance program created by Title XVIII of the Social Security Act of 1965. This act was designed to protect people aged 65 years and older from the high cost of healthcare. In 1972, the program was expanded to cover disabled workers as well as people with end-stage renal disease.

Difficulty: Moderate
Client Need: Safe and Effective Nursing Care
Cognitive Level: Knowledge
Page 21

PTS:	1