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1.

The best explanation of what Title VI of the Civil Rights Act mandates is the
freedom to:

A. Pick any physician and insurance company despite one’s income


B. Receive free medical benefits as needed within the county of residence
C. Have equal access to all health care regardless of race and religion
D. Have basic care with a sliding scale payment plan from all health care facilities
2. Which statement would best explain the role of the nurse when planning care for a
culturally diverse population? The nurse will plan care to:

A. Include care that is culturally congruent with the staff from predetermined criteria
B. Focus only on the needs of the client, ignoring the nurse’s beliefs and practices
C. Blend the values of the nurse that are for the good of the client and minimize the
client’s individual values and beliefs during care
D. Provide care while aware of one’s own bias, focusing on the client’s individual
needs rather than the staff’s practices
3. Which factor is least significant during assessment when gathering information
about cultural practices?
A. Language, timing
B. Touch, eye contact
C. Biocultural needs
D. Pain perception, management expectations
4. Transcultural nursing implies:

A. Using a comparative study of cultures to understand similarities and differences


across human groups to provide specific individualized care that is culturally
appropriate
B. Working in another culture to practice nursing within their limitations
C. Combining all cultural beliefs into a practice that is a nonthreatening approach to
minimize cultural barriers for all clients’ equality of care
D. Ignoring all cultural differences to provide the best generalized care to all clients.
5. What should the nurse do when planning nursing care for a client with a different
cultural background? The nurse should:

A. Allow the family to provide care during the hospital stay so no rituals or customs
are broken
B. Identify how these cultural variables affect the health problem
C. Speak slowly and show pictures to make sure the client always understands
D. Explain how the client must adapt to hospital routines to be effectively cared for
while in the hospital
6. Which activity would not be expected by the nurse to meet the cultural needs of the
client?

A. Promote and support attitudes, behaviors, knowledge, and skills to respectfully


meet client’s cultural needs despite the nurse’s own beliefs and practices
B. Ensure that the interpreter understands not only the language of the client but
feelings and attitudes behind cultural practices to make sure an ethical balance
can be achieved
C. Develop structure and process for meeting cultural needs on a regular basis and
means to avoid overlooking these needs with clients
D. Expect the family to keep an interpreter present at all times to assist in meeting
the communication needs all day and night while hospitalized
7. Ethical principles for professional nursing practice in a clinical setting are guided
by the principles of conduct that are written as the:

A. American Nurses Association’s (ANA’s) Code of Ethics


B. Nurse Practice Act (NPA) written by state legislation
C. Standards of care from experts in the practice field
D. Good Samaritan laws for civil guidelines
8. A bioethical issue should be described as:

A. The physician’s making all decisions of client management without getting input
from the client
B. A research project that included treating all the white men and not treating all the
black men to compare the outcomes of a specific drug therapy.
C. The withholding of food and treatment at the request of the client in a written
advance directive given before a client acquired permanent brain damage from an
accident.
D. After the client gives permission, the physician’s disclosing all information to the
family for their support in the management of the client.
9. When the nurse described the client as “that nasty old man in 354,” the nurse is
exhibiting which ethical dilemma?

A. Gender bias and ageism


B. HIPPA violation
C. Beneficence
D. Code of ethics violation
10. The distribution of nurses to areas of “most need” in the time of a nursing shortage
is an example of:

A. Utilitarianism theory
B. Deontological theory
C. Justice
D. Beneficence
11. Nurses are bound by a variety of laws. Which description of a type of law is
correct?

A. Statutory law is created by elected legislature, such as the state legislature that
defines the Nurse Practice Act (NPA).
B. Regulatory law includes prevention of harm for the public and punishment for
those laws that are broken.
C. Common law protects the rights of the individual within society for fair and equal
treatment.
D. Criminal law creates boards that pass rules and regulations to control society.
12. Besides the Joint Commission on Accreditation of Healthcare Organizations
(JACHO), which governing agency regulates hospitals to allow continued safe
services to be provided, funding to be received from the government and penalties if
guidelines are not followed?

A. Board of Nursing Examiners (BNE)


B. Nurse Practice Act (NPA)
C. American Nurses Association (ANA)
D. Americans With Disabilities Act (ADA)
13. When a client is confused, left alone with the side rails down, and the bed in a
high position, the client falls and breaks a hip. What law has been broken?

A. Assault
B. Battery
C. Negligence
D. Civil tort
14. When signing a form as a witness, your signature shows that the client:

A. Is fully informed and is aware of all consequences.


B. Was awake and fully alert and not medicated with narcotics.
C. Was free to sign without pressure
D. Has signed that form and the witness saw it being done
15. Which criterion is needed for someone to give consent to a procedure?

A. An appointed guardianship
B. Unemancipated minor
C. Minimum of 21 years or older
D. An advocate for a child
16. Which statement is correct?

A. Consent for medical treatment can be given by a minor with a sexually


transmitted disease (STD).
B. A second trimester abortion can be given without state involvement.
C. Student nurses cannot be sued for malpractice while in a nursing clinical class.
D. Nurses who get sick and leave during a shift are not abandoning clients if they
call their supervisor and leave a message about their emergency illness.
17. Most litigation in the hospital comes from the:

A. Nurse abandoning the clients when going to lunch


B. Nurse following an order that is incomplete or incorrect
C. Nurse documenting blame on the physician when a mistake is made
D. Supervisor watching a new employee check his or her skills level
18. The nurse places an aquathermia pad on a client with a muscle sprain. The nurse
informs the client the pad should be removed in 30 minutes. Why will the nurse return
in 30 minutes to remove the pad?

A. Reflex vasoconstriction occurs.


B. Reflex vasodilation occurs.
C. Systemic response occurs.
D. Local response occurs.
19. A client has recently been told he has terminal cancer. As the nurse enters the
room, he yells, “My eggs are cold, and I’m tired of having my sleep interrupted by
noisy nurses!” The nurse may interpret the client’s behavior as:

A. An expression of the anger stage of dying


B. An expression of disenfranchised grief
C. The result of maturational loss
D. The result of previous losses
20. When helping a person through grief work, the nurse knows:

A. Coping mechanisms that were effective in the past are often disregarded in
response to the pain of a loss
B. A person’s perception of a loss has little to do with the grieving process.
C. The sequencing of stages of grief may occur in order, they may be skipped, or
they may recur.
D. Most clients want to be left alone.
21. A client is hospitalized in the end stage of terminal cancer. His family members
are sitting at his bedside. What can the nurse do to best aid the family at this time?
A. Limit the time visitors may stay so they do not become overwhelmed by the
situation.
B. Avoid telling family members about the client’s actual condition so they will not
lose hope.
C. Discourage spiritual practices because this will have little connection to the client
at this time.
D. Find simple and appropriate care activities for the family to perform.
22. When caring for a terminally ill client, it is important for the nurse maintain the
client’s dignity. This can be facilitated by:

A. Spending time to let clients share their life experiences


B. Decreasing emphasis on attending to the clients’ appearance because it only
increases their fatigue
C. Making decisions for clients so they do not have to make them
D. Placing the client in a private room to provide privacy at all times
23. What are the stages of dying according to Elizabeth Kubler-Ross?

A. Numbing; yearning and searching; disorganization and despair; and


reorganization.
B. Accepting the reality of loss, working through the pain of grief, adjusting to the
environment without the deceased, and emotionally relocating the deceased and
moving on with life.
C. Anticipatory grief, perceived loss, actual loss, and renewal.
D. Denial, anger, bargaining, depression, and acceptance.
24. Bereavement may be defined as:

A. The emotional response to loss.


B. The outward, social expression of loss.
C. Postponing the awareness of the reality of the loss.
D. The inner feeling and outward reactions of the survivor.
25. A client who had a “Do Not Resuscitate” order passed away. After verifying there
is no pulse or respirations, the nurse should next:

A. Have family members say goodbye to the deceased.


B. Call the transplant team to retrieve vital organs.
C. Remove all tubes and equipment (unless organ donation is to take place), clean
the body, and position appropriately.
D. Call the funeral director to come and get the body.
26. A client’s family member says to the nurse, “The doctor said he will provide
palliative care. What does that mean?” The nurse’s best response is:
A. “Palliative care is given to those who have less than 6 months to live.”
B. “Palliative care aims to relieve or reduce the symptoms of a disease.”
C. “The goal of palliative care is to affect a cure of a serious illness or disease.”
D. “Palliative care means the client and family take a more passive role and the
doctor focuses on the physiological needs of the client. The location of death will
most likely occur in the hospital setting.”
27. Which of the following is not included in evaluating the degree of heritage
consistency in a client?

A. Gender
B. Culture
C. Ethnicity
D. Religion
28. When providing care to clients with varied cultural backgrounds, it is imperative
for the nurse to recognize that:

A. Cultural considerations must be put aside if basic needs are in jeopardy.


B. Generalizations about the behavior of a particular group may be inaccurate.
C. Current health standards should determine the acceptability of cultural practices.
D. Similar reactions to stress will occur when individuals have the same cultural
background.
29. To respect a client’s personal space and territoriality, the nurse:

A. Avoids the use of touch


B. Explains nursing care and procedures
C. Keeps the curtains pulled around the clients bed
D. Stands 8 feet away from the bed, if possible.
30. To be effective in meeting various ethnic needs, the nurse should:

A. Treat all clients alike.


B. Be aware of clients’ cultural differences.
C. Act as if he or she is comfortable with the client’s behavior.
D. Avoid asking questions about the client’s cultural background.
31. The most important factor in providing nursing care to clients in a specific ethnic
group is:

A. Communication
B. Time orientation
C. Biological variation
D. Environmental control
32. A health care issue often becomes an ethical dilemma because:
A. A clients legal rights coexist with a health professionals obligation.
B. Decisions must be made quickly, often under stressful conditions.
C. Decisions must be made based on value systems.
D. The choices involved do not appear to be clearly right or wrong.
33. A document that lists the medical treatment a person chooses to refuse if unable to
make decisions is the:

A. Durable power of attorney


B. Informed consent
C. Living will
D. Advance directives
34. Which statement about an institutional ethics committee is correct?

A. The ethics committee is an additional resource for clients and health care
professionals.
B. The ethics committee relieves health care professionals from dealing with ethical
issues.
C. The ethics committee would be the first option in addressing an ethical dilemma.
D. The ethics committee replaces decision making by the client and health care
providers.
35. The nurse is working with parents of a seriously ill newborn. Surgery has been
proposed for the infant, but the chances of success are unclear. In helping the parents
resolve this ethical conflict, the nurse knows that the first step is:

A. Exploring reasonable courses of action


B. Collecting all available information about the situation
C. Clarifying values related to the cause of the dilemma.
D. Identifying people who can solve the difficulty.
36. Miss Mary, an 88-year old woman, believes that life should not be prolonged
when hope is gone. She has decided that she does not want extraordinary measures
taken when her life is at its end. Because she feels this way, she has talked with her
daughter about her desires, completing a living will and left directions with her
physician. This is an example of:

A. Affirming a value
B. Choosing a value
C. Prizing a value
D. Reflecting a value
37. The scope of Nursing practice is legally defined by:

A. State nurses practice acts


B. Professional nursing organizations
C. Hospital policy and procedure manuals
D. Physicians in the employing institutions
38. A student nurse who is employed as a nursing assistant may perform any functions
that:

A. Have been learned about in school


B. Are expected of a nurse at that level
C. Are identified in the positions job description
D. Require technical rather than professional skill.
39. A confused client who fell out of bed because side rails were not used is an
example of which type of liability?

A. Felony
B. Assault
C. Battery
D. Negligence
40. The nurse puts a restraint jacket on a client without the client’s permission and
without the physicians order. The nurse may be guilty of:

A. Assault
B. Battery
C. Invasion of privacy
D. Neglect
41. In a situation in which there is insufficient staff to implement competent care, a
nurse should:

A. Organize a strike
B. Inform the clients of the situation
C. Refuse the assignment
D. Accept the assignment but make a protest in writing to the administration.
42. Which statement about loss is accurate?

A. Loss is only experienced when there is an actual absence of something valued.


B. The more the individual has invested in what is lost, the less the feeling of loss.
C. Loss may be maturational, situational, or both.
D. The degree of stress experienced is unrelated to the type of loss.
43. Trying questionable and experimental forms of therapy is a behavior that is
characterized of which stage of dying?

A. Anger
B. Depression
C. Bargaining
D. Acceptance
44. All of the following are crucial needs of the dying client except:

A. Control of pain
B. Preservation of dignity and self-worth
C. Love and belonging
D. Freedom from decision making
45. Cultural awareness is an in-depth self-examination of one’s:

A. Background, recognizing biases and prejudices.


B. Social, cultural, and biophysical factors
C. Engagement in cross-cultural interactions
D. Motivation and commitment to caring.
46. Cultural competence is the process of:

A. Learning about vast cultures


B. Acquiring specific knowledge, skills, and attitudes
C. Influencing treatment and care of clients
D. Motivation and commitment to caring.
47. Ethnocentrism is the root of:

A. Biases and prejudices


B. Meanings by which people make sense of their experiences.
C. Cultural beliefs
D. Individualism and self-reliance in achieving and maintaining health.
48. When action is taken on one’s prejudices:

A. Discrimination occurs
B. Sufficient comparative knowledge of diverse groups is obtained.
C. Delivery of culturally congruent care is ensured.
D. People think/know you are a dumbass for being prejudiced.
49. The dominant value orientation in North American society is:

A. Use of rituals symbolizing the supernatural.


B. Group reliance and interdependence
C. Healing emphasizing naturalistic modalities
D. Individualism and self-reliance in achieving and maintaining health.
50. Disparities in health outcomes between the rich and the poor illustrates: a (an)
A. Illness attributed to natural, impersonal, and biological forces.
B. Creation of own interpretation and descriptions of biological and psychological
malfunctions.
C. Influence of socioeconomic factors in morbidity and mortality.
D. Combination of naturalistic, religious, ad supernatural modalities.
51. Culture strongly influences pain expression and need for pain medication.
However, cultural pain:

A. May be suffered by a client whose valued way of life is disregarded by


practitioners.
B. Is more intense, thus necessitating more medication.
C. Is not expressed verbally or physically
D. Is expressed only to others of like culture.
52. The dominant values in American society on individual autonomy and self-
determination:

A. Rarely have an effect on other cultures


B. Do have an effect on health care
C. May hinder ability to get into a hospice program
D. May be in direct conflict with diverse groups.
53. In the United States, access to health care usually depends on a client’s ability to
pay for health care, either through insurance or by paying cash. The client the nurse is
caring for needs a liver transplant to survive. This client has been out of work for
several months and does not have insurance or enough cash. A discussion about the
ethics of this situation would involve predominantly the principle of:

A. Accountability, because you as the nurse are accountable for the well being of this
client.
B. Respect of autonomy, because this client’s autonomy will be violated if he does
not receive the liver transplant.
C. Ethics of care, because the caring thing that a nurse could provide this patient is
resources for a liver transplant.
D. Justice, because the first and greatest question in this situation is how to
determine the just distribution of resources.
54. The code of ethics for nurses is composed and published by:

A. The national league for Nursing


B. The American Nurses Association
C. The Medical American Association
D. The National Institutes of Health, Nursing division.
55. Nurses agree to be advocates for their patients. Practice of advocacy calls for the
nurse to:

A. Seek out the nursing supervisor in conflicting situations


B. Work to understand the law as it applies to the client’s clinical condition.
C. Assess the client’s point of view and prepare to articulate this point of view.
D. Document all clinical changes in the medical record in a timely manner.
56. Successful ethical discussion depends on people who have a clear sense of
personal values. When many people share the same values it may be possible to
identify a philosophy of utilitarianism, with proposes that:

A. The value of people is determined solely by leaders in the Unitarian church.


B. The decision to perform a lover transplant depends on a measure of the moral life
that the client has led so far.
C. The best way to determine the solution to an ethical dilemma is to refer the case
to the attending physician.
D. The value of something is determined by its usefulness to society.
57. The philosophy sometimes called the code of ethics of care suggests that ethical
dilemmas can best be solved by attention to:

A. Relationships
B. Ethical principles
C. Clients
D. Code of ethics for nurses.
58. In most ethical dilemmas, the solution to the dilemma requires negotiation among
members of the health care team. The nurse’s point of view is valuable because:

A. Nurses have a legal license that encourages their presence during ethical
discussions.
B. The principle of autonomy guides all participants to respect their own self-worth.
C. Nurses develop a relationship to the client that is unique among all professional
health care providers.
D. The nurse’s code of ethics recommends that a nurse be present at any ethical
discussion about client care.
59. Ethical dilemmas often arise over a conflict of opinion. Once the nurse has
determined that the dilemma is ethical, a critical first step in negotiating the difference
of opinion would be to:

A. Consult a professional ethicist to ensure that the steps of the process occur in full.
B. Gather all relevant information regarding the clinical, social, and spiritual aspects
of the dilemma.
C. List the ethical principles that inform the dilemma so that negotiations agree on
the language of the discussion.
D. Ensure that the attending physician has written an order for an ethics consultation
to support the ethics process.
60. The nurse practice acts are an example of:

A. Statutory law
B. Common law
C. Civil law
D. Criminal law
61. The scope of Nursing Practice, the established educational requirements for
nurses, and the distinction between nursing and medical practice is defined by:

A. Statutory law
B. Common law
C. Civil law
D. Nurse practice acts
62. The client’s right to refuse treatment is an example of:

A. Statutory law
B. Common law
C. Civil laws
D. Nurse practice acts
63. Even though the nurse may obtain the clients signature on a form, obtaining
informed consent is the responsibility of the:

A. Client
B. Physician
C. Student nurse
D. Supervising nurse.
64. The nurse is obligated to follow a physician’s order unless:

A. The order is a verbal order


B. The physicians order is illegible
C. The order has not been transcribed
D. The order is an error, violates hospital policy, or would be detrimental to the
client.
65. The nursing theorist who developed transcultural nursing theory is

A. Dorothea Orem
B. Madeleine Leininger
C. Betty Newman
D. Sr. Callista Roy

1. C.
2. D. Without understanding one’s own beliefs and values, a bias or preconceived
belief by the nurse could create an unexpected conflict or an area of neglect in the
plan of care for a client (who might be expecting something totally different from
the care). During assessment values, beliefs, practices should be identified by the
nurse and used as a guide to identify the choices by the nurse to meet specific
needs/outcomes of that client. Therefore identification of values, beliefs, and
practices allows for planning meaningful and beneficial care specific for this
client.
3. C. Cultural practices do not influence biocultural needs because they are inborn
risks that are related to a biological need and not a learned cultural belief or
practice.
4. A. Transcultural care means that by understanding and learning about specific
cultural practices the nurse can integrate these practices into the plan of care for a
specific individual client who has the same beliefs or practices to meet the client’s
needs in a holistic manner of care.
5. B. Without assessment and identification of the cultural needs, the nurse cannot
begin to understand how these might influence the health problem or health care
management.
6. D. It is not the family’s responsibility to assist in the communication process.
Many families will leave someone to help at times, but it is the hospital’s legal
obligation to find an interpreter for continued understanding by the client to make
sure the client is fully informed and comprehends in his or her primary language.
7. A. This set of ethical principles provides the professional guidelines established
by the ANA to maintain the highest standards for ideal conduct in practice. As a
profession, the ANA wanted to establish rules and then incorporate guidelines for
accountability and responsibility of each nurse within the practice setting.
8. B. The ethical issue was the inequality of treatment based strictly upon racial
differences. Secondly, the drug was deliberately withheld even after results
showed that the drug was working to cure the disease process in the white men for
many years. So after many years, the black men were still not treated despite the
outcome of the research process that showed the drug to be effective in
controlling the disease early in the beginning of the research project. Therefore
harm was done. Nonmaleficence, veracity, and justice were not followed.
9. A. Stereotyping an “old man” as “nasty”is a gender bias and an ageism issue. The
nurse is verbalizing a negative descriptor about the client.
10. C. Justice is defined as the fairness of distribution of resources. However,
guidelines for a hierarchy of needs have been established, such as with organ
transplantation. Nurses are moved to areas of greatest need when shortages occur
on the floors. No floor is left without staff, and another floor that had five staff
will give up two to go help the floor that had no staff.
11. A. Statutory law is created by legislature. It creates statues such as the NPA,
which defines the role of the nurse and expectations of the performance of one’s
duties and explains what is contraindicated as guidelines for breech of those
regulations.
12. D. If the hospital fails to follow ADA guidelines for meeting special needs, the
facility loses funding and status for receiving low-income loans or reimbursement
of expenses. ADA protects the civil rights of disabled people. It applies to both
the hospital clients and hospital staff. Privacy issues for persons who are positive
for human immunodeficiency virus (HIV) have been one issue in relationship to
getting information when hospital staff have been exposed to unclean sticks. The
ADA allows the infected client the right to choose whether or not to disclose that
information.
13. C. Knowing what to do to prevent injury is a part of the standards of care for
nurses to follow. Safety guidelines dictate raising the side rails, staying with the
client, lowering the bed, and observing the client until the environment is safe. As
a nurse, these activities are known as basic safety measures that prevent injuries,
and to not perform them is not acting in a safe manner. Negligence is conduct that
falls below the standard of care that protects others against unreasonable risk of
harm.
14. D. Your signature as a witness only states that the person signing the form was
the person who was listed in the procedure.
15. A. A guardian has been appointed by a court and has full legal rights to choose
management of care.
16. A. Anyone, at any age, can be treated without parental permission for an STD
infection. The client is “advised” to contact sexual partners but is not “required”
to give names. Permission from parents is not needed, based upon current privacy
laws.
17. B. The nurse is responsible for clarifying all orders that are illegible,
unreasonable, unsafe, or incorrect. The failure of the nurse to question the
physician about an order creates an area of liability on the nurse’s part because
this is perceived as a medical action and not the role of the nurse to write orders.
Some RNs do have prescriptive privileges based upon advanced degrees and
certification. Therefore the nurse who cannot correct the order must document
that the physician was called and clarification or a new order was given to correct
the unclear or illegible one that was currently on the chart. Phone calls, follow-up,
and lack of follow-up by the physician should also be documented if there is a
problem with getting the information in a timely manner. The nurse must show
the sequence of events of a situation in a clear manner if there is any conflict or
question about any orders or procedures that were not appropriate. Assessments
and documentation of the client’s status should also be included if there is a
potential risk for harm present. Contact of the staff’s chain of command should
also be specifically stated for the proof of the responsibilities being followed
according to hospital policy.
18. A. If heat is applied for 1 hour or more, blood flow is reduced by reflex
vasoconstriction. Vasoconstriction is the opposite of the desired effect of heat
application
19. A. In the anger stage of Kubler-Ross’s stages of dying, the individual resists the
loss and may strike out at everyone and everything, in this case, the nurse.
20. C. Grief is manifested in a variety of ways that are unique to an individual and
based on personal experiences, cultural expectations, and spiritual beliefs. The
sequencing of stages or behaviors of grief may occur in order, they may be
skipped, or they may reoccur. The amount of time to resolve grief also varies
among individuals.
21. D. It is helpful for the nurse to find simple care activities for the family to
perform, such as feeding the client, washing the client’s face, combing hair, and
filling out the client’s menu. This helps the family demonstrate their caring for the
client and enables the client to feel their closeness and concern. a. Older adults
often become particularly lonely at night and may feel more secure if a family
member stays at the bedside during the night. The nurse should allow visitors to
remain with dying clients at any time if the client wants them. It is up to the
family to determine if they are feeling overwhelmed, not the nurse.
22. A. Spending time to let clients share their life experiences enables the nurse to
know clients better. Knowing clients then facilitates choice of therapies that
promote client decision making and autonomy, thus promoting a client’s self-
esteem and dignity.
23. D.
24. D.
25. C. The body of the deceased should be prepared before the family comes in to
view and say their goodbyes. This includes removing all equipment, tubes,
supplies, and dirty linens according to protocol, bathing the client, applying clean
sheets, and removing trash from the room.
26. B. The goal of palliative care is the prevention, relief, reduction, or soothing of
symptoms of disease or disorders without effecting a cure.
27. A.
28. B.
29. B.
30. B.
31. A.
32. D.
33. D.
34. A.
35. B.
36. C.
37. A.
38. C.
39. D.
40. B.
41. D.
42. C.
43. C.
44. D.
45. A. Cultural awareness is an in-depth examination of one’s own background,
recognizing biases and prejudices and assumptions about other people.
46. B. Cultural competence is the process of acquiring specific knowledge, skills, and
attitudes that ensure delivery of culturally congruent care.
47. A.
48. A.
49. D.
50. C. Disparities in health outcomes between the rich and the poor illustrate the
influence of socioeconomic factors in morbidity and mortality. Social factors such
as poverty and lack of universal medical insurance compromise the health status
of the poor and unemployed.
51. A. Nurses need not assume that pain relief is equally valued across groups.
Cultural pain may be suffered by a client whose valued way of life is disregarded
by practitioners.
52. D. The dominant value in American society of individual autonomy and self-
determination may be in direct conflict with diverse groups. Advance directives,
informed consent, and consent for hospice are examples of mandates that my
violate client’s values.
53. D. Justice refers to fairness. Health care providers agree to strive for justice in
health care. The term often is used during discussions about resources. Decisions
about who should receive available organs are always difficult.
54. B. the ANA has established widely accepted codes that professional nurses
attempt to follow.
55. C. Nurses strengthen their ability to advocate for a client when nurses are able to
identify personal values and then accurately identify the values of the client and
articulate the client’s point of view.
56. D. A utilitarian system of ethics proposes that the value of something is
determined by its usefulness.
57. A. The ethic of care explores the notion of care as a central activity of human
behavior. Those who write about the ethics of care advocate a more female biased
theory that is based on understanding relationships, especially personal narratives.
58. C. When ethical dilemmas arise, the nurses point of view unique and critical. The
nurse usually interacts with clients over longer time intervals than do other
disciples.
59. B. Each step in the processing of an ethical dilemma resembles steps in critical
thinking. The nurse begins by gathering information and moves through
assessment, identification of the problem, planning, implementation, and
evaluation.
60. A.
61. D.
62. B.
63. B.
64. D.
65. B. Madeleine Leininger developed the theory on transcultural theory based on her
observations on the behavior of selected people within a culture.

1. Ms. Caputo is newly-promoted to a patient care manager position.


She updates her knowledge on the theories in management and
leadership in order to become effective in her new role. She learns that
some managers have low concern for services and high concern for
staff. Which style of management refers to this?

A. Organization Man
B. Impoverished Management
C. Country Club Management
D. Team Management

2. Her former manager demonstrated passion for serving her staff


rather than being served. She takes time to listen, prefers to be a
teacher first before being a leader, which is characteristic of

A. Transformational leader
B. Transactional leader
C. Servant leader
D. Charismatic leader

3. On the other hand, Ms. Caputo notices that the Chief Nurse Executive
has charismatic leadership style. Which of the following behaviors best
describes this style?

A. Possesses inspirational quality that makes followers gets attracted of him and
regards him with reverence
B. Acts as he does because he expects that his behavior will yield positive
results
C. Uses visioning as the core of his leadership
D. Matches his leadership style to the situation at hand.

4. Which of the following conclusions of Ms. Caputo about leadership


characteristics is TRUE?

A. There is a high correlation between the communication skills of a leader and


the ability to get the job done.
B. A manager is effective when he has the ability to plan well.
C. Assessment of personal traits is a reliable tool for predicting a manager’s
potential.
D. There is good evidence that certain personal qualities favor success in
managerial role.

5. She reads about Path Goal theory. Which of the following behaviors
is manifested by the leader who uses this theory?

A. Recognizes staff for going beyond expectations by giving them citations


B. Challenges the staff to take individual accountability for their own practice
C. Admonishes staff for being laggards.
D. Reminds staff about the sanctions for non performance.
6. One leadership theory states that “leaders are born and not made,”
which refers to which of the following theories?

A. Trait
B. Charismatic
C. Great Man
D. Situational

7. She came across a theory which states that the leadership style is
effective dependent on the situation. Which of the following styles best
fits a situation when the followers are self-directed, experts and are
matured individuals?

A. Democratic
B. Authoritarian
C. Laissez faire
D. Bureaucratic

8. She surfs the internet for more information about leadership styles.
She reads about shared leadership as a practice in some magnet
hospitals. Which of the following describes this style of leadership?

A. Leadership behavior is generally determined by the relationship between the


leader’s personality and the specific situation
B. Leaders believe that people are basically good and need not be closely
controlled
C. Leaders rely heavily on visioning and inspire members to achieve results
D. Leadership is shared at the point of care.

9. Ms. Caputo learns that some leaders are transactional leaders. Which
of the following does NOT characterize a transactional leader?
A. Focuses on management tasks
B. Is a caretaker
C. Uses trade-offs to meet goals
D. Inspires others with vision

10. She finds out that some managers have benevolent-authoritative


style of management. Which of the following behaviors will she exhibit
most likely?

A. Have condescending trust and confidence in their subordinates


B. Gives economic or ego awards
C. Communicates downward to the staff
D. Allows decision making among subordinates

11. Henry is a Unit Manager I the Medical Unit. He is not satisfied with
the way things are going in his unit. Patient satisfaction rate is 60% for
two consecutive months and staff morale is at its lowest. He decides to
plan and initiate changes that will push for a turnaround in the
condition of the unit. Which of the following actions is a priority for
Henry?

A. Call for a staff meeting and take this up in the agenda.


B. Seek help from her manager.
C. Develop a strategic action on how to deal with these concerns.
D. Ignore the issues since these will be resolved naturally.

12. He knows that there are external forces that influence changes in
his unit. Which of the following is NOT an external force?

A. Memo from the CEO to cut down on electrical consumption


B. Demands of the labor sector to increase wages
C. Low morale of staff in his unit
D. Exacting regulatory and accreditation standards
13. After discussing the possible effects of the low patient satisfaction
rate, the staff started to list down possible strategies to solve the
problems head-on. Should they decide to vote on the best change
strategy, which of the following strategies is referred to this?

A. Collaboration
B. Majority rule
C. Dominance
D. Compromise

14. One staff suggests that they review the pattern of nursing care that
they are using, which is described as a:

A. job description
B. system used to deliver care
C. manual of procedure
D. rules to be followed

15. Which of the following is TRUE about functional nursing?

A. Concentrates on tasks and activities


B. Emphasizes use of group collaboration
C. One-to-one nurse-patient ratio
D. Provides continuous, coordinated and comprehensive nursing services

16. Functional nursing has some advantages, which one is an


EXCEPTION?

A. Psychological and sociological needs are emphasized.


B. Great control of work activities.
C. Most economical way of delivering nursing services.
D. Workers feel secure in dependent role
17. He raised the issue on giving priority to patient needs. Which of the
following offers the best way for setting priority?

A. Assessing nursing needs and problems


B. Giving instructions on how nursing care needs are to be met
C. Controlling and evaluating the delivery of nursing care
D. Assigning safe nurse: patient ratio

18. Which of the following is the best guarantee that the patient’s
priority needs are met?

A. Checking with the relative of the patient


B. Preparing a nursing care plan in collaboration with the patient
C. Consulting with the physician
D. Coordinating with other members of the team

19. When Henry uses team nursing as a care delivery system, he and
his team need to assess the priority of care for a group of patients,
which of the following should be a priority?

A. Each patient as listed on the worksheet


B. Patients who needs least care
C. Medications and treatments required for all patients
D. Patients who need the most care

20. He is hopeful that his unit will make a big turnaround in the
succeeding months. Which of the following actions of
Henry demonstrates that he has reached the third stage of change?

A. Wonders why things are not what it used to be


B. Finds solutions to the problems
C. Integrate the solutions to his day-to-day activities
D. Selects the best change strategy
21. Joey is a newly-appointed nurse manager of The Holy Spirit Medical
Center, a tertiary hospital located within the heart of the metropolis. He
thinks of scheduling planning workshop with his staff in order to ensure
an effective and efficient management of the department. Should he
decide to conduct a strategic planning workshop, which of the following
is NOT a characteristic of this activity?

A. Long-term goal-setting
B. Extends to 3-5 years in the future
C. Focuses on routine tasks
D. Determines directions of the organization

22. Which of the following statements refer to the vision of the


hospital?

A. The Holy Spirit Medical Center is a trendsetter in tertiary health care in the
next five year
B. The officers and staff of The Holy Spirit Medical Center believe in the unique
nature of the human person
C. All the nurses shall undergo continuing competency training program.
D. The Holy Spirit Medical Center aims to provide a patient-centered care in a
total healing environment.

23. The statement, “The Holy Spirit Medical Center aims to provide
patient-centered care in a total healing environment” refers to which of
the following?

A. Vision
B. Goal
C. Philosophy
D. Mission
24. Joey plans to revisit the organizational chart of the department. He
plans to create a new position of a Patient Educator who has a
coordinating relationship with the head nurse in the unit. Which of the
following will likely depict this organizational relationship?

A. Box
B. Solid line
C. Broken line
D. Dotted line

25. He likewise stresses the need for all the employees to follow orders
and instructions from him and not from anyone else. Which of the
following principles does he refer to?

A. Scalar chain
B. Discipline
C. Unity of command
D. Order

26. Joey orients his staff on the patterns of reporting relationship


throughout the organization. Which of the following principles refer to
this?

A. Span of control
B. Hierarchy
C. Esprit d’ corps
D. Unity of direction

27. He emphasizes to the team that they need to put their efforts
together towards the attainment of the goals of the program. Which of
the following principles refers to this?
A. Span of control
B. Unity of direction
C. Unity of command
D. Command responsibility

28. Joey stresses the importance of promoting ‘esprit d corps’ among


the members of the unit. Which of the following remarks of the staff
indicates that they understand what he pointed out?

A. “Let’s work together in harmony; we need to be supportive of one another”


B. “In order that we achieve the same results; we must all follow the directives
of Julius and not from other managers.”
C. “We will ensure that all the resources we need are available when needed.”
D. “We need to put our efforts together in order to raise the bar of excellence in
the care we provide to all our patients.”

29. He discusses the goal of the department. Which of the following


statements is a goal?

A. Increase the patient satisfaction rate


B. Eliminate the incidence of delayed administration of medications
C. Establish rapport with patients.
D. Reduce response time to two minutes.

30. He wants to influence the customary way of thinking and behaving


that is shared by the members of the department. Which of the
following terms refer to this?

A. Organizational chart
B. Cultural network
C. Organizational structure
D. Organizational culture
31. He asserts the importance of promoting a positive organizational
culture in their unit. Which of the following behaviors indicate that this
is attained by the group?

A. Proactive and caring with one another


B. Competitive and perfectionist
C. Powerful and oppositional
D. Obedient and uncomplaining

32. Stephanie is a new Staff Educator of a private tertiary hospital. She


conducts orientation among new staff nurses in her department.
Joseph, one of the new staff nurses, wants to understand the channel
of communication, span of control and lines of communication. Which of
the following will provide this information?

A. Organizational structure
B. Policy
C. Job description
D. Manual of procedures

33. Stephanie is often seen interacting with the medical intern during
coffee breaks and after duty hours. What type of organizational
structure is this?

A. Formal
B. Informal
C. Staff
D. Line

34. She takes pride in saying that the hospital has a decentralized
structure. Which of the following is NOT compatible with this type of
model?
A. Flat organization
B. Participatory approach
C. Shared governance
D. Tall organization

35. Centralized organizations have some advantages. Which of the


following statements are TRUE?

1. Highly cost-effective
2. Makes management easier
3. Reflects the interest of the worker
4. Allows quick decisions or actions.

A. 1 & 2
B. 2 & 4
C. 2, 3& 4
D. 1, 2, & 4

36. Stephanie delegates effectively if she has authority to act, which is


BEST defined as:

A. having responsibility to direct others


B. being accountable to the organization
C. having legitimate right to act
D. telling others what to do

37. Regardless of the size of a work group, enough staff must be


available at all times to accomplish certain purposes. Which of these
purposes is NOT included?

A. Meet the needs of patients


B. Provide a pair of hands to other units as needed
C. Cover all time periods adequately.
D. Allow for growth and development of nursing staff.

38. Which of the following guidelines should be least considered in


formulating objectives for nursing care?

A. Written nursing care plan


B. Holistic approach
C. Prescribed standards
D. Staff preferences

39. Stephanie considers shifting to transformational leadership. Which


of the following statements best describes this type of leadership?

A. Uses visioning as the essence of leadership.


B. Serves the followers rather than being served.
C. Maintains full trust and confidence in the subordinates
D. Possesses innate charisma that makes others feel good in his presence.

40. As a manager, she focuses her energy on both the quality of


services rendered to the patients as well as the welfare of the staff of
her unit. Which of the following management styles does she adopt?

A. Country club management


B. Organization man management
C. Team management
D. Authority-obedience management

Answers and Rationale

Answers and rationale are given below for this exam. Check your correct
answers and read the rationales for additional learning. Tell us your scores on
the comments section.
1. Answer: C. Country Club Management

Country club management style puts concern for the staff as number one
priority at the expense of the delivery of services. He/she runs the department
just like a country club where everyone is happy including the manager.

2. Answer: C. Servant leader

Servant leaders are open-minded, listen deeply, try to fully understand others
and not being judgmental

3. Answer: A. Possesses inspirational quality that makes followers gets


attracted of him and regards him with reverence

Charismatic leaders make the followers feel at ease in their presence. They feel
that they are in good hands whenever the leader is around.

4. Answer: C. Assessment of personal traits is a reliable tool for


predicting a manager’s potential.

It is not conclusive that certain qualities of a person would make him become a
good manager. It can only predict a manager’s potential of becoming a good
one.

5. Answer: A. Recognizes staff for going beyond expectations by giving


them citations

Path Goal theory according to House and associates rewards good performance
so that others would do the same

6. Answer: C. Great Man


Leaders become leaders because of their birth right. This is also called Genetic
theory or the Aristotelian theory

7. Answer: C. Laissez faire

Laissez faire leadership is preferred when the followers know what to do and are
experts in the field. This leadership style is relationship-oriented rather than
task-centered.

8. Answer: D. Leadership is shared at the point of care.

Shared governance allows the staff nurses to have the authority, responsibility
and accountability for their own practice.

9. Answer: D. Inspires others with vision

Inspires others with a vision is characteristic of a transformational leader. He is


focused more on the day-to-day operations of the department/unit.

10. Answer: A. Have condescending trust and confidence in their


subordinates

Benevolent-authoritative managers pretentiously show their trust and


confidence to their followers

11. Answer: A. Call for a staff meeting and take this up in the agenda.

This will allow for the participation of every staff in the unit. If they contribute to
the solutions of the problem, they will own the solutions; hence the chance for
compliance would be greater.

12. Answer: C. Low morale of staff in his unit


Low morale of staff is an internal factor that affects only the unit. All the rest of
the options emanate from the top executive or from outside the institution.

13. Answer: B. Majority rule

Majority rule involves dividing the house and the highest vote wins. 1/2 + 1 is a
majority.

14. Answer: B. system used to deliver care

A system used to deliver care. In the 70’s it was termed as methods of patient
assignment; in the early 80’s it was called modalities of patient care then
patterns of nursing care in the 90’s until recently authors called it nursing care
systems.

15. Answer: A. Concentrates on tasks and activities

Functional nursing is focused on tasks and activities and not on the holistic care
of the patients

16. Answer: A. Psychological and sociological needs are emphasized.

When the functional method is used, the psychological and sociological needs of
the patients are neglected; the patients are regarded as ‘tasks to be done ‘

17. Answer: A. Assessing nursing needs and problems

This option follows the framework of the nursing process at the same time
applies the management process of planning, organizing, directing and
controlling

18. Answer: B. Preparing a nursing care plan in collaboration with the


patient
The best source of information about the priority needs of the patient is the
patient himself. Hence using a nursing care plan based on his expressed priority
needs would ensure meeting his needs effectively.

19. Answer: D. Patients who need the most care

In setting priorities for a group of patients, those who need the most care
should be number-one priority to ensure that their critical needs are met
adequately. The needs of other patients who need less care ca be attended to
later or even delegated to assistive personnel according to rules on delegation.

20. Answer: C. Integrate the solutions to his day-to-day activities

Integrate the solutions to his day-to-day activities is expected to happen during


the third stage of change when the change agent incorporate the selected
solutions to his system and begins to create a change.

21. Answer: C. Focuses on routine tasks

Strategic planning involves options A, B and D except C which is attributed to


operational planning

22. Answer: A. The Holy Spirit Medical Center is a trendsetter in tertiary


health care in the next five years

A vision refers to what the institution wants to become within a particular period
of time.

23. Answer: B. Goal

24. Answer: C. Broken line


This is a staff relationship hence it is depicted by a broken line in the
organizational structure

25. Answer: C. Unity of command

The principle of unity of command means that employees should receive orders
coming from only one manager and not from two managers. This averts the
possibility of sowing confusion among the members of the organization

26. Answer: B. Hierarchy

Hierarchy refers to the pattern of reporting or the formal line of authority in an


organizational structure.

27. Answer: B. Unity of direction

Unity of direction means having one goal or one objective for the team to
pursue; hence all members of the organization should put their efforts together
towards the attainment of their common goal or objective.

28. Answer: A. “Let’s work together in harmony; we need to be


supportive of one another”

The principle of ‘esprit d’ corps’ refers to promoting harmony in the workplace,


which is essential in maintaining a climate conducive to work.

29. Answer: A. Increase the patient satisfaction rate

Goal is a desired result towards which efforts are directed.

30. Answer: D. Organizational culture


An organizational culture refers to the way the members of the organization
think together and do things around them together. It’s their way of life in that
organization

31. Answer: A. Proactive and caring with one another

32. Answer: A. Organizational structure

Organizational structure provides information on the channel of authority, (i.e.,


who reports to whom and with what authority) the number of people who
directly reports to the various levels of hierarchy and the lines of communication
whether line or staff.

33. Answer: B. Informal

This is usually not published and oftentimes concealed.

34. Answer: D. Tall organization

Tall organizations are highly centralized organizations where decision making is


centered on one authority level.

35. Answer: A. 1 & 2

Centralized organizations are needs only a few managers hence they are less
expensive and easier to manage

36. Answer: C. having legitimate right to act

Authority is a legitimate or official right to give command. This is an officially


sanctioned responsibility

37. Answer: B. Provide a pair of hands to other units as needed


Providing a pair of hands for other units is not a purpose in doing an effective
staffing process. This is a function of a staffing coordinator at a centralized
model.

38. Answer: D. Staff preferences

Staff preferences should be the least priority in formulating objectives of


nursing care. Individual preferences should be subordinate to the interest of the
patients.

39. Answer: A. Uses visioning as the essence of leadership.

Transformational leadership relies heavily on visioning as the core of leadership.

40. Answer: C. Team management

Team management has a high concern for services and high concern for staff.

Prioritization

1. A 16-year old patient with cystic fibrosis is admitted with increased


shortness of breath and possible pneumonia. Which nursing activity is
most important to include in the patient’s care?

A. Perform postural drainage and chest physiotherapy every 4 hours


B. Allow the patient to decide whether she needs aerosolized medications
C. Place the patient in a private room to decrease the risk of further infection
D. Plan activities to allow at least 8 hours of uninterrupted sleep

2. A patient with a pulmonary embolus is receiving anticoagulation with


IV heparin. What instructions would you give the nursing assistant who
will help the patient with activities of daily living? Select all that apply.
A. Use a lift sheet when moving and positioning the patient in bed
B. Use an electric razor when shaving the patient each day
C. Use a soft-bristled toothbrush or tooth sponge for oral care
D. Use a rectal thermometer to obtain a more accurate body temperature
E. Be sure the patient’s footwear has a firm sole when the patient ambulates

3. A patient with acute respiratory distress syndrome (ARDS) is


receiving oxygen by a nonrebreather mask, but arterial blood gas
measurements still show poor oxygenation. As the nurse responsible
for this patient’s care, you would anticipate a physician order for what
action?

A. Perform endotracheal intubation and initiate mechanical ventilation


B. Immediately begin continuous positive airway pressure (CPAP) via the
patient’s nose and mouth
C. Administer furosemide (Lasix) 100 mg IV push stat
D. Call a code for respiratory arrest

4. A patient with chronic obstructive pulmonary disease (COPD). Which


intervention for airway management should you delegate to a nursing
assistant (PCT)?

A. Assisting the patient to sit up on the side of the bed


B. Instructing the patient to cough effectively
C. Teaching the patient to use incentive spirometry
D. Auscultation of breath sounds every 4 hours

5. A patient with sleep apnea has a nursing diagnosis of Sleep


Deprivation related to disrupted sleep cycle. Which action should you
delegate to the nursing assistant (PCT)?

A. Discuss weight-loss strategies such as diet and exercise with the patient
B. Teach the patient how to set up the BiPAP machine before sleeping
C. Remind the patient to sleep on his side instead of his back.
D. Administer modafinil (Provigil) to promote daytime wakefulness

6. After change of shift, you are assigned to care for the following
patients. Which patient should you assess first?

A. A 60-year old patient on a ventilator for whom a sterile sputum specimen


must be sent to the lab
B. A 55-year old with COPD and a pulse oximetry reading from the previous
shift of 90% saturation
C. A 70-year old with pneumonia who needs to be started on intravenous
(IV) antibiotics
D. A 50-year old with asthma who complains of shortness of breath after using
a bronchodilator

7. After the respiratory therapist performs suctioning on a patient who


is intubated, the nursing assistant measures vital signs for the patient.
Which vital sign value should the nursing assistant report to the RN
immediately?

A. Heart rate of 98 beats/min


B. Respiratory rate of 24 breaths/min
C. Blood pressure of 168/90 mm Hg
D. Tympanic temperature of 101.4 F (38.6 C)

8. An experienced LPN, under the supervision of the team leader RN, is


providing nursing care for a patient with a respiratory problem. Which
actions are appropriate to the scope of practice of an experienced
LPN? Select all that apply.

A. Auscultate breath sounds


B. Administer medications via metered-dose inhaler (MDI)
C. Complete in-depth admission assessment
D. Initiate the nursing care plan
E. Evaluate the patient’s technique for using MDI’s

9. The charge nurse is making assignments for the next shift. Which
patient should be assigned to the fairly new nurse (6 months
experience) pulled from the surgical unit to the medical unit?

A. A 58-year old on airborne precautions for tuberculosis (TB)


B. A 68-year old just returned from bronchoscopy and biopsy
C. A 72-year old who needs teaching about the use of incentive spirometry
D. A 69-year old with COPD who is ventilator dependent

10. The high-pressure alarm on a patient’s ventilator goes off. When


you enter the room to assess the patient, who has ARDS, the oxygen
saturation monitor reads 87% and the patient is struggling to sit up.
Which action should you take next?

A. Reassure the patient that the ventilator will do the work of breathing for him
B. Manually ventilate the patient while assessing possible reasons for the high-
pressure alarm
C. Increase the fraction of inspired oxygen on the ventilator to 100% in
preparation for endotracheal suctioning
D. Insert an oral airway to prevent the patient from biting on the endotracheal
tube

11. The nursing assistant tells you that a patient who is receiving
oxygen at a flow rate of 6 L/min by nasal cannula is complaining of
nasal passage discomfort. What intervention should you suggest to
improve the patient’s comfort for this problem?

A. Suggest that the patient’s oxygen be humidified


B. Suggest that a simple face mask be used instead of a nasal cannula.
C. Suggest that the patient be provided with an extra pillow
D. Suggest that the patient sit up in a chair at the bedside

12. The patient with COPD has a nursing diagnosis of Ineffective


Breathing Pattern. Which is an appropriate action to delegate to the
experienced LPN under your supervision?

A. Observe how well the patient performs pursed-lip breathing


B. Plan a nursing care regimen that gradually increases activity intolerance
C. Assist the patient with basic activities of daily living
D. Consult with the physical therapy department about reconditioning exercises

13. The patient with COPD tells the nursing assistant that he did not get
his annual flu shot this year and has not had a pneumonia vaccination.
You would be sure to instruct the nursing assistant to report which of
these?

A. Blood pressure of 152/84 mm Hg


B. Respiratory rate of 27 breaths/min
C. Heart rate of 92 beats/min
D. Oral temperature of 101.2 F (38.4C)

14. To improve respiratory status, which medication should you be


prepared to administer to the newborn infant with RDS?

A. Theophylline (Theolair, Theochron)


B. Surfactant (Exosurf)
C. Dexamethasone (Decadron)
D. Albuterol (Proventil)

15. When a patient with TB is being prepared for discharge, which


statement by the patient indicates the need for further teaching?
A. “Everyone in my family needs to go and see the doctor for TB testing.”
B. “I will continue to take my isoniazid until I am feeling completely well.”
C. “I will cover my mouth and nose when I sneeze or cough and put my used
tissues in a plastic bag.”
D. “I will change my diet to include more foods rich in iron, protein, and vitamin
C.”

16. When assessing a 22-year old patient who required


emergency surgeryand multiple transfusion 3 days ago, you find that
the patient looks anxious and has labored respirations at the rate of 38
breaths/min. The oxygen saturation is 90% with the oxygen delivery at
6 L/min via nasal cannula. Which action is most appropriate?

A. Increase the flow rate on the oxygen to 10 L/min and reassess the patient
after about 10 minutes
B. Assist the patient in using the incentive spirometer and splint his chest with a
pillow while he coughs
C. Administer the ordered morphine sulfate to the patient to decrease
his anxiety and reduce the hyperventilation
D. Switch the patient to a nonrebreather mask at 95% to 100% oxygen and call
the physician to discuss the patient’s status.

17. Which intervention for a patient with a pulmonary embolus could be


delegated to the LPN on your patient care team?

A. Evaluating the patient’s complaint of chest pain


B. Monitoring laboratory values for changes in oxygenation
C. Assessing for symptoms of respiratory failure
D. Auscultating the lungs for crackles

18. Which of these medication orders for a patient with a pulmonary


embolism is more important to clarify with the prescribing physician
before administration?
A. Warfarin (Coumadin) 1.0 mg by mouth (PO)
B. Morphine sulfate 2 to 4 mg IV
C. Cephalexin (Keflex) 250 mg PO
D. Heparin infusion at 900 units/hr

19. You are a team leader RN working with a student nurse. The
student nurse is to teach a patient how to use and MDI without a
spacer. Put in correct order the steps that the student nurse should
teach the patient.

A. Remove the inhaler cap and shake the inhaler


B. Open your mouth and place the mouthpiece 1 to 2 inches away
C. Tilt your head back and breathe out fully
D. Hold your breath for at least 10 seconds
E. Press down firmly on the canister and breathe deeply through your mouth
F. Wait at least 1 minute between puffs.

20. You are acting as preceptor for a newly graduated RN during her
second week of orientation. You would assign the new RN under your
supervision to provide care to which patients? Select all that apply.

A. A 38-year old with moderate persistent asthma awaiting discharge


B. A 63-year old with a tracheostomy needing tracheostomy care every shift.
C. A 56-year old with lung cancer who has just undergone left lower lobectomy
D. A 49-year old just admitted with a new diagnosis of esophageal cancer.

Answers and Rationale

1. Answer: A. Perform postural drainage and chest physiotherapy every


4 hours

Airway clearance techniques are critical for patients with cystic fibrosis and
should take priority over the other activities. Although allowing more
independent decision making is important for adolescents, the physiologic need
for improved respiratory function takes precedence at this time. A private room
may be desirable for the patient but is not necessary. With increased shortness
of breath, it will be more important that the patient have frequent respiratory
treatments than 8 hours of sleep.

2. Answers: A, B, C, and E.

While a patient is receiving anticoagulation therapy, it is important to avoid


trauma to the rectal tissue, which could cause bleeding (e.g., avoid rectal
thermometers and enemas). All of the other instructions are appropriate to the
care of a patient receiving anticoagulants.

3. Answer: A. Perform endotracheal intubation and initiate mechanical


ventilation

A non-rebreather mask can deliver nearly 100% oxygen. When the patient’s
oxygenation status does not improve adequately in response to delivery of
oxygen at this high concentration, refractory hypoxemia is present. Usually at
this stage, the patient is working very hard to breathe and may go into
respiratory arrest unless health care providers intervene by providing intubation
and mechanical ventilation to decrease the patient’s work of breathing.

4. Answer: A. Assisting the patient to sit up on the side of the bed

Assisting patients with positioning and activities of daily living is within the
educational preparation and scope of practice of a nursing assistant. Teaching,
instructing, and assessing patients all require additional education and skills and
are more appropriate for a licensed nurse.

5. Answer: C. Remind the patient to sleep on his side instead of his


back.
The nursing assistant can remind patients about actions that have already been
taught by the nurse and are part of the patient’s plan of care. Discussing and
teaching require additional education and training. These actions are within the
scope of practice of the RN. The RN can delegate administration of medication
to an LPN/LVN.

6. Answer: D. A 50-year old with asthma who complains of shortness of


breath after using a bronchodilator

The patient with asthma did not achieve relief from shortness of breath after
using the bronchodilator and is at risk for respiratory complications. This
patient’s needs are urgent. The other patients need to be assessed as soon as
possible, but none of their situations are urgent. in COPD patients pulse
oximetry oxygen saturations of more than 90% are acceptable.

7. Answer: D. Tympanic temperature of 101.4 F (38.6 C)

Infections are always a threat for the patient receiving mechanical ventilation.
The endotracheal tube bypasses the body’s normal air-filtering mechanisms and
provides a direct access route for bacteria or viruses to the lower part of
the respiratory system.

8. Answers: A and B.

The experienced LPN is capable of gathering data and making observations,


including noting breath sounds and performing pulse oximetry. Administering
medications, such as those delivered via MDIs, is within the scope of practice of
the LPN. Independently completing the admission assessment, initiating the
nursing care plan, and evaluating a patient’s abilities require additional
education and skills. These actions are within the scope of practice of the
professional RN.
9. Answer: C. A 72-year old who needs teaching about the use of
incentive spirometry

Many surgical patients are taught about coughing, deep breathing, and use of
incentive spirometry preoperatively. To care for the patient with TB in isolation,
the nurse must be fitted for a high-efficiency particulate air (HEPA) respirator
mask. The bronchoscopy patient needs specialized procedure, and the
ventilator-dependent patient needs a nurse who is familiar with ventilator care.
Both of these patients need experienced nurses.

10. Answer: B. Manually ventilate the patient while assessing possible


reasons for the high-pressure alarm

Manual ventilation of the patient will allow you to deliver an FiO2 of 100% to the
patient while you attempt to determine the cause of the high-pressure alarm.
The patient may need reassurance, suctioning, and/or insertion of an oral
airway, but the first step should be assessment of the reason for the high-
pressure alarm and resolution of the hypoxemia.

11. Answer: A. Suggest that the patient’s oxygen be humidified

When the oxygen flow rate is higher than 4 L/min, the mucous membranes can
be dried out. The best treatment is to add humidification to the
oxygen delivery system. Application of a water-soluble jelly to the nares can
also help decrease mucosal irritation. None of the other options will treat the
problem.

12. Answer: A. Observe how well the patient performs pursed-lip


breathing

Experienced LPNs/LVNs can use observation of patients to gather data


regarding how well patients perform interventions that have already been
taught. Assisting patients with ADLs is more appropriately delegated to a
nursing assistant. Planning and consulting require additional education and
skills, appropriate to an RN.

13. Answer: D. Oral temperature of 101.2 F (38.4C)

A patient who did not have the pneumonia vaccination or flu shot is at increased
risk for developing pneumonia or influenza. An elevated temperature indicates
some form of infection, which may be respiratory in origin. All of the other vital
sign values are slightly elevated but are not a cause for immediate concern.

14. Answer: B. Surfactant (Exosurf)

Exosurf neonatal is a form of synthetic surfactant. An infant with RDS may be


given two to four doses during the first 24 to 48 hours after birth. It improves
respiratory status, and research has show a significant decrease in the incidence
of pneumothorax when it is administered.

15. Answer: B. “I will continue to take my isoniazid until I am feeling


completely well.”

Patients taking isoniazid must continue the drug for 6 months. The other 3
statements are accurate and indicate understanding of TB. Family members
should be tested because of their repeated exposure to the patient. Covering
the nose and mouth when sneezing or coughing, and placing the tissues in
plastic bags help prevent transmission of the causative organism. The dietary
changes are recommended for patients with TB.

16. Answer: D. Switch the patient to a nonrebreather mask at 95% to


100% oxygen and call the physician to discuss the patient’s status.

The patient’s history and symptoms suggest the development of ARDS, which
will require intubation and mechanical ventilation. The maximum
oxygen delivery with a nasal cannula is an Fio2 of 44%. This is achieved with
the oxygen flow at 6 L/min, so increasing the flow to 10 L/min will not be
helpful. Helping the patient to cough and deep breathe will not improve the lung
stiffness that is causing his respiratory distress. Morphine sulfate will only
decrease the respiratory drive and further contribute to his hypoxemia.

17. Answer: D. Auscultating the lungs for crackles.

An LPN who has been trained to auscultate lungs sounds can gather data by
routine assessment and observation, under supervision of an RN. Independently
evaluating patients, assessing for symptoms of respiratory failure, and
monitoring and interpreting laboratory values require additional education and
skill, appropriate to the scope of practice of the RN.

18. Answer: A. Warfarin (Coumadin) 1.0 mg by mouth (PO).

Medication safety guidelines indicate that use of a trailing zero is not


appropriate when writing medication orders because the order can easily be
mistaken for a larger dose, such as 10 mg. The order should be clarified before
administration. The other orders are appropriate, based on the patient’s
diagnosis.

19. Answer: A, C, B, E, D, F.

Before each use, the cap is removed and the inhaler is shaken according to the
instructions in the package insert. Next the patient should tilt the head back and
breathe out completely. As the patient begins to breathe in deeply through the
mouth, the canister should be pressed down to release one puff (dose) of the
medication. The patient should continue to breathe in slowly over 3 to 5
seconds and then hold the breath for at least 10 seconds to allow the
medication to reach deep into the lungs. The patient should wait for at least 1
minute between puffs from the inhaler.

20. Answers. A and B.


The new RN is at an early point in her orientation. The most appropriate
patients to assign to her are those in stable condition who require routine care.
The patient with the lobectomy will require the care of a more experienced
nurse, who will perform frequent assessments and monitoring for postoperative
complications. The patient admitted with newly diagnosed
esophageal cancer will also benefit from care by an experienced nurse. This
patient may have questions and needs a comprehensive admission assessment.
As the new nurse advances through her orientation, you will want to work with
her in providing care for these patients with more complex needs.

Research

1. What should be included in “scholarly literature”? Select all that


apply.

A. Research reports reported in primary sources only


B. Conceptual and theoretical literature from primary sources only
C. Published and unpublished reports of research
D. Primary and secondary sources

2. Reviews of the literature are conducted for PURPOSES OF RESEARCH


as well as for the CONSUMER OF RESEARCH. How are these reviews
similar? Select all that apply.

A. Amount of literature required to be reviewed


B. Degree of critical reading required
C. Importance of conceptual literature
D. Purpose of the review

3. What are characteristics of the literature review required for a


quantitative research study? Select all that apply.
A. The review is exhaustive and must include all studies conducted in the area
B. Doctoral dissertations and masters’ theses are excellent sources of
information
C. Computer-accessed materials are acceptable
D. Primary sources are not as important as secondary sources

4. Which of the following is an example of a primary source in a


research study?

A. A published commentary on the findings of another study


B. A doctoral dissertation that critiques all research in the area of attention
deficit disorder
C. A textbook of medical-surgical nursing
D. A journal article about a study that used large, previously unpublished
databases generated by the United States census

5. What is the best source to use when conducting a level I systematic


meta-analysis of the literature?

A. An electronic database
B. Doctoral dissertations
C. The Cochrane Statistical Methods
D. An electronic database and Doctoral dissertations

6. What is a characteristic of an audio recording of an unpublished


research study reported at a professional conference?

A. Databased literature
B. Secondary Sources
C. Are more difficult to analyze than written reports.
D. Are not useful because they are not published

7. What is the first step in the qualitative research process?


A. Data analysis
B. Sample
C. Review of literature
D. Study design

8. Which mode of clinical application for qualitative research is


considered to be the sharing of qualitative findings with the patient?

A. Insight or empathy
B. Anticipatory guidance
C. Assessment of status or progress
D. Coaching

9. Which research process steps may be noted in an article’s abstract?


Select all that apply.

A. Identifying the phenomenon


B. Research question study purpose
C. Literature review
D. Design
E. Sample
F. Legal-ethical issues
G. Data-collection procedure

10. What does a level-of-evidence model use to evaluate the strength of


a research study and its findings? Select all that apply.

A. Creativity
B. Quality
C. Quantity
D. Consistency
E. Efficiency
11. What are the critiquing criteria used to judge the worth of a
research study? Select all that apply.

A. Measures
B. Objectives
C. Standards
D. Effectiveness
E. Evaluation guides
F. Questions

12. Which statement best describes qualitative research? Select all that
apply.

A. Studies are conducted in natural settings.


B. Data are collected from a large number of subjects.
C. Data collected tend to be numeric.
D. The research design is systematic and subjective.

13. What does a critique of a research study always include? Select all
that apply.

A. Determining its strengths and weaknesses


B. Researching similar studies
C. Using critical reading skills
D. Explaining your own personal opinions

14. For which of the following research questions would qualitative


methods be most appropriate?

A. Which pain medications decrease the need for sleep medication in elderly
patients?
B. What is the meaning of health for migrant farm-worker women?
C. Under what conditions does a decubitus ulcer heal most quickly?
D. How does frequency of medication administration impact the degree
of painexperienced following knee replacement surgery?

15. Which of the following phrases would be found in a report of a


qualitative study?

A. “The hypothesis of this study is?”


B. “Perceived pain was measured using the Abbott pain scale?”
C. “The control group received no instruction?”
D. “Subjects were asked to relate their perceptions of pain?”

16. Which of the following phrases would be found in a report of a


quantitative study?

A. “A convenience sample was chosen?”


B. “The phenomenon studied was?”
C. “Data were analyzed and interpreted?”
D. “Researchers sought to explore the meaning of the hospital experience?”

17. Which of the following hypotheses are indicative of an experimental


research design? Select all that apply.

A. Frequent irrigation of Foley catheters will be positively related to urinary tract


infections.
B. The incidence of urinary tract infections will be greater in patients whose
Foley catheters are irrigated frequently than in those whose Foley catheters are
irrigated less frequently.
C. Frequent irrigation of Foley catheters is associated with urinary tract
infections.
D. The incidence of urinary tract infections will not differ between patients with
or without Foley catheters.
18. Which statements are part of the criteria used to judge the
soundness of a stated research question? Select all that apply.

A. A relationship between two or more variables


B. An operational definition of each variable
C. The nature of the population being tested
D. The possibility of empirical testing

19. Which criteria are used to determine testability of a hypothesis?


Select all that apply.

A. Use of quantifiable words such as greater than or less than


B. A hypothesis stated in such a way that it can be clearly supported or not
supported
C. The use of value-laden words in a hypothesis
D. Data-collection efforts that prove the validity of the hypothesis

20. What are the advantages to using directional hypotheses? Select all
that apply.

A. The indication of the use of a theory base to derive the hypothesis


B. The provision of a specific theoretical frame of reference
C. Ensurance that findings will be generalizable
D. The indication of a nonbiased selection of subjects

Answers and Rationale

1. Answer: C, D

2. Answer: B, C

3. Answer: B, C
4. Answer: D. A journal article about a study that used large, previously
unpublished databases generated by the United States census

This is a report of an original study, so it is the primary source of the study.

5. Answer: C. The Cochrane Statistical Methods

6. Answer: A. Databased literature

Audio and video recordings of research presentations are examples of


databased literature.

7. Answer: C. Review of literature

Review of literature is the 1st step in the qualitative research process. Data
analysis is the sixth step in the qualitative research process. Sampling is the
third step in the qualitative research process. The study design is the second
step in the qualitative research process.

8. Answer: B. Anticipatory guidance

Anticipatory guidance is the sharing of qualitative findings with the patient.


Other options are not considered to be the sharing of qualitative findings with
the patient.

9. Answer: A, B, D

10. Answer: B, C, D

11. Answer: A, C, E, F

12. Answer: A, D
13. Answer: A, C

14. Answer: B. What is the meaning of health for migrant farm-worker


women?

This question seeks to explore a phenomenon (health) for a specific population.

15. Answer: D. “Subjects were asked to relate their perceptions of


pain?”

Data collected were perceptions of pain, not numeric data. Other options are
found in a report of a quantitative study.

16. Answer: A. “A convenience sample was chosen?”

When a sample of convenience is chosen, the study is a quantitative study.


Qualitative studies explore phenomena. Data collected in qualitative studies are
“interpreted.” Qualitative studies explore the meaning of human experience.

17. Answer: B, D

18. Answer: A, C, D

19. Answer: A, B

Quantifiable words increase the testability of a hypothesis (A). The more clearly
the hypothesis is stated, the easier it will be to accept or reject it based on
study findings (B). Hypotheses should not have value-laden words (C). Data-
collection processes are not part of the criterion used to evaluate the testability
of hypotheses (D).

20. Answer: A, B
1. What is the purpose of grounded theory?

A. To support theoretical frameworks


B. To generate theory from data
C. To develop explanatory models
D. To find significant differences among groups of people

2. Why is it important to understand the philosophy underlying each


type of research?

A. Conclusions reached should be congruent with the research question.


B. The research method that best meets intended purpose of the study should
be used.
C. The paradigm of the method should be the same as that of the researcher.
D. The reader should understand the level of abstraction of the study.

3. Which conceptual analysis point of the framework for rigor used for
interpretive phenomenology refers to how the study findings will
continue to have meaning for the reader?

A. Resonance
B. Concreteness
C. Actualization
D. Openness

4. Which question will critique the sampling of a research project?

A. Is the strategy used for analysis compatible with the purpose of the study?
B. What is the projected significance of the work to nursing?
C. Are the informants who were chosen appropriate to inform the research?
D. What are the philosophic underpinnings of the research method?

5. Which question will critique the method of a research project?


A. Is the strategy used for analysis compatible with the purpose of the study?
B. What is the projected significance of the work to nursing?
C. Are the informants who were chosen appropriate to inform the research?
D. What are the philosophic underpinnings of the research method?

6. Which question will critique the purpose of a research project?

A. Is the strategy used for analysis compatible with the purpose of the study?
B. What is the projected significance of the work to nursing?
C. Are the informants who were chosen appropriate to inform the research?
D. What are the philosophic underpinnings of the research method?

7. Which question will critique the credibility of a research project?

A. Is the strategy used for analysis compatible with the purpose of the study?
B. Does the researcher document the research process?
C. Are the researcher’s conceptualizations true to the data?
D. Has adequate time been allowed to understand fully the phenomenon?

8. Which question will critique the auditability of a research project?

A. Is the strategy used for analysis compatible with the purpose of the study?
B. Does the researcher document the research process?
C. Are the researcher’s conceptualizations true to the data?
D. Has adequate time been allowed to fully understand the phenomenon?

9. Which question will critique the fittingness of a research project?

A. Is the strategy used for analysis compatible with the purpose of the study?
B. Does the researcher document the research process?
C. Are the researcher’s conceptualizations true to the data?
D. Has adequate time been allowed to fully understand the phenomenon?
10. What are the uses of qualitative research methods? Select all that
apply.

A. Guiding nursing practice


B. Studying the effects of nursing care on an outcome variable
C. Developing survey instruments
D. Developing nursing theory

11. What are scientific criteria appropriate for qualitative research?


Select all that apply.

A. Auditability
B. Credibility
C. Fittingness
D. Reliability

12. What are ethical concerns for qualitative researchers? Select all
that apply.

A. Because the study emerges over time, the researcher may not anticipate and
inform the participants of a potential threat.
B. To maintain a naturalistic environment for interviews, formal documents such
as consent forms are not used.
C. Because there are so few participants in a qualitative study, no participant
can opt out of the study.
D. Because the researcher and participant interact over a period of time,
relationships developed between them may change the focus of the interaction

13. Which of the following is most accurate regarding the grounded-


theory method?

A. Data are collected using an etic perspective.


B. It is a process of constructing human experience.
C. Secondary sources are sometimes used.
D. It is an inductive approach.

14. What is the term used for the coding and clustering of data to form
categories in the grounded-theory method?

A. Theoretical sampling
B. Constant-comparative method
C. Emic method
D. Metasynthesis

15. What is a characteristic of an intrinsic case study?

A. It yields a better understanding of each case.


B. It provides a foundation to challenge a generalization.
C. It does not include quantitative data.
D. It can scrutinize only uncomplicated phenomena.

16. What is a characteristic of metasynthesis?

A. It is useful for triangulating research.


B. It synthesizes critical masses of qualitative findings.
C. It leads to a higher reliability of research findings.
D. It cannot be conducted on historical or case study findings.

17. What is meant by the “fittingness” of a research study?

A. Truth of findings as judged by the participants


B. The appropriateness of the interview questions posed
C. Faithfulness to everyday reality of the participants
D. The adequacy of the coding system used

18. How can qualitative outcome analysis be used? Select all that apply.
A. To determine the reliability of intervention outcomes in a study
B. To confirm the applicability of clinical strategies
C. To develop interventions and then test those selected
D. To build theory

19. When critiquing a qualitative study, which of the following


questions are helpful in determining the study’s auditability? Select all
that apply.

A. Has adequate time been allowed to understand the phenomenon fully?


B. Can the reader follow the researcher’s thinking?
C. Are the results meaningful to individuals not involved in the research?
D. Does the researcher document the research process?

20. Which question is helpful in determining the study’s credibility?

A. Do the participants recognize the experience as their own?


B. What strategies were used to analyze the data?
C. How were human subjects protected?
D. Are the findings applicable outside the study situation?

Answers and Rationale

1. Answer: B. To generate theory from data

The grounded theory method refers to a qualitative approach of building theory


about a phenomenon about which little is known.

2. Answer: B. The research method that best meets intended purpose of


the study should be used.

Different research methods accomplish different goals and offer different types
and levels of evidence that inform practice.
3. Answer: C. Actualization

4. Answer: C. Are the informants who were chosen appropriate to


inform the research?

5. Answer: A. Is the strategy used for analysis compatible with the


purpose of the study?

6. Answer: B. What is the projected significance of the work to nursing?

7. Answer: D. Has adequate time been allowed to understand fully the


phenomenon?

8. Answer: B. Does the researcher document the research process?

9. Answer: A. Is the strategy used for analysis compatible with the


purpose of the study?

10. Answer: A, C, D

11. Answer: A, B, C

12. Answer: A, D

13. Answer: D. It is an inductive approach.

Data are collected using the emic perspective (A). The grounded-theory method
is a process of constructing theory from human experience (B). In grounded-
theory only primary sources (the participants) are used (C).

14. Answer: B. Constant-comparative method

15. Answer: A. It yields a better understanding of each case.


An intrinsic case study is undertaken to have a better understanding of the
case.

16. Answer: B. It synthesizes critical masses of qualitative findings.

17. Answer: C. Faithfulness to everyday reality of the participants

Credibility is the truth of findings as judged by the participants (A). Auditability


assists the reader to judge the appropriateness of the interview questions posed
(B). Auditability assists the reader to judge the adequacy of the coding system
used (D).

18. Answer: B, C, D

19. Answer: B, C

20. Answer: A. Do the participants recognize the experience as their


own?