Chapter 1: Nursing Today

MULTIPLE CHOICE

	1.	The first practicing nurse epidemiologist was
a.	Florence Nightingale.	
b.	Mildred Montag.	
c.	Clara Barton.	
d.	Mary Agnes Snively.	

ANS:	A
Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. Mildred Montag, Clara Barton, and Mary Agnes Snively came after Nightingale, each contributing to the nursing profession in her own way. Clara Barton founded the American Red Cross. Dr. Mildred Montag established the first associate degree nursing program in 1952. Mary Agnes Snively began forming the Canadian National Association of Trained Nurses in 1883.

DIF:	Remember	REF:	2	
OBJ:	Discuss the historical development of professional nursing roles.	
TOP:	Assessment	MSC:	Teaching/Learning	

	2.	The American Red Cross was founded by
a.	Florence Nightingale.	
b.	Harriet Tubman.	
c.	Clara Barton.	
d.	Mary Mahoney.	

ANS:	C
In 1882, the United States ratified the American Red Cross, founded by Clara Barton. Florence Nightingale established the Training School for Nurses in London, England, in 1860. Harriet Tubman was active in the Underground Railroad movement during the American Civil War. Mary Mahoney was the first professionally trained African American nurse.

DIF:	Remember	REF:	2	
OBJ:	Discuss the historical development of professional nursing roles.	
TOP:	Assessment	MSC:	Teaching/Learning	

	3.	Nurses working in the Henry Street Settlement in 1893 were among the first nurses to demonstrate autonomy in practice. This was because those nurses
a.	Had no ability to work in the hospital setting.	
b.	Were required to use critical thinking skills.	
c.	Focused solely on healing the very ill.	
d.	Planned their care around research findings.	

ANS:	B
In 1893, nurses working in the Henry Street Settlement were some of the first to demonstrate autonomy in practice because they encountered situations that required quick and innovative problem solving and critical thinking, and provided therapies aimed at maintaining wellness, as well as curing the ill. Nursing hospitals expanded in the late nineteenth century and were major providers of nursing care. Not until the early twentieth century was there a movement toward a scientific, research-based body of nursing knowledge.

DIF:	Understand	REF:	2	
OBJ:	Discuss the historical development of professional nursing roles.	
TOP:	Assessment	MSC:	Teaching/Learning	

	4.	In 1923, the Goldmark Report was an important study that
a.	Formed formal nurse midwifery programs.	
b.	Established the Center for Ethics and Human Rights.	
c.	Revised the ANA code of ethics.	
d.	Led to the development of the Yale School of Nursing.	

ANS:	D
In 1923, the Goldmark Report identified the need for increased financial support for university-based schools of nursing. As a result, the Yale School of Nursing was developed. Graduate nurse midwifery programs did not come into existence until the 1940s, and the Center for Ethics and Human Rights was founded in 1990. The ANA code of ethics was published in 1985 and was last updated in 2001.

DIF:	Remember	REF:	2-3	
OBJ:	Discuss the historical development of professional nursing roles.	
TOP:	Assessment	MSC:	Teaching/Learning	

	5.	The major difference between a baccalaureate degree nursing program and an associate’s degree nursing program is that the baccalaureate program includes studies in 
a.	Basic sciences and theoretical courses.	
b.	Social sciences and humanities.	
c.	Theoretical and clinical courses.	
d.	Basic sciences and clinical courses.	

ANS:	B
Both associate’s degree programs and baccalaureate programs focus on basic sciences and on theoretical and clinical courses. Baccalaureate programs, however, also focus on courses in the social sciences, arts, and humanities to support nursing theory.

DIF:	Understand	REF:	5	
OBJ:	Describe educational programs available for professional registered nurse education.
TOP:	Evaluation	MSC:	Teaching/Learning	

	6.	The nurse has been working in the clinical setting for several years as an advanced practice nurse and has earned her master’s degree as a family nurse practitioner. However, she seems unfulfilled and has a strong desire to do research. To fulfill her desire, the nurse most likely would apply to attend a program that would lead to a
a.	Doctor of Nursing Science degree (DNSc).	
b.	Doctor of Philosophy degree (PhD).	
c.	Doctor of Nursing Practice degree (DNP).	
d.	Doctor in the Science of Nursing degree (DSN).	

ANS:	B
PhD programs emphasize basic research and theory and are research oriented. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. The DNP is a practice doctorate that prepares advanced practice nurses such as nurse practitioners.

DIF:	Understand	REF:	5	
OBJ:	Describe educational programs available for professional registered nurse education.
TOP:	Evaluation	MSC:	Teaching/Learning	

	7.	The nurse is caring for her patients and is focused on managing their care as opposed to managing and performing skills. This nurse demonstrates which level of proficiency according to Benner?
a.	Novice	
b.	Competent	
c.	Proficient	
d.	Expert	

ANS:	C
The proficient nurse focuses on managing care as opposed to managing and performing skills. The novice nurse deals with a specific set of rules or procedures, which are usually stepwise and linear. The competent nurse understands the organization and the specific care required by specific types of patients and has experience with psychomotor skills. The expert nurse identifies patient-centered problems, as well as problems related to the health care system.

DIF:	Understand	REF:	6	
OBJ:	Describe educational programs available for professional registered nurse education.
TOP:	Evaluation	MSC:	Teaching/Learning	

	8.	Which of the following resources guides faculty on structure and evaluation of the nursing curriculum?
a.	ANA’s Standards of Nursing Practice	
b.	Essentials of Baccalaureate Education	
c.	NLNAC Interpretive Guidelines	
d.	Standards of Professional Performance	

ANS:	B
The American Association of Colleges of Nursing (AACN) published Essentials of Baccalaureate Education for Professional Nursing: A Final Report (1998), which guides faculty on structure and evaluation of the curriculum and the performance of the graduate. The ANA’s Standards of Nursing Practice demonstrates the critical thinking model known as the nursing process. Standards of Professional Performance describes a competent level of behavior in the professional role. NLNAC Interpretive Guidelines identifies core competencies for the professional nurse.

DIF:	Understand	REF:	5	
OBJ:	Describe educational programs available for professional registered nurse education.
TOP:	Evaluation	MSC:	Teaching/Learning	

	9.	The nurse is caring for the patient who has had major abdominal surgery and also has a large sacral pressure sore. The nurse implements coughing and deep breathing exercises and consults the wound care specialist to evaluate and prescribe care for the pressure sore, even though no physician order has provided instructions to do so. In doing this, the nurse is implementing the element of
a.	Autonomy.	
b.	Accountability.	
c.	Advanced practice.	
d.	Nurse practitioner.	

ANS:	A
Autonomy is an essential element of professional nursing. Some independent nursing interventions such as implementing coughing and deep breathing exercises and collaboration with other health professionals can be initiated without medical orders. Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. “Advanced practice nurse” is an umbrella term for advanced clinical nurses such as nurse practitioners who provide care to a group of patients.

DIF:	Understand	REF:	6-7	
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Evaluation
MSC:	Teaching/Learning	

	10.	The physician is planning to take the patient to surgery in the morning and leaves an order for the nurse to get the patient to sign the surgical permit. The physician’s note indicates that the patient has been educated on the procedure. However, the patient tells the nurse, “I have no idea what he’s going to do. He rushed in and rushed out so fast, I couldn’t ask any questions.” The nurse does not allow the patient to sign the permit and calls the physician to inform him of the patient’s statement. This is an example of the nurse acting as
a.	Patient advocate.	
b.	Patient educator.	
c.	Manager.	
d.	Clinical nurse specialist.	

ANS:	A
As a patient advocate, the nurse protects the patient’s human and legal rights, including the right of the patient to understand procedures before signing permits. Although nurses can be educators, it is the responsibility of the surgeon to provide education for the patient in preparation for surgery, and it is the nurse’s responsibility to notify the physician if the patient is not properly educated. Managers coordinate the activities of members of the nursing staff in delivering nursing care, and clinical nurse specialists are experts in a specialized area of nursing practice in a variety of settings.

DIF:	Apply	REF:	7	
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Evaluation
MSC:	Teaching/Learning	

	11.	The patient requires routine gynecological services after giving birth to her son, and while seeing the nurse midwife, she asks for a referral to a pediatrician for the newborn. The nurse midwife should
a.	Provide the referral as requested.	
b.	Offer to provide the newborn care.	
c.	Refer the patient to the supervising physician.	
d.	Tell the patient that she cannot make referrals.	

ANS:	B
The practice of nurse midwifery involves providing independent care for women during normal pregnancy, labor, and delivery, as well as care for the newborn. As an independent practitioner, supervising physicians are not required by the certified nurse midwife (CNM). However, a CNM practices with a health care agency that provides medical consultation, collaborative management, and referral. After being apprised of the CNM role, if the patient insists on seeing a pediatrician, the nurse midwife should provide the referral.

DIF:	Apply	REF:	8	
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Implementation
MSC:	Teaching/Learning	

	12.	The student nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). It is important for the student to understand that the CRNA
a.	Works under the guidance of an anesthesiologist.	
b.	Manages acute medical conditions.	
c.	Manages gynecological services such as PAP smears.	
d.	Must have a PhD degree in anesthesiology.	

ANS:	A
Nurse anesthetists provide surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician with advanced knowledge of surgical anesthesia. Nurse practitioners, not CRNAs, manage self-limiting acute and chronic stable medical conditions; certified nurse midwives provide gynecological services such as routine Papanicolaou (Pap) smears. The CRNA is an RN with an advanced education in a nurse anesthesia accredited program. A PhD is not a requirement.

DIF:	Understand	REF:	8	
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Implementation
MSC:	Teaching/Learning	

	13.	The nurse is speaking in front of a group of ninth grade students about nursing as a profession. One student states that she does not want to be a nurse because all nurses do is take care of sick people and play politics. The most appropriate response that the nurse could give and expand on is that
a.	Nursing is ideal for the person who hates politics.	
b.	Nursing focuses on curing the person’s disease.	
c.	Nursing is not political because it has its own knowledge base.	
d.	An area of nursing exists for every interest.	

ANS:	D
It is important to remember that opportunities are limitless for caring, compassionate, and competent nursing care; an area of nursing exists for every interest. Current philosophies and definitions of nursing demonstrate the holistic trend in nursing—to address the whole person in all dimensions, in health and illness, and in interaction with family and community. Political activism and commitment are a part of professionalism and are an important aspect of the delivery of health care. Nursing continues to draw on the social sciences and other fields as the focus of nursing care expands.

DIF:	Understand	REF:	9	
OBJ:	Discuss the influence of social and economic changes on nursing practices.
TOP:	Implementation		MSC:	Teaching/Learning	

	14.	A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensive care units to 3:1. The nurse realizes that
a.	Legislation is politics beyond the nurse’s control.	
b.	National programs have no bearing on state politics.	
c.	The individual nurse can influence legislative decisions.	
d.	Focusing on nursing care provides the best patient benefit.	

ANS:	C
Nurses can influence policy decisions at all governmental levels. One way is to get involved in ANA’s national efforts, such as Nursing’s Agenda for the Future: A Call to the Nation. This effort is critical in exerting nurses’ influence early in the political process. Nurses need to become serious students of social needs, activists in influencing policy to meet those needs, and generous contributors of time and money to nursing organizations and candidates to help legislate conditions that are likely to produce the best care possible.

DIF:	Analyze	REF:	10-11	
OBJ:	Discuss the influence of social and economic changes on nursing practices.
TOP:	Implementation		MSC:	Teaching/Learning	

	15.	During the American Civil War, which of the following women was active in the Underground Railroad movement and assisted in leading more than 300 slaves to freedom?
a.	Harriet Tubman	
b.	Clara Barton	
c.	Dorothea Dix	
d.	Mary Ann Ball (Mother Bickerdyke)	

ANS:	A
Harriet Tubman was active in the Underground Railroad movement and assisted in leading more than 300 slaves to freedom. Clara Barton, founder of the American Red Cross, tended soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them in death. As superintendent of the female nurses of the Union Army, Dorothea Lynde Dix organized hospitals, appointed nurses, and oversaw and regulated supplies to the troops. Mother Bickerdyke organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers.

DIF:	Remember	REF:	2	
OBJ:	Discuss the historical development of professional nursing roles.	
TOP:	Assessment	MSC:	Teaching/Learning	

	16.	Graduates of baccalaureate degree or associate’s degree nursing programs are eligible to take which of the following to become registered nurses in the state in which they will practice?
a.	Continuing education credits	
b.	In-service education programs	
c.	National Council Licensure Examination	
d.	Graduate education	

ANS:	C
Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associate’s degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurse associations, professional nursing organizations, and educational and health care institutions. In-service education programs consist of instruction or training provided by a health care agency or institution. An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals. A nurse who is completing a graduate program can receive a master’s degree in nursing.

DIF:	Remember	REF:	5	
OBJ:	Describe educational programs available for professional registered nurse education.
TOP:	Evaluation	MSC:	Teaching/Learning	

	17.	Which concept means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided?
a.	Autonomy	
b.	Accountability	
c.	Patient advocacy	
d.	Patient education	

ANS:	B
Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. As a patient advocate, the nurse protects the patient’s human and legal rights and provides assistance in asserting these rights if the need arises. As an educator, the nurse explains concepts and facts about health, describes the reasons for routine care activities, demonstrates procedures such as self-care activities, reinforces learning or patient behavior, and evaluates the patient’s progress in learning.

DIF:	Remember	REF:	6-7	
OBJ:	Discuss the influence of social and economic changes on nursing practices.
TOP:	Evaluation	MSC:	Teaching/Learning	

MULTIPLE RESPONSE

	1.	The nurse in the twenty-first century is facing an extremely complex profession with multiple external forces affecting the nursing profession. Factors influencing the nursing profession include which of the following? (Select all that apply.)
a.	Demography	
b.	Women’s health care	
c.	Human rights	
d.	The threat of bioterrorism	
e.	The medically underserved	

ANS:	A, B, C, D, E
Multiple external forces affect nursing. These include demographic changes in the population, human rights, increasing numbers of medically underserved, and the threat of bioterrorism. The women’s movement brought greater sensitivity to the health care needs of women and the role of women in health care research.

DIF:	Remember	REF:	3	
OBJ:	Discuss the influence of social and economic changes on nursing practices.
TOP:	Diagnosis	MSC:	Nursing Process	

	2.	After licensure, the practicing nurse is required to update his or her knowledge about the latest research and practice developments. The most common way nurses do this is through _____ programs. (Select all that apply.)
a.	Continuing education 	
b.	Master’s degree 	
c.	In-service education 	
d.	DNP 	

ANS:	A, C
Continuing education updates the nurse’s knowledge about the latest research and practice developments. In-service education programs are provided by a health care agency to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can provide the nurse with continuing education credit. Master’s degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. The DNP is a practice doctorate that prepares advanced practice nurses.

DIF:	Understand	REF:	5-6	
OBJ:	Describe educational programs available for professional registered nurse education.
TOP:	Evaluation	MSC:	Teaching/Learning	

	3.	Which of the following is (are) an example of an advanced practice nurse? (Select all that apply.)
a.	Nurse practitioner	
b.	Clinical nurse specialist	
c.	Patient advocate	
d.	Certified registered nurse anesthetist	
e.	Nurse midwife	

ANS:	A, B, D, E
Although all nurses should function as patient advocates, “advanced practice nurse” is an umbrella term for an advanced clinical nurse such as a nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or nurse midwife.

DIF:	Remember	REF:	7-8	
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Evaluation
MSC:	Teaching/Learning	

	4.	The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to “float” two of its nurses to the oncology unit if oncology can “float” a nursing assistant to the orthopedic unit to help with obtaining vital signs. This is an example of (Select all that apply.)
a.	Autonomy.	
b.	Accountability.	
c.	Political activism.	
d.	Politics.	

ANS:	A, B, D
Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. Nurses are involved in politics when seeking additional resources. However, political activism usually involves more than day-to-day activities such as unit staffing.

DIF:	Apply	REF:	6-7| 10-11	
OBJ:	Discuss the influence of social and economic changes on nursing practices.
TOP:	Implementation		MSC:	Teaching/Learning