Chapter 1: Nursing and the Health Care System
Elsevier items and derived items © 2009 by Elsevier Inc.

MULTIPLE CHOICE

	1.	Florence Nightingale’s contributions to nursing practice and education
1.	are historically important but have no validity for nursing today.	
2.	were neither recognized nor appreciated in her own time.	
3.	were a major factor in reducing the death rate in the Crimean War.	
4.	were continued in the United States in the same model.	

ANS:	3
It is important for the nurse to have an understanding of the history of nursing. The nurse should have knowledge of Florence Nightingale and her contributions to the nursing profession.

DIF:	Cognitive Level: Knowledge	REF:	Pages 1-2	OBJ:	Theory #1
TOP:	Nursing History		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	2.	Early nursing education and care in the United States
1.	were excellent during the Civil War and resulted in reduced death rates.	
2.	provided independence for women through education and employment.	
3.	were an educational model based in institutions of higher learning.	
4.	have continued to be entirely focused on hospital nursing.	

ANS:	2
The nurse needs to know of the historical importance of the impact of nursing education to women.

DIF:	Cognitive Level: Knowledge	REF:	Pages 2-3	OBJ:	Theory #4
TOP:	Nursing History		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	3.	The best description of the role that a student practical nurse must learn to function as an LPN includes
1.	caregiver, educator, and collaborator.	
2.	nursing assistant, delegator, and environmental specialist.	
3.	medication dispenser, collaborator, and transporter.	
4.	dietitian, educator, and housekeeper.	

ANS:	1
The nurse needs an understanding of the various roles that she must perform in her nursing practice.

DIF:	Cognitive Level: Knowledge	REF:	Page 3	OBJ:	Theory #8
TOP:	Art and Science of Nursing	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	4.	Although nursing theories differ in their attempts to define nursing, all of them express the relationships among nursing concepts. Which of the following  nursing concepts express the attempts of theorists to define nursing?
1.	Self-actualization, fundamental needs, and belonging	
2.	Stress reduction, self-care, and a systems model	
3.	Curative care, restorative care, and terminal care	
4.	Human relationships, the environment, and health	

ANS:	4
The nurse needs to be knowledgeable about the various similarities and differences of nursing theories.

DIF:	Cognitive Level: Knowledge	REF:	Page 4	OBJ:	Theory #4
TOP:	Nursing Theories		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	5.	Standards of care and clinical nursing practice are established by
1.	the individual nurse.	
2.	the licensing board in each state.	
3.	professional organizations such as the American Nurses Association.	
4.	hospitals, nursing homes, or other agencies that employ nurses.	

ANS:	3
The nurse needs an understanding of the contributions that professional nursing organizations make to the nursing profession.

DIF:	Cognitive Level: Knowledge	REF:	Page 5	OBJ:	Theory #4
TOP:	Nursing Practice		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	6.	A common goal that is found in many definitions of nursing is to
1.	cure illness and prevent death.	
2.	establish lifelong friendships based on caring.	
3.	facilitate coping skills and behaviors.	
4.	choose the best treatments for the patient.	

ANS:	3
A nursing goal is to encourage wellness so the patient can be self-reliant to the best of their ability.

DIF:	Cognitive Level: Knowledge	REF:	Page 4	
OBJ:	Clinical Practice #1		TOP:	Art and Science of Nursing
KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A		

	7.	An example of collaboration in a health care agency includes
1.	discussing with the dietitian how to best provide additional calories for a patient in the nursing home who has lost 3 pounds in the last month.	
2.	assigning a particular nursing assistant to a patient who needs gentle, unhurried care because the LPN knows the assistant is especially good in this way.	
3.	reviewing with a patient the medications he will need to take at home to ensure he knows the correct dosage and timing, as well as side effects.	
4.	calling a physician to indicate that the terminally ill patient admitted earlier in the week has died.	

ANS:	1
The nurse needs to be able to understand the concept and role of collaboration in the nursing profession to provide continuity of care.

DIF:	Cognitive Level: Comprehension	REF:	Page 4	OBJ:	Theory #10
TOP:	Art and Science of Nursing	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	8.	An educational career ladder in health care usually refers to
1.	the ability of a nurse to learn on the job and be promoted to a higher or different level of responsibility.	
2.	a nurse who works in one department of a hospital and transfers to another, for example, moving from a surgical unit to a maternity unit.	
3.	a person obtaining additional education to move from one level of nursing to another; for example, from nurses’ aide to practical nurse.	
4.	learning that increasing income from work in health care comes from experience, time, and commitment.	

ANS:	3
The nurse needs to have an understanding of the different levels of education through which she may progress during her nursing career. It is also important that the nurse clearly understands the educational requirements in each level of the career ladder.

DIF:	Cognitive Level: Knowledge	REF:	Page 7	OBJ:	Theory #7
TOP:	Nursing Education Pathways	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	9.	When diagnosis-related groups (DRGs) were established by Medicare in 1983, the purpose was to
1.	put patients with the same diagnosis on the same unit.	
2.	attempt to contain the costs of health care.	
3.	increase the length of a hospital stay.	
4.	identify a patient’s condition more quickly.	

ANS:	2
The nurse needs to understand that the purpose of instituting DRGs was to contain skyrocketing costs of health care.

DIF:	Cognitive Level: Knowledge	REF:	Page 9	OBJ:	Theory #12
TOP:	Health Care System		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	10.	An effect of DRGs and managed care for nurses working in health care agencies is that
1.	nursing documentation is crucial to clearly prove a patient’s needs for care and for the agencies to obtain reimbursement.	
2.	nursing assessment is less important now because the physician’s diagnosis is the only consideration in reimbursement.	
3.	nursing salaries have caught up to physicians’ salaries as the importance of nursing care has become clear.	
4.	cross-training has resulted in more personnel to care for the patient, and the nurse’s responsibilities are lessened.	

ANS:	1
The nurse needs to be knowledgeable about the importance of documentation in the patient’s medical record. All care delivered by nurses must be reflected in the chart with narrative notes, focus charting, and/or flow sheets in order for the facility to be able to receive payment for those services. Clear and concise documentation also reinforces that a patient continues to need the treatments for which managed care is being billed.

DIF:	Cognitive Level: Knowledge	REF:	Page 9	OBJ:	Theory #12
TOP:	Managed Care			KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	11.	If a person who is a member of a health maintenance organization (HMO) is having respiratory problems such as fever, cough, and fatigue for several days and wants to see a doctor, he
1.	could go directly to an emergency room for treatment.	
2.	could go to any general practitioner of choice.	
3.	would be able to contact a respiratory specialist.	
4.	needs to see his primary care physician.	

ANS:	4
The nurse must be aware of the requirements for different health insurance plans. Participants in an HMO must see their primary physician and receive a referral for a specialist for the HMO to pay for the care.

DIF:	Cognitive Level: Knowledge	REF:	Page 9	OBJ:	Theory #11
TOP:	Managed Care			KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	12.	An advantage of preferred provider organizations (PPOs) is that
1.	they make insurance coverage of employees less expensive to employers.	
2.	there are fewer physicians to choose from than in an HMO.	
3.	long-term relationships with physicians are more likely.	
4.	an individual can become a member of a PPO without belonging to a group.	

ANS:	1
The nurse must have knowledge about PPOs, which provide discounted rates to large employers who provide insurance coverage for their employees. In return, the insurance company receives a large pool of patients for their physicians.

DIF:	Cognitive Level: Knowledge	REF:	Pages 9-10	OBJ:	Theory #11
TOP:	Preferred Provider Organizations	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	13.	During the period following the Civil War, nursing education most closely resembled which of the following?
1.	Academic setting in formal classrooms	
2.	Apprenticeship	
3.	Five-year hospital-based programs	
4.	Primarily training with physicians in their offices	

ANS:	2
The nurse should have knowledge regarding the history of nursing.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	Theory #4
TOP:	Nursing History		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	14.	Interventions are best defined as which of the following?
1.	Transcribing doctors’ orders	
2.	Caregiving skills	
3.	Aseptic techniques	
4.	Guidelines for handling infectious wastes	

ANS:	2
The nurse needs to be able to define terms that describe skills performed in the nursing profession that restore and maintain a patient’s health.

DIF:	Cognitive Level: Knowledge	REF:	Page 3	OBJ:	Theory #8
TOP:	Art and Science of Nursing	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: N/A		

	15.	Florence Nightingale based her curriculum on which of the following beliefs?
1.	Nutrition is unimportant in nursing care.	
2.	Fresh, clean air is beneficial only to healthy people.	
3.	Nursing is distinct and separate from the practice of medicine.	
4.	Continuing education is unnecessary for nurses.	

ANS:	3
It is important for nurses to have an understanding of Florence Nightingale and her beliefs related to the profession of nursing. Florence Nightingale based her curriculum on the following beliefs: nutrition is an important part of nursing care; fresh, clean air is beneficial to the sick; nursing is distinct and separate from the practice of medicine and should be taught by nurses; and continuing education is needed for nurses.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	Theory #1
TOP:	Nursing History		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	16.	Who was appointed by the Union government to organize women volunteers to provide nursing care for soldiers during the Civil War?
1.	Florence Nightingale	
2.	Dorothea Dix	
3.	Clara Barton	
4.	Lillian Wald	

ANS:	2
The Union government appointed Dorothea Dix, a social worker, to organize women volunteers to provide nursing care for the soldiers during the Civil War. Florence Nightingale asked the Secretary of War to allow her to train women to care for the sick and wounded during the Crimean War. Clara Barton took volunteers into the field hospitals to care for soldiers of both armies. She later founded the American Red Cross. Lillian Wald took nursing out into the community and in 1893 established the Henry Street Settlement Service in New York City.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	Theory #4
TOP:	Nursing History		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	17.	Who trained women to care for the sick and wounded during the Crimean War?
1.	Florence Nightingale	
2.	Dorothea Dix	
3.	Clara Barton	
4.	Lillian Wald	

ANS:	1
Florence Nightingale asked the Secretary of War to allow her to train women to care for the sick and wounded during the Crimean War. The Union government appointed Dorothea Dix, a social worker, to organize women volunteers to provide nursing care for the soldiers during the Civil War. Clara Barton took volunteers into the field hospitals to care for soldiers of both armies. She later founded the American Red Cross. Lillian Wald took nursing out into the community and in 1893 established the Henry Street Settlement Service in New York City.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	Theory #1
TOP:	Nursing History		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	18.	Who founded the American Red Cross?
1.	Lillian Wald	
2.	Dorothea Dix	
3.	Florence Nightingale	
4.	Clara Barton	

ANS:	4
Clara Barton took volunteers into the field hospitals to care for soldiers of both armies. She later founded the American Red Cross. Florence Nightingale asked the Secretary of War to allow her to train women to care for the sick and wounded during the Crimean War. The Union government appointed Dorothea Dix, a social worker, to organize women volunteers to provide nursing care for the soldiers during the Civil War. Lillian Wald took nursing out into the community and in 1893 established the Henry Street Settlement Service in New York City.

DIF:	Cognitive Level: Knowledge	REF:	Page 2	OBJ:	Theory #4
TOP:	Nursing History		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	19.	The nursing theorist whose practice framework is based on 14 fundamental needs is
1.	Dorothy Johnson.	
2.	Jean Watson.	
3.	Virginia Henderson.	
4.	Martha Rogers.	

ANS:	3
Dorothy Johnson’s practice framework is based on seven behavioral subsystems in an adaptation model. Jean Watson’s practice framework is based on “carative” factors with caring as an interpersonal process used to meet human needs. Virginia Henderson’s practice framework is based on 14 fundamental needs. Martha Rogers’ practice framework is based on the concept of “unitary man” evolving along the life process.

DIF:	Cognitive Level: Knowledge	REF:	Page 4; Table 1-1	
OBJ:	Theory #4	TOP:	Nursing Theorists		
KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A		

	20.	The nursing theorist whose practice framework is based on seven behavioral subsystems is
1.	Betty Neumann.	
2.	Sister Callista Roy.	
3.	Dorothy Johnson.	
4.	Patricia Benner.	

ANS:	3
Dorothy Johnson’s practice framework is based on seven behavioral subsystems in an adaptation model. Betty Neuman’s practice framework is based on a systems model with stress reduction as its goal. Nursing care occurs on various levels: primary prevention, secondary prevention, or tertiary prevention. Sister Callista Roy’s practice framework is based on four adaptive modes: physiologic, psychological, sociological, and independence. Patricia Brenner’s practice framework is based on primacy of caring: caring is central and allows for the giving and receiving of help. Caring extends to all aspects of care of the patient.

DIF:	Cognitive Level: Knowledge	REF:	Page 4; Table 1-1	
OBJ:	Theory #4	TOP:	Nursing Theorists		
KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A		

	21.	The Standards of Nursing Practice are designed to protect which of the following?
1.	The nurse	
2.	The patient	
3.	The health care agency where nursing care is given	
4.	All of the above	

ANS:	4
It is important for the nurse to understand the Standards of Nursing Practice and whom/what they are designed to protect.

DIF:	Cognitive Level: Knowledge	REF:	Page 5	OBJ:	Theory #10
TOP:	Nursing Standards		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Safe, Effective Care Environment	

	22.	A state's nurse practice act is designed to protect
1.	The nurse	
2.	The physician	
3.	The public	
4.	The hospital	

ANS:	3
The nurse needs to understand what nurse practice acts are and whom/what they are designed to protect.

DIF:	Cognitive Level: Knowledge	REF:	Page 6	OBJ:	Theory #10
TOP:	Nursing Standards		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Safe, Effective Care Environment	

	23.	It is appropriate for practical nurses to provide direct patient care under the supervision of which of the following?
1.	A nursing assistant	
2.	A dentist	
3.	A nursing student	
4.	A phlebotomist	

ANS:	2
Practical nurses provide direct patient care under the supervision of a registered nurse, physician, or dentist.

DIF:	Cognitive Level: Application	REF:	Page 7	OBJ:	Theory #9
TOP:	Collaborative Care		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Safe, Effective Care Environment	

	24.	An example of tertiary care is which of the following?
1.	Hospice care	
2.	Restorative care	
3.	Emergency care	
4.	Home health care	

ANS:	1
The nurse needs to be knowledgeable about preventive, secondary, and tertiary care. Items 2, 3, and 4 are all examples of secondary (acute) care.

DIF:	Cognitive Level: Application	REF:	Page 10; Figure 1-8; Box 1-3
OBJ:	Theory #8	TOP:	Managed Care			
KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A		

COMPLETION

	25.	________ ________ ________ protect the public and define the legal scope of practice in each state.

ANS:	
Nurse practice acts
The nurse needs to be able to define the nurse practice act for her state. The nurse needs to be able to identify the role of the nurse practice act.

DIF:	Cognitive Level: Knowledge	REF:	Page 6	
OBJ:	Clinical practice #2		TOP:	Nursing Practice	
KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A		

MULTIPLE RESPONSE

	26.	Characteristics of primary nursing include which of the following? (Select all that apply.)
1.	Eliminates fragmentation between shifts	
2.	Evolved in the mid-1950s	
3.	One nurse plans and directs care	
4.	Ancillary workers are used to increase productivity	
5.	Work tasks are assigned to associate nurses	
6.	Associate nurses take over care and planning when the primary nurse is off duty	

ANS:	1, 3, 4, 6
The nurse needs to be able to appropriately identify the characteristics of the nursing care delivery systems.

DIF:	Cognitive Level: Knowledge	REF:	Page 8	OBJ:	Theory #8
TOP:	Nursing Care Delivery	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	27.	In 1991, the American Nurses Association (ANA) published the Standards of Clinical Nursing Practice. These standards are designed to do which of the following? (Select all that apply.)
1.	Set standards for safe nursing care delivery.	
2.	Define the legal scope of practice.	
3.	State legal requirements for clinical practice.	
4.	Protect the nurse, patient, and health care agency.	
5.	Regulate the nursing profession.	
6.	Define activities in which nurses may engage.	

ANS:	1, 4
The nurse needs to be able to identify the articles that are established to set standards for clinical nursing practice. The nurse needs to be able to differentiate between the attributes of the Standards of Clinical Nursing Practice and the nurse practice acts.

DIF:	Cognitive Level: Knowledge	REF:	Page 5	
OBJ:	Clinical practice #2		TOP:	Nursing Practice	
KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A		

	28.	Which of the following describe the role of a nurse as a delegator? (Select all that apply.)
1.	A nurse changing a patient’s wound dressing	
2.	A registered nurse giving a bed bath to a patient, with a certified nursing assistant	
3.	A licensed practical nurse assigning patient care tasks to certified nursing assistants	
4.	A registered nurse giving instructions to a patient and his family regarding his new medications	
5.	A licensed vocational nurse instructing the unit secretary to page a physician to the floor	
6.	A nursing supervisor assigning the floor orderly three patients who need additional assistance to get out of bed	

ANS:	3, 5, 6
The nurse needs to be able to identify the characteristics of the roles of the nursing profession. It is important for the nurse to be able to differentiate between the roles of caregiver, educator, collaborator, and delegator in theory and in clinical practice.

DIF:	Cognitive Level: Comprehension	REF:	Pages 3-4	OBJ:	Theory #5
TOP:	Art and Science of Nursing	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A