Conceptual Foundations The Bridge Professional Nursing 6th Edition Friberg Creasia-Test Bank

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Conceptual Foundations The Bridge Professional Nursing 6th Edition Friberg Creasia-Test Bank

Chapter 02: Pathways of Nursing Education

 

MULTIPLE CHOICE

 

  1. A faculty member explains to students that one concern of the American Nurses Association’s 1965 position statement designating the baccalaureate degree (BSN) as the educational entry point for nursing is that
a. diploma programs remain the most popular educational program for nurses.
b. it is difficult to monitor other programs for congruency with BSN programs.
c. multiple educational paths create confusion for the public and the profession.
d. some states are creating different licensure exams for different pathways.

 

 

ANS:  C

The existence of multiple entry paths for nursing education is confusing both to the public and to aspiring nursing students, who may have difficulty understanding and comprehending the differences and what they mean.

Diploma programs have declined sharply in number, with only 47 programs remaining in the United States in 2013.

The ANA does not monitor different programs to evaluate congruency with BSN programs.

States are not creating different licensure examinations for graduates of different programs.

 

DIF:    Cognitive Level: Understand          REF:   22

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. A hospital-based nursing administrator is responsible for the diploma nursing program affiliated with that hospital. In deciding to keep the program open, the administrator develops changes that address a major historical concern with this type of program. In doing so, the administrator would most likely
a. arrange for faculty from the local college to teach science courses.
b. limit the hours students are expected to work in the hospital.
c. lower the tuition rate and apply for increased federal student grants.
d. require nursing faculty to be doctorally prepared to remain on staff.

 

 

ANS:  B

Diploma students were traditionally expected to staff the hospital with which their program was affiliated, often to the detriment of their educational experiences. This exploitation was described in several important studies of nursing education.

Traditional diploma programs do not offer college credit, no matter who teaches the courses.

Diploma programs were expensive to operate and expensive to students, and this had a part in their decreasing numbers. Federal funding (through a variety of means) is available for individual students, and although it is administered by institutions, it is not granted to the institution itself.

Requiring doctorally prepared faculty would not address an historic concern with diploma education.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: N/A

 

  1. In analyzing trends within the profession that are correlated to the rise in baccalaureate nursing (BSN) programs, the nurse historian would outline that
a. degree inflation is contributing to the demand for BSN programs.
b. increased social status and pay correspond to education at the college level.
c. men in nursing demand an increase in BSN programs compared with other programs.
d. the rise in doctorally prepared nurses corresponds to an increase in BSN programs.

 

 

ANS:  D

BSN programs were often hampered by the lack of faculty prepared to teach at the collegiate level, which led to a reluctance of colleges and universities to establish BSN programs. Doctoral programs have been preparing nurse scholars and researchers, who have contributed to nursing’s scientific backbone. The rise in these programs can be seen as a parallel development with the rise in BSN programs.

The proliferation of advanced degrees in nursing is not the result of degree inflation; rather, it is a response to the increased sophistication and complexity of the health care environment today.

Although nurses today do enjoy better pay and improved social status than in the past, this trend is not strongly correlated to the rise in BSN programs.

Men in nursing are not a driving force for the increase in BSN programs.

 

DIF:    Cognitive Level: Analyze               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: N/A

 

  1. A member of a state board of nursing explains to senior nursing students that liberal arts, communication, and health care policy are all appropriate subjects for study in a BSN program because
a. a broad range of knowledge is important to work with educated consumers.
b. as nurses they will care for patients from increasingly diverse backgrounds.
c. physicians rely on the nursing staff to educate their patients on such issues.
d. they are prepared to assume entry-level leadership positions in various settings.

 

 

ANS:  D

BSN-prepared nurses are able to function as generalists and as entry-level leaders in a multitude of settings, leading to the need for inclusion of topics other than nursing care in their education.

Consumers are more educated today than before, but this is not germane to the inclusion of these topics in nursing education.

Diversity is increasing, but this is not related to the need for education in liberal arts and health care policy.

These topics are not taught so that nurses can teach their patients.

 

DIF:    Cognitive Level: Understand          REF:   24

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. A nursing dean in a baccalaureate nursing (BSN) program wishes to create a program that meets the needs of multiple and diverse students, responds to current trends, and increases enrollment. What modification to the existing program would best meet this goal?
a. Allow RNs to validate community health nursing through volunteer work.
b. Bring faculty and classes to major hospitals employing non-BSN nurses.
c. Create seamless entry points and tracts for RN and second-degree students.
d. Find alternative times and days for classroom and clinical experiences.

 

 

ANS:  C

A large group of diploma and associate degree (ADN) nurses could benefit from seamless entry points and BSN tracts designed especially for them. Another group of potential BSN-prepared nurses consists of individuals changing careers after completing degrees in other fields. Programs to address the needs of these students have proliferated. RN-BSN and accelerated nursing programs that are seamless and easy to navigate would go far in helping nursing meet the goal of the National Advisory Council for Nursing Education that at least two thirds of the nursing workforce hold a BSN or higher degree. Programs that offer specialized tracts for RNs and second-degree students would also help ease the nursing shortage because they are typically shorter in duration.

Although the inclusion of community health nursing was an early differentiator between diploma and BSN programs, BSN programs have expanded well beyond this, and coursework for the BSN is more varied and complex than just simply adding a course in community health nursing.

Bringing faculty and classes to major hospitals might make it more convenient for non-BSN nurses to complete their degrees, but the logistics would be difficult, and enrollment might be small. This also only capitalizes on the non-BSN nurse working in hospitals and does not address the needs of second-degree students or those employed in other settings.

Alternative days and times for classroom and clinical experiences may help those who are juggling family or work commitments but would not address current trends in nursing or specifically meet the needs of students with diverse educational backgrounds.

 

DIF:    Cognitive Level: Synthesize           TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs: N/A

 

  1. An advanced-degree nurse working in a hospital is responsible for evaluating and synthesizing new knowledge and applying it to the population with whom he or she works. Other nurses recognize that this nurse probably has which degree?
a. Doctor of nursing practice (DNP)
b. Doctor of nursing science (DNSc)
c. Doctor of philosophy (PhD)
d. Nursing doctorate (ND)

 

 

ANS:  A

The clinical practice doctorate in nursing is the DNP. This degree would prepare the nurse to translate and apply knowledge to the clinical setting rather than be responsible for generating new knowledge.

The DNSc (or DNS) degree is a research-focused degree culminating in preparing and defending the student’s dissertation.

The PhD is another degree awarded to nurses completing a research-focused doctoral level program. The holder of this degree must also prepare and defend a dissertation based on original research.

The ND degree, originally intended for research utilization, has lost favor, with only four schools granting it in 2004. With the advent of the DNP program, ND programs made the transition to the DNP model.

 

DIF:    Cognitive Level: Remember           REF:   28

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. To discriminate between the two major branches of doctoral education for nurses, the aspiring student would classify the differences between them as primarily
a. cognate versus practice emphasis.
b. knowledge formulation versus utilization.
c. systems generation versus systems thinking.
d. tool generation versus tool application.

 

 

ANS:  B

The main difference between the two programs of study is that the research-focused programs (PhD and DNSc) produce scholars who are capable of generating new knowledge, but the practice-focused programs (DNP) produce highly specialized practitioners who use knowledge in the clinical setting. The DNSc program is gradually being phased out.

Both types of doctoral programs have cognate core courses.

The DNP programs do prepare their graduates in highly skilled systems thinking, but the research-focused programs do not restrict their emphasis to the creation of new systems.

Tool generation may be part of a research study but is not necessarily a component.

 

DIF:    Cognitive Level: Understand          REF:   27 | 28

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. A potential nursing student is worried about the cost of attending a baccalaureate degree program. After examining the available options, the student would conclude that which of the following is probably the best route for an affordable education?
a. Attending an in-state government-sponsored institution
b. Investigating work-study options at all program types
c. Obtaining scholarships to attend a private institution
d. Working part time while attending nursing school

 

 

ANS:  A

State- and government-sponsored institutions are nearly always much less expensive than private education and give significant tuition discounts to in-state students.

Work-study plans are just one component of financial aid. Although obtaining work-study financing will help with the cost of the education, this alone may not offer significant reduction in actual costs, especially if the student attends a private school.

Scholarships for private institutions can significantly decrease the cost of attending, but students may not be eligible or may not be awarded scholarships because they are based on need or scholarship or a combination of both. Considering that private education is usually significantly more expensive than public education at a government-sponsored college, this option is not the most affordable, but it should be investigated because the possibility does exist for this option to make education quite affordable.

Working part time will probably not gain the student enough income to make a significant difference in the cost of attending college.

 

DIF:    Cognitive Level: Analyze               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: N/A

 

  1. A prospective nursing student is researching nursing schools. One of the schools is fully accredited by the CCNE, has no history of adverse actions taken by its state board of nursing, and is staffed by faculty members who appear to be appropriately credentialed for their positions. What inference can the student make about this program?
a. CCNE accreditation is the only option for nursing school accreditation.
b. Faculty credentials have little bearing on the quality of nursing programs.
c. The findings ensure that the program meets at least minimal requirements.
d. This is a top-rated program whose graduates are ultimately successful.

 

 

ANS:  C

Students are protected from marginal programs by both regional and specialty accreditation and by approval of the program by state legal regulatory bodies, specifically state boards of nursing. Accreditation by specialty bodies means that programs at least meet, and may exceed, minimum standards.

Faculty qualifications are a vital component when assessing program quality.

Both the Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) are approved by the Department of Education as official accreditations agencies.

The information described means that the school at least meets basic requirements; however, it does not help rank it. Perhaps a better measure of the rank of schools can be found in the percentage of first-time writers of the board examination who are successful over several years.

 

DIF:    Cognitive Level: Analyze               TOP:   Nursing Process: Analysis

MSC:  NCLEX Client Needs: N/A

 

  1. A nurse practicing in a specialty area wishes to be recognized for the specialized skill set and knowledge obtained in order to be an effective member of the health care team serving that particular patient population. The nurse would best complete this goal by
a. completing a rigorous continuing education program.
b. gaining admission to a graduate nursing degree program
c. obtaining a secondary license in that area of practice.
d. passing the certification examination in that particular specialty.

 

 

ANS:  D

Certification by specialty nursing organizations recognizes the knowledge and clinical practices associated with high-quality practice in a specialty area of nursing.

Continuing education is vital and is required to maintain nursing licensure, but it will not ensure public and professional recognition for proficiency in a specialty area.

Gaining admission to a graduate degree program is admirable, but it will not reward current knowledge and skill with recognition. A higher degree focuses on attainment of new knowledge.

There are no secondary licenses.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: N/A

 

  1. A panel of nursing deans and faculty has met to discuss increasing the number of baccalaureate-prepared nurses in a mostly rural state. What collaborative project could the panel design that would be best for meeting this goal?
a. A summer-intensive program where students live and study at the university during the summer
b. A “weekend college” program offered every other weekend at the university for working RNs
c. An on-campus accelerated-track BSN program designed for the student who has a degree in another area
d. An online program with outlying clinical sites that are run jointly between the university and community colleges

 

 

ANS:  D

An online program would greatly enhance accessibility. More nurses are educated in associate degree programs from junior or community colleges than in either diploma or BSN programs. The coursework would be directed and taught by faculty with appropriate credentials for teaching at the BSN level, and clinical experiences could be managed locally by community college faculty with supervision by the parent university faculty.

In a mostly rural state, creating a summer-intensive program where students would still have to live and study outside their hometowns does not increase accessibility.

The weekend college idea would still require students from the rural areas to travel perhaps long distances to attend school.

Programs designed to capture non-nursing majors who wish to enter nursing are growing in popularity, but this does not improve accessibility for the rural population.

 

DIF:    Cognitive Level: Synthesize           TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs: N/A

 

  1. An analysis of the three major types of basic nursing education would reveal to the student that the biggest difference in programs is that
a. ADN nurses lack the education in community health that other program graduates have.
b. BSN nurses are educated to work independently and enter leadership roles.
c. collegiate experiences in BSN programs ensure that graduates have a well-rounded education.
d. diploma graduates are trained to function under the supervision of a BSN nurse.

 

 

ANS:  B

BSN programs include coursework in liberal arts, humanities, leadership, and management, enabling the BSN graduate to use sound critical thinking skills, to function independently as a generalist nurse, and to assume entry-level leadership roles.

Although ADN nurses do not usually have community health in their curricula, this is not the biggest difference among programs.

Associate degree programs are also offered in collegiate environments, including junior and community colleges and universities.

Diploma graduates were envisioned as complete bedside nurses. The ADN nurse is a technical nurse trained to function under direct BSN supervision.

 

DIF:    Cognitive Level: Analyze               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: N/A

 

  1. A recent high school graduate wants to pursue registered nursing education in the local community. What type of program would this student most likely investigate?
a. Associate degree program
b. Baccalaureate degree program
c. Diploma program
d. Licensed practical nurse program

 

 

ANS:  A

The associate degree program is often offered at local community colleges. Baccalaureate programs are usually found at larger colleges or universities. The few remaining diploma programs are associated with hospitals. Because the nurse wants RN education, a licensed practical nurse program would not be considered.

 

DIF:    Cognitive Level: Understand          REF:   25

TOP:   Nursing Process: Assessment          MSC:  NCLEX Client Needs: N/A

 

  1. A registered nurse is considering doctoral programs but is concerned with accessibility. Which type of program is probably most accessible to this RN?
a. Clinical nurse leader program
b. Nursing doctorate (ND) program
c. Practice-focused program
d. Research-focused program

 

 

ANS:  C

The practice-focused doctoral programs are growing rapidly as APRN programs are converting to the DNP. The clinical nurse leader is a master’s level education. The ND programs are being phased out. The research-focused programs are less accessible than the practice-focused programs.

 

DIF:    Cognitive Level: Remember           REF:   29 | Table 2-1

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. The student of nursing history learns what information about the advent of nursing education?
a. Baccalaureate programs caught on quickly after being started.
b. Collegiate forces advocated for early university education.
c. Early programs were patterned after the Nightingale model.
d. Physicians were against using any trained nurse in hospitals.

 

 

ANS:  C

The earliest nursing education occurred in hospital-based programs patterned after the Nightingale model of collegiate nursing education. However, anticollegiate forces prevailed, and the diploma process became the standard for nursing education. Baccalaureate programs did not catch on well until after World War II. Physicians recognized the value of a trained nursing staff.

 

DIF:    Cognitive Level: Remember           REF:   23

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. A university nursing dean is particularly interested in attracting more male students. What action by the dean would most likely result in the best outcome for this goal?
a. Create an accelerated baccalaureate degree program.
b. Establish a “fast track” program for business leaders.
c. Partner with the local community college on seamless entry.
d. Recruit heavily among male-dominated occupations.

 

 

ANS:  A

Accelerated BSN programs are an important point of entry for underrepresented groups in nursing, including men. Although it may be difficult to recruit men directly from high school, the accelerated program offers men an attractive way to change careers later in life. Business leaders may not be all male. A seamless transition from an associate degree to an RN-completion degree is an important step in increasing the number of BSN-prepared nurses but does not specifically target men. Recruiting men from traditional “male” occupations may or may not be successful.

 

DIF:    Cognitive Level: Apply                  TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs: N/A

 

MULTIPLE RESPONSE

 

  1. In comparing and contrasting licensed practical nursing (LPN) programs with associate degree (ADN) programs, the potential nursing student notices similarities between the two, including (Select all that apply.)
a. both programs prepare graduates to be supervised by BSN nurses.
b. graduates of both programs are considered to be technical nurses.
c. licensure exams for graduates of both programs are interchangeable.
d. LPN and ADN programs offer similar college credit for coursework.
e. the programs both take a similar length of time to complete.

 

 

ANS:  A, B

Both the LPN and ADN programs envision nurses who will be supervised by higher prepared RNs.

Both the LPN and ADN programs prepare nurses who are considered technical in nature.

Whereas the LPN takes the NCLEX-PN examination, the ADN graduate takes the NCLEX-RN examination.

LPN programs often do not carry college credit, which makes it difficult to matriculate into RN programs.

LPN programs generally are 9 to 15 months long, whereas ADN programs are typically 2 years in duration.

 

DIF:    Cognitive Level: Understand          REF:   25

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. In evaluating the success of a clinical nurse leader (CNL) program, a nursing dean would determine that program goals had been met when graduates were able to successfully (Select all that apply.)
a. demonstrate leadership in hospital nursing departments.
b. function effectively in an advanced specialty nursing role.
c. oversee care coordination of a distinct group of patients.
d. provide direct patient care in complex situations.
e. supervise ancillary and adjunctive nursing staff members.

 

 

ANS:  C, D

One of the two major roles of the CNL is to oversee the care coordination of a distinct group of patients.

The other major role of the CNL is to provide direct patient care in complex situations.

CNLs design and implement care and are accountable for care outcomes, but they do not necessarily serve in departmental leadership positions.

CNLs are considered generalists, not specialists.

The CNL role is not designed as a direct supervisory role, such as a charge nurse.

 

DIF:    Cognitive Level: Evaluate               TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A high school guidance counselor is working with a student who wants to attend a baccalaureate nursing school. The counselor explains that the main considerations when choosing a nursing program are (Select all that apply.)
a. accessibility.
b. cost.
c. location.
d. program length.
e. quality.

 

 

ANS:  A, B, E

Accessibility is one of three major considerations when choosing a nursing program.

Cost is one of the three major considerations when choosing a nursing program.

Quality is one of the three major considerations when choosing a nursing program.

Location may be important to students either wishing or not wishing to relocate, but it is not generally one of the major considerations in choosing a program.

Nearly all baccalaureate programs are designed to be 4 years in length, assuming a full-time load.

 

DIF:    Cognitive Level: Understand          REF:   29 | Table 2-1

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. A nurse is discussing certification with a coworker and explains that goals of the certification process include (Select all that apply.)
a. endorsing demonstrated knowledge.
b. enhancing nurses’ professionalism.
c. helping boost pay scales for nursing.
d. providing for differentiated practice.
e. serving as a quality control activity.

 

 

ANS:  A, B, E

Certification is directed to endorsing demonstrated knowledge and skill associated with high-quality performance in a specialty area.

Certification also enhances professionalism and allows the public and other professionals to recognize those with professional achievements.

Certification does serve as a quality control activity, because nurses who obtain certification must demonstrate superior knowledge and clinical behaviors.

Certification does not include boosting pay scales as a goal, although in some institutions, certified nurses do receive a monetary benefit.

Although many certification exams require a BSN, differentiating practice is not a goal of certification.

 

DIF:    Cognitive Level: Understand          REF:   32 | 33

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

 

  1. A nursing dean oversees a BSN program that is taught partially online. In evaluating program effectiveness and sustainability, the dean should pay special attention to the (Select all that apply.)
a. effect of online learning on the process of professional socialization.
b. comparison of online graduates’ NCLEX-RN pass rates with traditional BSN pass rates.
c. consequences of distance education on availability of financial aid.
d. correlation of online learning strategies with students’ learning needs.
e. impact of distance technology needs on donor willingness to contribute.

 

 

ANS:  A, B, C, D

Professional socialization can be profoundly affected by distance technology and should be evaluated during reviews of program effectiveness. Socialization into the professional role is vital to maintain ethical and moral standards.

A comparison of board pass rates will allow evaluation of the effectiveness of both program types.

Students’ ability to obtain financial aid may be affected by distance education, particularly when looking for work-study positions, tutoring, and assistantships.

Matching student learning needs with online teaching styles to create effective learning environments would be another area to evaluate.

Donations, although important, would be a secondary consideration. Not all donors designate their contributions to specific needs.

 

DIF:    Cognitive Level: Evaluate               TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs: N/A

 

  1. A nursing dean wants to recruit students who more closely match demographic trends. In planning activities with the marketing department, the dean should plan activities to attract (Select all that apply.)
a. students with disabilities.
b. ethnic minorities.
c. men.
d. recent high school graduates.
e. underemployed groups.

 

 

ANS:  B, C

Ethnic and racial minorities make up only about 18% of nursing students in baccalaureate and graduate programs today. The trends reflect growing ethnic and racial diversity in the country.

Men account for only 10% of BSN students today despite making up approximately 50% of the population.

Recent high school graduates are not included in demographic trends.

Underemployed groups rise and fall sporadically with economic changes and are not reflected in trends that nursing schools typically follow.

Recruitment of disabled students is not a trend in nursing school admissions.

 

DIF:    Cognitive Level: Apply                  TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs: N/A

 

  1. When analyzing the development of nursing education for a research paper, the nursing student notes that certain factors have been important contributors to the current system of nursing education in this country, including (Select all that apply.)
a. changing demographics.
b. cost of education.
c. historical events.
d. societal health care needs.
e. women’s roles.

 

 

ANS:  C, D

Historical events, particularly wars, were vital contributors to our current system of nursing education.

Changes in the health care needs of society have helped spur the development of our current system of nursing education.

Changing demographics were not responsible for the current system of nursing education.

The cost of education was not germane to the rise of our current system of nursing education.

Women’s roles were not important in the development of our current system of nursing education.

 

DIF:    Cognitive Level: Analyze               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: N/A

 

  1. A potential nursing student is evaluating a local hospital-based diploma program. The student favors this program because several relatives are alumni. In helping the student critically evaluate the strengths and weaknesses of this program, what information does the high school guidance counselor offer? (Select all that apply.)
a. Courses typically do not carry any college credit for transfer.
b. Diploma programs are not accredited by any national organization.
c. Short program duration leads to career entry sooner than other programs.
d. Students typically have strong clinical skills upon graduation.
e. Tuition in these programs is often the least expensive.

 

 

ANS:  A, D

Diploma programs usually graduate nurses with strong clinical skills, but courses usually do not carry any college credit. Diploma programs are accredited and graduates are eligible for the NCLEX-RN examination. These programs are typically 2 to 3 years long. Tuition in community colleges is usually the cheapest option.

 

DIF:    Cognitive Level: Understand          REF:   23

TOP:   Integrated Process: Teaching/Learning                            MSC:  NCLEX Client Needs: N/A

Chapter 10: Teaching and Learning in the 21st Century

 

MULTIPLE CHOICE

 

  1. A nurse educator recognizes that presenting course content in a logical progression from simple concepts to more complex ones is a characteristic of __________ theories.
a. behaviorist
b. change
c. cognitive
d. humanistic

 

 

ANS:  A

Behaviorist theories emphasize learning concepts from simple to complex with minimal learner participation in the learning activity.

Change theories posit that learning occurs in ways that are congruent with an individual’s value systems.

Cognitive theories state that learners link new knowledge to meaningful knowledge they already possess.

Humanistic theories allow learners to set their own goals.

 

DIF:    Cognitive Level: Remember           REF:   189

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A diabetic nurse educator teaches according to the principles of the cone of experience theory. Which activity planned by this nurse would best demonstrate the concepts in the theory when teaching a patient with diabetes to self-administer insulin injections?
a. Demonstrate and then allow plenty of practice and return demonstrations.
b. Find out the client’s motivating factors and design rewards that fit these motivators.
c. Identify the learning styles of individual clients and tailor teaching to his or her style.
d. Use teaching styles that stimulate all five senses, limiting environmental distractions.

 

 

ANS:  A

Edgar Dale’s cone of experience theory says that skills are best learned with an initial demonstration followed by lots of practice time and the opportunity for repeat demonstrations.

Finding out the client’s motivating factors and designing rewards that fit these motivators would reflect concepts of change theory.

Identify the learning styles of individual clients and tailoring teaching to his or her style would reflect concepts found in cognitive theories.

Using teaching styles that stimulate all five senses and limiting environmental distractions would reflect the concepts in cognitive theory.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nursing dean is telling an applicant for a nursing faculty position that the school uses “learning-centered education” in which students are responsible for active learning and faculty members serve as guides. The potential faculty member labels the style of teaching at this college as based on __________ theories.
a. behaviorist
b. change
c. cognitive
d. humanistic

 

 

ANS:  C

Cognitive theories detail active engagement in learning while designing activities that link new knowledge to old. A learning-centered environment would fit this description.

Behaviorist theory includes presenting material from simple to complex with minimal learner engagement. This would be best observed in lectures.

Change theories are most often used in patient teaching and include assessing readiness to learn and recognizing that changes must be congruent with the patient’s values.

Humanistic theory would encourage students to set their own goals for the learning experience.

 

DIF:    Cognitive Level: Remember           REF:   189

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A faculty member is preparing a class that covers very sophisticated and difficult material. This faculty member uses the cognitive learning theories predominantly. To use cognitive theory to teach this material, the faculty member would most likely
a. assess students’ knowledge first because they may need to “unlearn” other material.
b. assign a case study that requires group collaboration and problem solving.
c. prepare a detailed lecture complete with informative slides and handouts.
d. require students to read heavily on their own and give minimal information.

 

 

ANS:  B

Active learning, including having to actively seek information and collaborating with others, is consistent with cognitive learning theories.

Having students “unlearn” old knowledge would be consistent with behaviorist theories.

Detailed lectures and handouts are most consistently aligned with behaviorist theory.

Having students do heavy reading on their own might be part of a cognitive theory-based class, but there is not enough detail about the learning process to make this answer correct.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nurse working with professionals in continuing education understands that the learning theory that probably will be most useful in this job is a __________ theory.
a. behaviorist
b. change
c. cognitive
d. humanistic

 

 

ANS:  D

Humanistic theories are usually most useful for adult learning because the learners tend to be self-motivated, self-directed, and self-evaluated.

This nurse will be working with self-motivated adult learners, so behaviorist theory is not a good match.

This nurse will be working with self-motivated adult learners, so change theory is not a good match.

This nurse will be working with self-motivated adult learners, so cognitive theory is not the best match.

 

DIF:    Cognitive Level: Remember           REF:   189

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A clinical faculty member stresses “see one–do one–teach one” as a teaching methodology. When asked about this technique, the instructor explains that
a. doing all three things covers several learning styles.
b. it gives the students a feeling of mastery of the topic.
c. people retain a high percentage of what they teach.
d. teaching others helps develop leadership in students.

 

 

ANS:  C

According to Dale (1969), people will retain about 95% of what they teach.

Multiple learning styles do come into play with this methodology, but this is not the best answer.

Giving students a “feeling” of mastery is not the focus of teaching; the goal is actual mastery of the subject.

Promoting leadership is a good goal, but it is not the reason for this educational technique.

 

DIF:    Cognitive Level: Understand          REF:   190

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. According to the cone theory of learning, the least effective method for learning is
a. discussing.
b. listening.
c. reading.
d. writing.

 

 

ANS:  C

People retain only 10% of what they read, according to this theory.

People retain 70% of what they discuss, according to this theory.

People retain 20% of what they hear, according to this theory.

People retain 60% of what they write, according to this theory.

 

DIF:    Cognitive Level: Remember           REF:   190

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nursing school wants to invest in expensive simulation equipment. The college president resists, asking why so much money is needed for a computerized simulation mannequin and programs instead of just having students practice in the skills lab. The best response the nursing dean can offer to justify this expense is:
a. “A day doing simulations can substitute for clinical when census is low.”
b. “Actively engaging in scenarios will improve students’ ability to learn.”
c. “Routinely practicing skills in the lab is helpful but boring to students.”
d. “Because other colleges use simulations, we need them to stay competitive.”

 

 

ANS:  B

Actively engaging in learning activities through simulations, role-play, or other experiential learning is a more effective way to learn content that requires motor skills.

Some courses that typically have an unpredictable patient census (e.g., Obstetrics) often substitute simulations for clinical days, but it is not the best answer because it does not address learning specifically.

Practicing in a traditional skills lab may be boring, but this is not the best reason.

Staying competitive with other schools may be important, but this is not the best answer.

 

DIF:    Cognitive Level: Understand          REF:   190

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nurse has planned a detailed and individualized teaching plan for a patient who had a double mastectomy. While working with her, the nurse notes that the patient seems distracted and unable to remember what was just taught; also, her skill at changing her dressings is poor. The nurse is frustrated and consults a colleague, who explains that the most likely reason for this behavior is
a. denial of the need to learn self-care.
b. inadequate pain relief or treatment.
c. lack of emotional readiness to learn.
d. not enough time to perform the skills.

 

 

ANS:  C

This patient has had emotional upheaval related to a diagnosis of cancer and the loss of both breasts. The most likely cause of her seeming inability to learn is lack of emotional readiness.

The patient may certainly be in denial. This is a very narrow interpretation of lack of emotional readiness, the correct answer. There may be other factors that contribute to lack of emotional readiness besides denial.

Pain should be assessed and treated, but this is not the most likely cause.

The nurse may be pushing the patient through the skills set too quickly, and this should be assessed, but it is not the most likely reason for the difficulty learning.

 

DIF:    Cognitive Level: Understand          REF:   191

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nurse has spent time teaching a patient and has provided several pamphlets along with written discharge orders in anticipation of discharge from the hospital in the morning. The patient appears bored and says, “I can’t find my glasses.” The best action by the nurse is to
a. ask the patient why he or she is bored.
b. come back later when the patient is ready.
c. inquire gently about reading ability.
d. stop teaching and find the patient’s glasses.

 

 

ANS:  C

A likely explanation for the patient’s behavior is illiteracy. The nurse should gently ask the patient about his or her reading level. A statement such as “Many people find this information difficult to read and understand” can open the door to a discussion about reading ability. As an alternative, the nurse can simply read the information out loud to the patient.

Assuming the patient is actually bored might well cause defensiveness. In addition, “why” questions also often put patients on the defensive.

If the patient is truly not ready to listen, coming back later might be an option after assessing that this is the case. However, this is not the best answer in this case because it does not address the reason for the lack of readiness.

Finding the patient’s glasses is not the best answer; the patient may continue looking bored and find other ways to stall the learning session.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A patient needs to make several challenging life changes to cope with a serious chronic illness. Instead of teaching the patient, the nurse spends time visiting with the patient and inquiring about family life, work, and hobbies. When a new nurse asks the reason for “wasting so much time” with the patient, the first nurse explains,
a. “All patients like to feel important and that you are interested in them.”
b. “I like to establish rapport first before just jumping in and teaching.”
c. “Knowing more about the patient informs me about possible motivators.”
d. “When patients view you as friendly, they are more likely to respond.”

 

 

ANS:  C

Motivation can be a very powerful tool to encourage a patient to make desired behavior changes. For instance, if a patient with a serious chronic illness wants to participate in activities with his or her children, this could serve as a motivation to stay well and out of the hospital, which uses time, money, and other resources that could be instead applied toward the desired activity. The motivation for learning can be powerful and should be harnessed to enhance learning.

It may be true that patients like nurses to be interested in them, but this it is not related to an educational purpose.

Establishing rapport is very important in all nurse–patient relationships, but this is not the best answer for this question.

Although it is true that being friendly is more likely to cause patients to respond, this is not the best answer to this question.

 

DIF:    Cognitive Level: Understand          REF:   192

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A patient has been attending an outpatient diabetes education group. On assessing the patient after several sessions, the nurse determines that the patient’s knowledge is far below what the diabetic educator expects. The patient states, “I can’t stand that group! All that talk mixes me up.” The nurse concludes the most likely reason for this response is that the patient
a. is not an auditory learner and is frustrated.
b. should give the group experience more time.
c. really does not like the people in the group.
d. would respond better to personal discussion.

 

 

ANS:  A

There are three predominant learning styles: visual, auditory, and tactile/kinesthetic. If discussion is frustrating and confusing, the patient is probably not an auditory learner, and teaching techniques need to be adjusted.

The patient has already been to several sessions and remains unhappy with the experience, so giving the group experience more time is not a good choice.

Whether or not the patient likes the other people in the group is not highly relevant. It would be more reasonable to assess the patient’s learning style.

If the patient is not an auditory learner, even one-on-one discussions will not be the best learning experience. It would be better to reason that the learning style is the issue and conduct further assessments.

 

DIF:    Cognitive Level: Evaluate               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nurse is directing a patient to information on the Internet and recommends the site Health on the Net (HON). The nurse explains that this site
a. evaluates the reliability of Internet health information.
b. presents a variety of health care topics written for lay people.
c. is a telehealth site with online health care consultations.
d. uses a program to determine the reading level of text.

 

 

ANS:  A

HON is the gold standard site for investigating the reliability of health information found on the Internet.

HON does not contain health information of its own but rather evaluates other websites for reliability.

HON is not a telehealth site where people can obtain health care consultations.

There are computer programs and websites that can determine the reading level of various materials, but HON is not one of them.

 

DIF:    Cognitive Level: Understand          REF:   194

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nursing faculty member wants to use Internet-based synchronous learning to make up a class that was missed because of school closure. The instructor would plan to create a(n)
a. electronic drop box.
b. e-mail discussion.
c. slide presentation.
d. web conference.

 

 

ANS:  D

A web conference would be considered a synchronous activity because all participants could log on to and participate in the activity at the same time.

An electronic drop box is merely an Internet site where materials (e.g., a Word document) can be deposited. This would be an asynchronous learning activity.

E-mail discussion does not occur synchronously, so this would be an asynchronous learning activity.

A slide presentation can be uploaded to a specified website, and students can view it at their leisure, which would be an asynchronous activity.

 

DIF:    Cognitive Level: Remember           REF:   194

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. The technology-savvy nurse often refers patients to interactive online learning resources for health care information. What issue does this nurse need to consider as a priority when using this method of instruction?
a. Divide between people with technology and those without it
b. Learning style most receptive to using Internet resources
c. Relative lack of information on specific disease topics
d. The types of devices on which patients access these sites

 

 

ANS:  A

According to a recent survey, 85% of Americans use the Internet. For whatever reason, 15% do not. The nurse must be cognizant of the divide between these two groups because not everyone even has ready access to the Internet. If patients need to go to a public library or some other public space to access information, this decreases the likelihood of their actually doing so. The other options are items to assess, but they are not nearly as important as ensuring the patients have the ability and resources to use the Internet.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nurse is teaching a patient who is a recent immigrant from an Asian culture. The patient listens politely to discharge instructions and agrees to follow them. Two days later, the patient is readmitted, and the nurse is surprised to find none of the discharge instructions have been followed. The nurse would most likely conclude the patient
a. did not have the resources to adhere to the directions.
b. is noncompliant or he or she would have asked questions.
c. lacked enough knowledge to follow through the instructions.
d. was too embarrassed to indicate a lack of understanding.

 

 

ANS:  D

Although individuals within cultures vary widely and nothing should be assumed, people from traditional Asian cultures place a high value on “saving face” and not being embarrassed. With this patient’s cultural background, the nurse should assess for this possibility. Before doing so, the nurse should probably consult with someone more familiar with the patient’s culture. The nurse should also consider using printed material in the patient’s native language.

The patient’s resources should certainly be assessed, but given the patient’s cultural background, this would not be the most likely cause.

Assuming that the patient is noncompliant is a very judgmental view and leaves no room for any explanation other than the patient choosing to not follow through.

Insufficient knowledge may have been the cause, despite the teaching. However, given the patient’s cultural background, this is not the most likely cause.

 

DIF:    Cognitive Level: Evaluate               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nursing professor has three students from Africa in class. None of them is doing well, but they rebuff invitations to come to the professor’s office with questions about the material. What action by the nursing professor would best address this problem?
a. Find a mentor from their own culture who can help them be successful.
b. Meet with them in a neutral spot and have discussion questions for them.
c. Reassure them that the professor is available during office hours for questions.
d. Send them to the academic skills specialist in the college for more help.

 

 

ANS:  B

Although individuals within cultures vary widely and nothing should be assumed, people from traditional African cultures respect authority and may be hesitant to ask questions for fear that it will appear they are challenging the instructor. Meeting the students in a neutral place (not the professor’s office) lessens the power hierarchy. By having discussion questions ready for them, the instructor eliminates this burden from the students.

It may be possible to find a mentor from the students’ own culture, but it also may be quite difficult to find someone who is both successful and willing to work with these students. It would also require a great deal of time; thus, it is not the best answer.

It is important to let students know when you are available, but this alone will not do much to encourage the students to seek help.

Some students may need more intensive help from an academic skills specialist, but simply sending these students to someone else does little to address the possible cultural issues behind the problem.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A student nurse is teaching a patient from an unfamiliar culture about diabetic self-care. The patient is willing and able to take blood glucose readings and give insulin injections but will not use the sliding scale insulin protocol the physician has ordered. Which action by the student would be most beneficial?
a. Ask why the patient is unwilling to follow the scale.
b. Assess the patient’s health-related value system.
c. Call the physician and ask for a simplified regimen.
d. Have someone else try to teach the sliding scale.

 

 

ANS:  B

Because the patient is from an unfamiliar culture, it is possible that health-related values are interfering with the patient’s adaptation of the desired behaviors. In a culture that is fatalistic, the patient may believe he or she does not have the same choices the nurse might have and so cannot make the kind of self-determination decisions required to use a sliding scale for insulin injections. Assessing the patient’s health-related beliefs can shed light on this situation.

Asking “why” questions often puts people on the defensive and may not elicit helpful information.

A simplified regimen, in itself, is not what is important. The physician may need to abandon the idea of a sliding scale for this patient, but changes should not be made to the regimen without first gaining more information and assessing how culture is influencing the patient’s actions.

Without understanding the patient’s cultural influences, simply having someone else try the teaching will probably not be helpful.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A mentor is working with a new faculty member to design learning activities and explains that using Bloom’s taxonomy is helpful to
a. describe changes in the learner’s biases and values.
b. distinguish Cognitive Levels based on complexity.
c. level text material based on year in nursing school.
d. organize assessment data into the nursing process.

 

 

ANS:  B

Cognitive objectives involve the mastery of material along a continuum of complexity. Bloom’s taxonomy describes this continuum.

Describing changes in the learner’s biases and values describes affective objectives.

Bloom’s taxonomy is not used to level material across a curriculum.

Bloom’s taxonomy is not used to organize data into the nursing process.

 

DIF:    Cognitive Level: Understand          REF:   199

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A faculty mentor is explaining to a new faculty member how to assess affective objectives. The mentor states that the individual needing to make a health-related behavior change first needs to accomplish
a. accepting.
b. receiving.
c. responding.
d. valuing.

 

 

ANS:  B

Receiving indicates that the message has been heard and is thus the first-level objective.

Accepting is not one of the affective objectives.

Responding occurs after receiving.

Valuing occurs after responding.

 

DIF:    Cognitive Level: Understand          REF:   199

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nurse who runs a pulmonary rehabilitation program wants to incorporate an educational component designed to facilitate patients’ ownership of their own health. To accomplish this goal, the nurse would most likely create sessions based on
a. individual counseling.
b. group discussions.
c. lectures.
d. role-playing.

 

 

ANS:  B

Group sessions in which individuals all have a common concern—in this case, pulmonary disease—offer the participants a chance to share information and opinions and provide the best opportunity for people to take responsibility for learning about their health needs.

Counseling and education are not synonymous. Counseling would not necessarily accomplish the goal of teaching material and having patients take responsibility of their health.

Lectures are a good format when basic material needs to be presented first. This is not the best answer in this situation.

Role-playing helps people understand the feelings and reactions to situations. Because the participants all have the experience in common, this strategy would not best meet the goal.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A student is meeting with a faculty member for a midterm clinical evaluation. The faculty member explains that this type of evaluation is
a. finalized.
b. formative.
c. professional.
d. summative.

 

 

ANS:  B

This type of evaluation is called formative and occurs while the learning activity is still taking place.

Finalized is not one of the three major types of evaluations.

Professional is not one of the three major types of evaluations.

A summative evaluation occurs after the learning activity has occurred.

 

DIF:    Cognitive Level: Remember           REF:   201

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A faculty member who has substantially changed the way he conducts classes and presents content now wishes to evaluate the effectiveness of the new strategies. To best meet this goal, the faculty member should plan to
a. ask the students which method of instruction they liked best.
b. compare final examination grades for this class and previous classes.
c. give pop quizzes periodically throughout the course of the class.
d. have an experienced faculty member conduct a peer evaluation.

 

 

ANS:  B

Performing a summative evaluation at the end of the semester would allow the faculty member to determine which instructional method might be best. Comparing final examination results would provide this information, although the instructor needs to consider other influencing factors as well.

If the faculty member were assessing student satisfaction, this would be a valid answer; however, the faculty member wants to assess learning effectiveness.

Pop quizzes would be a type of formative evaluation, allowing for shifts in teaching style so that students could better meet objectives.

A peer evaluation can provide important feedback, but this will not provide definitive information on which teaching method worked best.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A faculty member is experienced and has taught the same material successfully for several semesters. This year’s class is having more difficulty than usual. The faculty member would most likely conclude that
a. admissions standards may have been relaxed recently.
b. students are less prepared for college than in the past.
c. texts should be updated to reflect enhanced technology.
d. unknown barriers exist that are hindering the learning.

 

 

ANS:  D

Because the teacher is experienced and has been successful in the past, he or she should assess the students for unknown barriers such as stress, lack of time, lack of support, or other personal characteristics of the learners.

Even if it were true that admission standards had been relaxed, this would only explain one type of barrier to learning. Before assuming this, further assessment would need to be made.

It is possible that current students are less prepared for college than past students, but this is too narrow to be the correct answer.

Students who are younger and more capable with technology may prefer “texts” that are web based or web enhanced, but this in itself would not prevent students from learning.

 

DIF:    Cognitive Level: Evaluate               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. A patient has been readmitted to the hospital, and the admitting nurse discovers that the patient did not follow through with previous discharge instructions. The nurse also discovers that the patient understood the directions and had all the necessary supplies. The nurse would gain the most valuable information by asking the patient about (Select all that apply.)
a. how important the patient thought the self-care was.
b. whether the patient felt capable of actually performing self-care.
c. whether the patient realizes the consequences of noncompliance.
d. whom the patient can call when he or she has questions about care.
e. why the patient was unwilling to perform self-care measures.

 

 

ANS:  A, B

To attain behavior changes, the person being taught must value the information and the behavior change.

The person must feel confident in his or her ability to perform the self-care measures; if the person does not believe that he or she has the ability to do the activity, the person may not even attempt it.

Using such threatening language as “the consequences of noncompliance” probably would make the patient feel defensive. Although this needs to be assessed (in a more gentle fashion), it is not the priority and can be addressed later.

It is important to know what resources, including other people, the patient has available, but this is not likely the most important area to assess.

Assuming the patient is unwilling is judgmental; in fact, the patient may have been very willing but felt unable to perform the activity. Other stresses may have interfered as well.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nurse is assessing a patient before developing a teaching plan. What questions or statements will best obtain data on this patient related to health literacy? (Select all that apply.)
a. Have you missed appointments because you misunderstood the instructions?
b. How well are you able to read?
c. How would you look for information on your diagnosis?
d. Tell me how you compare two similar products.
e. What would make you go to the emergency department?

 

 

ANS:  A, C, D, E

Health literacy is not just the ability to read; it also includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms, and the ability to negotiate complex health care systems. Asking questions related to missing appointments, looking for information, comparing products, and making decisions would yield good information on the state of this patient’s health literacy. Reading level is important but is not the best indicator.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A nurse has finished teaching a patient about self-management of a new disease just diagnosed. What statements by the patient indicate to the nurse that the patient’s health literacy may be a barrier to learning? (Select all that apply.)
a. “Can you write down the instructions step by step?”
b. “I can’t read this brochure you gave me yesterday.”
c. “I got admitted because I didn’t know which doctor to call.”
d. “These instructions mix me up and frustrate me.”
e. “This new medication is too expensive for me to take.”

 

 

ANS:  A, C, D

Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms, and the ability to negotiate complex health care systems. Needing instructions written down step by step, not knowing what health care provider to call, and getting mixed up and frustrated over instructions demonstrate this patient’s lack of the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Not being able to read well and not being able to afford medications are certainly barriers to explore, but they are not related to health literacy.

 

DIF:    Cognitive Level: Evaluate               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

 

  1. A patient states that she uses the Internet to look up everything related to her medical condition and treatment and so does not need the teaching prepared by the nurse. What aspects of health literacy are especially important for the nurse to assess in this patient? (Select all that apply.)
a. Ability to condense a huge amount of information
b. Ability to determine what information is reliable
c. Motivation of the patient to do her own research
d. Reason the patient prefers learning on the Internet
e. Trust in the nurse to provide accurate information

 

 

ANS:  A, B

Health literacy includes the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions. If the patient can condense the enormous amount of information on the Internet and determine what is reliable, she has a reasonable degree of health literacy. Motivation, the rationale for the patient’s preference, and trust are not related to health literacy, although they might be important pieces of information to obtain.

 

DIF:    Cognitive Level: Evaluate               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Health Promotion and Maintenance

Chapter 20: Patient Safety

 

MULTIPLE CHOICE

 

  1. In the 2000 Institute of Medicine’s milestone report To Err Is Human: Building a Safer Health System, how many patients were estimated to die each year as a result of errors occurring in a hospital setting?
a. 25,000
b. 35,000
c. 50,000
d. 98,000

 

 

ANS:  D

A total of 98,000 people were estimated to have died each year from errors during hospital care.

The report estimated that more than 25,000 people, as many as 98,000, die each year from errors occurring during hospital care.

The report estimated that more than 35,000 people, as many as 98,000, die each year from errors occurring during hospital care.

The report estimated that more than 50,000 people, as many as 98,000, die each year from errors occurring during hospital care.

 

DIF:    Cognitive Level: Remember           REF:   343

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nurse asks the manager why the nursing staff seems to have the bulk of the responsibility for preventing errors in patient care. The manager explains that the primary reason nurses are best situated to recognize and prevent errors is because they
a. are leaders on the health care team.
b. have refined communication skills.
c. interact with patients so frequently.
d. provide the majority of risky care.

 

 

ANS:  C

Nurses interact with patients on a frequent basis and so are positioned to prevent medical errors as much as 90% of the time.

Nurses should play a leadership role in all patient care situations, but this is not the best answer for this question because in many work environments, nurses still take a subservient role.

Nurses are taught communication skills in nursing school, but nurses and other health care providers are taught to communicate in very different ways.

Nurses do provide some care that is considered risky, such as medication administration, but physicians often provide the riskiest care, such as operations and invasive procedures.

 

DIF:    Cognitive Level: Understand          REF:   343

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The nurse executive explains to a group of newly hired nurses that the major responsibility for preventing errors in patient care lies with the
a. individual because of legal obligations for safety.
b. individual, because that is who makes the error.
c. system, because it is responsible for employee acts.
d. system, because process designs can lead to errors.

 

 

ANS:  D

Process design and implementation most often lead to the commission of errors. The nurse is a key member of the team to identify poor processes and to work on improvement of processes.

Professional staff does have a legal responsibility for safe care, but hospital systems are more often the root cause of errors.

Individuals do make each error, but often the error is the result of many problems within the system and processes of the health care facility.

The system is responsible for many of its employees’ actions but not for all.

 

DIF:    Cognitive Level: Analyze               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nursing executive wishes to implement a new policy based on initial National Patient Safety Goals 2002 to eliminate wrong patient, wrong site, and wrong procedure. Which action by the executive would best meet one of the goals?
a. Collaborate with the laboratory for timely reporting of laboratory values.
b. Formulate a time-out policy.
c. Mandate that all fall-prone patients be clearly identified.
d. Reevaluate work flow design and patient–staffing ratios.

 

 

ANS:  B

One of the initial National Patient Safety Goals 2002 was to eliminate wrong patient, wrong site, and wrong procedure surgeries, so establishing a policy that requires a time-out to verify patient, site, and procedure before starting an operation would help meet this goal.

Timely reporting of lab values would not be closely related to any of the initial National Patient Safety Goals 2002.

Reducing falls is a laudable goal, but identifying high-risk patients was not one of the initial National Patient Safety Goals 2002.

Work flow design and patient–staffing ratios may be related to patient errors, but these measures would not closely align with any of the original National Patient Safety Goals 2002.

 

DIF:    Cognitive Level: Apply                  TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nurse manager in a hospital receives Joint Commission sentinel event alerts. When one is received that concerns a process that occurs in the manager’s facility, the best action by this manager is to
a. consult with other managers to see whether this has been a problem.
b. create a file and add related information as it becomes available.
c. initiate a new policy to address the shortcomings of the process.
d. investigate how this process has been affecting patient safety.

 

 

ANS:  D

The best answer would be for the nurse manager to begin a thorough investigation of how this process works in the specific facility and how it affects patient safety.

Although consulting with other managers would be part of the best response, this is not the most complete answer.

Whereas maintaining a file of information is a passive activity, responding to patient safety requires an active approach.

Initiating a policy may be needed, but first the manager needs to investigate how the process at this specific facility affects patient safety.

 

DIF:    Cognitive Level: Apply                  TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The nurse knows that the purpose of the Department of Health and Human Services (DHHS) is to
a. prioritize patient safety regulations.
b. promote use of research in practice.
c. protect the health of all Americans.
d. provide guidance on hospital policy.

 

 

ANS:  C

Protecting the health of all Americans and providing services for people who cannot provide for themselves is the overarching goal of the DHHS.

Prioritizing safety regulations is not the main purpose of the DHHS.

Promoting research in practice is not the main purpose of the DHHS.

Providing guidance on hospital policies is not the main goal of the DHHS.

 

DIF:    Cognitive Level: Remember           REF:   344

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nursing manager wants to investigate the best practice research on a specific patient safety issue. The best action by the nursing manager would be to
a. consult with other facilities to see what their related practices are.
b. convene a work group to develop related policies and procedures.
c. read recent issues of a nursing management journal for research.
d. research the literature, paying special attention to synthesis work.

 

 

ANS:  D

The manager should research the relevant literature, using such resources as the Agency for Healthcare Research and Quality (AHRQ). One of the goals of AHRQ is to promote research in everyday practice, and as part of that goal, this agency provides syntheses of current research.

Other facilities may not be using best practice.

It is premature to convene work groups before collecting data. This might be part of an action plan once the research has been done.

Journals of nursing management do carry some research articles and best practice articles but would not be the best location for this information.

 

DIF:    Cognitive Level: Apply                  TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The nurse knows that the primary purpose of the Patient Safety and Quality Improvement Act of 2005 was to
a. create a government agency that tracks all patient safety problems.
b. encourage sharing of information to promote a culture of safety.
c. mandate patient safety programs and prescribe penalties for errors.
d. require hospitals create quality improvement initiatives for safety.

 

 

ANS:  B

The primary purpose of this act was to encourage health care institutions to share information related to safety issues in a safe environment. This allows for trends to be identified that can be mitigated through safety programs and process improvement, thus creating a culture of safety.

The primary purpose of this act was not to create a new government agency to track safety problems.

The primary purpose of this act was to create a safe environment in which information can be shared to help create a culture of safety, not to penalize those who commit errors.

The Patient Safety and Quality Improvement act of 2005 does not require quality improvement initiatives.

 

DIF:    Cognitive Level: Remember           REF:   345

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nursing manager is concerned about professional sanctions that might result if several near-miss episodes are reported to a Patient Safety Organization (PSO) under the Agency of Healthcare Research and Quality (AHRQ). The chief nurse executive explains to the manager that under the Patient Safety and Quality Improvement Act of 2005,
a. certain critical errors or near misses can be penalized under law.
b. PSOs only provide safety initiative information data to the AHRQ.
c. state legislatures are able to sanction facilities under the 2005 Act.
d. this information is confidential and protected from legal action.

 

 

ANS:  D

PSOs maintain strict confidentiality, and their work products are protected against legal action. This helps encourage reporting and a culture of safety.

Saying that certain critical errors or near misses can be penalized under law does not address the manager’s concern.

Information about errors and near-miss episodes is handled through PSOs.

Saying that state legislatures are able to sanction facilities under the 2005 Act does not address the manager’s concern.

 

DIF:    Cognitive Level: Understand          REF:   345

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The nurse defends DHHS reporting of successful medical error reduction initiatives to Congress by summarizing that
a. Congress has oversight when safety is poor.
b. congressional members oversee state reporting.
c. laws are created to meet patient safety needs.
d. increasing patient safety is national priority

 

 

ANS:  D

The Patient Safety and Quality Improvement Act of 2005 was passed by Congress to address critical national patient safety issues and foster a culture of safety nationwide.

Congress does not begin the oversight process when safety records are poor.

Congressional representatives do not oversee individual state reporting.

Laws have been created to address patient safety issues, but this is not the main reason why patient safety data are eventually reported to Congress.

 

DIF:    Cognitive Level: Evaluate               TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A hospital has significantly reduced the number of errors and near-miss episodes it has in the past 2 years. An accreditation body visitor might conclude that error and near-miss reductions are most directly related to
a. remediation of individual employees who make errors.
b. policies and procedures that have been created to avoid problems.
c. facility strategies to detect and address any potential problems.
d. staff education in facility patient safety processes.

 

 

ANS:  C

Facilities that operate under a culture of safety encourage all employees to be vigilant in observing for conditions and processes that could potentially lead to errors and near misses.

Individuals who make errors may indeed be given additional education or training, but this is not the best answer because most errors come from system problems.

Facilities should have policies and procedures to help lessen the number of errors or near misses, but without vigilance in finding sources of potential problems, the policies created may not be maximally beneficial.

Educating the staff does not go far enough in preventing errors. The facility needs to make a concerted effort to detect and address potential system problems, as system problems are the most common cause of errors.

 

DIF:    Cognitive Level: Evaluate               TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nursing manager explains to the executive committee that reducing errors requires
a. disciplining staff members who continue to make errors.
b. focusing on systems problems and not blaming individuals.
c. having an anonymous error reporting procedure for staff.
d. holding individuals responsible for the errors they commit.

 

 

ANS:  B

A “just culture” encourages open and honest reporting when errors or near misses occur. The analysis that follows reporting should focus on system flaws and not individual fault.

Having a culture in which individuals are blamed and shamed for their errors reduces the probability of error reporting. If this occurs, no meaningful action can be taken to reduce the likelihood of errors.

A safe mechanism for reporting errors should be available, but if all reporting were anonymous, it would be difficult to track and trend data.

Individuals and organizations should be held accountable for errors if indicated, but most errors are the result of system flaws.

 

DIF:    Cognitive Level: Apply                  TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The nursing manager understands that the phrase “active failure” in regard to patient safety means a(n)
a. system process is actively injuring patients and needs modification.
b. workplace practice is actively contributing to poor patient outcomes.
c. error has actively caused a patient to have a negative consequence.
d. unsafe act was committed by someone in direct contact with patients.

 

 

ANS:  D

An active failure is an unsafe act committed by a person in direct contact with the patient. This is directly opposite a latent failure, which is caused by a systems problem.

An active failure is caused by a person in direct contact with the patient, not by a systems process.

An active failure is caused by a person in direct contact with the patient, not by a workplace practice per se.

An active failure is an unsafe act committed by a person in direct contact with the patient.

 

DIF:    Cognitive Level: Remember           REF:   346

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A manager is concerned with the number of medication errors occurring on their unit. The manager determines that these errors represent latent errors when an investigation reveals that
a. many nurses are not using two different forms of patient identification.
b. nurses do not take the time to have high-risk medications double checked.
c. the medication bar codes are often unreadable by the computer scanner.
d. to save time, nurses gather all their patients’ medications at one time.

 

 

ANS:  C

Using bar codes that are unreadable to the computer scanner is a system problem, otherwise known as a latent failure.

Failure to use two different forms of patient identification is an error committed by individuals who have direct patient contact. This is known as an active failure.

Nurses failing to double check high-risk medications is an error committed by individuals who have direct patient contact. This is known as an active failure.

Nurses gathering all of their patients’ medications at one time is an error committed by individuals who have direct patient contact. This is known as an active failure.

 

DIF:    Cognitive Level: Analyze               TOP:   Nursing Process: Analysis

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. An accreditation body visitor is touring a facility that has been designated as a High Reliability Organization (HRO). The visitor could reasonably conclude that this facility’s nursing staff
a. is highly reliable in preventing errors.
b. has a reliable patient safety record and is a model for hospitals.
c. is constantly alert for systems processes that could lead to errors.
d. reliably reports all patient care errors to the appropriate body.

 

 

ANS:  C

An HRO has employees who are constantly alert for things that could go wrong and ways to recognize and recover from mistakes if they are made.

An HRO is not defined by whether or not it employs nursing staff that is highly reliable in preventing errors.

An HRO is not defined by whether or not it has a reliable patient safety record or is a model for hospitals.

An HRO is not defined by whether or not it reliably reports all patient care errors to the appropriate body.

 

DIF:    Cognitive Level: Evaluate               TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nurse is working with a patient who seems changed from earlier in the shift. The nurse cannot pinpoint exactly what has changed but is concerned that the patient is getting worse. The best action by the nurse would be to
a. call the physician and voice concerns about the patient’s status.
b. consult with the charge nurse and ask for his or her opinion.
c. continue monitoring the patient, looking for distinct changes.
d. document the findings and reassess the patient in an hour.

 

 

ANS:  A

Nurses should listen to their inner voices and confidently voice concerns, in this case by calling the physician about the patient’s status.

Consulting with someone who has more expertise is always a good idea, but the best option is for the nurse to voice concerns to the physician.

Waiting for distinct changes to occur before reporting the patient’s status may lead to a poor outcome. Many times the patient deteriorates significantly before showing distinct symptoms. Nurses often report that “something was not right” with a patient who later worsens.

Documentation is important, but if the nurse feels the patient is getting worse, waiting an hour to reassess would not be in the interest of patient safety.

 

DIF:    Cognitive Level: Apply

TOP:   Integrated Process: Communication and Documentation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nursing manager explains to a group of newly hired graduate nurses that maintaining situational awareness means
a. being aware of possible problems encountered in patient situations.
b. remaining aware of patient status and how it can change quickly.
c. the ability to recover quickly from mistakes once they do occur.
d. understanding how everyone’s role is related to patient outcomes.

 

 

ANS:  D

The nurse must understand everyone’s role in the complex health care situation and how each role contributes to patient outcomes. This also includes understanding how problems can occur related to everyone else’s roles.

Being aware of possible problems encountered in patient situations is an important concept for patient safety, but this is not the meaning of situational awareness.

Remaining aware of patient status and how it can change quickly is an important concept for patient safety, but this is not considered situational awareness.

The ability to recover quickly from mistakes when they occur is the concept known as “resiliency.”

 

DIF:    Cognitive Level: Understand          REF:   347

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A manager is counseling a nurse who has violated safety protocols several times. The most appropriate action by the manager is to
a. allow the nurse to continue working only under direct supervision.
b. have the nurse prepare an educational in-service on safety protocols.
c. maintain a confidential file on the nurse’s actions and outcomes.
d. report the behavior to the state board of nursing for discipline.

 

 

ANS:  D

Protection for nurses who commit errors or are involved in near-miss episodes is an important part of a “just culture.” However, according to the Institute of Medicine, protection from disciplinary action from the facility and from regulatory agencies should not be granted in three specific situations: criminal misconduct, active malfeasance, or when reporting an incident has been delayed unnecessarily. This nurse would likely be seen as committing active malfeasance (actively or purposely violates safety protocols) and should be reported to the state board of nursing for discipline.

A nurse who has violated safety protocols on several occasions would most likely be seen as committing active malfeasance by continuing to violate the protocols. The nurse’s behavior should be reported to the state board of nursing for discipline.

Having the nurse prepare an educational in-service on safety protocols might have been an option for the first offense, but continuing to violate safety protocols warrants a much more serious response. The nurse’s behavior should be reported to the state board of nursing for discipline.

Confidentiality when making mistakes is an important part of a “just culture,” in which reporting errors and near misses is institutionalized. However, in the case of repeatedly violating safety protocols, this nurse cannot expect to have the incidents remain confidential. The nurse’s behavior should be reported to the state board of nursing for discipline.

 

DIF:    Cognitive Level: Analyze               TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The nursing executive attempting to incorporate the American Association of Critical-Care Nurses’ (AACN’s) Healthy Work Environment Standards would formulate which policy? The manager would create a policy to
a. encourage all nurses to return to school to complete degrees.
b. limit environmental hazards currently present in the facility.
c. provide discounts to a local fitness center for all employees.
d. use a standard “handoff” report format at change of shift.

 

 

ANS:  D

The AACN standards contain six areas, including skilled communication. Using a standardized handoff tool would improve nurses’ communication skills.

Although important, encouraging all nurses to return to school to complete degrees is not related to the AACN standards.

Although important, limiting environmental hazards currently present in the facility is not related to the AACN standards.

Providing discounts to a local fitness center for all employees would be a nice benefit but is not related to the AACN standards.

 

DIF:    Cognitive Level: Apply

TOP:   Integrated Process: Communication and Documentation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A chief nursing officer (CNO) has been hired to develop a healthy work environment and culture of safety in a hospital with a long record of safety problems and poor patient outcomes. The best initial action by the CNO would be to
a. create a policy where any nurse can stop procedures for a safety check.
b. design team-building events and basic communications in-services.
c. have all nurses in the facility reapply and interview for their jobs.
d. inform nurses that it is their job to report potential safety problems.

 

 

ANS:  B

This culture or environment would be considered immature, so the CNO needs to start with basic building blocks of a safe environment, including teamwork and skilled communication.

Eventually, the CNO would want to implement policies similar to “Stop the Line,” whereby all nurses have the authority to speak up and intervene before problems arise. However, in a facility where even basic safety is an issue (an immature environment), training needs to occur on more basic ideas of safety, such as skilled communication and teamwork.

A culture of safety includes focusing on system problems leading to safety issues, not on individual nurses. Having all nurses reapply for their jobs indicates that because of past problems, only the “best” nurses (or nurses with better safety records) will be retained. It would be better to start fresh by implementing the “just culture” philosophy and move forward without penalizing the staff for past problems.

Informing nurses that it is their job to report potential safety problems would be part of any drive to improve patient safety and outcomes, but this alone will not empower the staff to report problems, especially proactively.

 

DIF:    Cognitive Level: Apply                  TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nursing manager for a cardiac unit wishes to improve collaborative teamwork to improve patient care outcomes. Which action by the manager would best accomplish this goal?
a. Create permanent nurse–aide work groups.
b. Formulate nurse–cardiologist work teams.
c. Implement daily multidisciplinary rounds.
d. Require face-to-face reports between nurses.

 

 

ANS:  C

Implementing daily multidisciplinary rounds would best accomplish the goal because all members of the team would hear about each other’s contributions and how each member views the patient situation. Each member of the team would feel like an important member. When collaboration occurs, patient safety improves.

Creating permanent nurse–aide work groups would help with teamwork and collaboration but only between nurses and nurses’ aides, so this answer is too narrow in focus.

Formulating nurse–cardiologist work teams would help with teamwork and collaboration, but because it only includes two members of the multidisciplinary team, the answer is too narrow in focus.

Requiring face-to-face reports between nurses would help with teamwork and collaboration but only involves the professional nursing staff, so this answer is too narrow in focus.

 

DIF:    Cognitive Level: Apply

TOP:   Integrated Process: Communication and Documentation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nurse applying for a job in a hospital notes that administration promotes accurate and timely reporting of errors and near misses. The facility has a multidisciplinary team to analyze this information as it becomes available and design solutions to identified problems. This nurse could infer that
a. nurses in this facility have a high degree of ownership in patient safety.
b. nursing staff has been penalized in the past for reporting safety protocol violations.
c. the hospital has had some significant issues with patient safety in the past.
d. this facility’s culture would be considered “immature” related to safety.

 

 

ANS:  A

To maintain a strong culture of safety, nurses need to have ownership and a sense of personal responsibility in promoting a work environment that prioritizes patient safety.

In a culture where proactive reporting of safety problems and timely reporting of errors is the norm, nurses need to feel safe from disciplinary action when they make such reports.

It may or may not be true that the hospital has had some significant issues with patient safety in the past; one cannot tell from the information given.

An immature safety culture should focus on teamwork and communication skills; this environment is more mature, with a focus on more advanced safety concepts.

 

DIF:    Cognitive Level: Evaluate               TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A chief nursing officer (CNO) wishes to integrate the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) model of teamwork training into the hospital where the CNO works. The first action by the CNO should be to
a. design training for onsite trainers.
b. determine readiness for such training.
c. investigate specific training models.
d. pick high-risk areas to start training.

 

 

ANS:  B

The first phase of teamwork training should be to conduct a preassessment to determine the facility’s readiness to change. Using the TeamSTEPPS program, this occurs in phase 1.

Designing training for selected onsite trainers would be part of phase 2, in which members are trained.

Because the CNO has already decided on a specific model to use, this means that investigating specific training models has already been done.

After the CNO determines readiness, phase 2 consists of a “train the trainer” approach, which is then implemented in identified high-risk areas first. This is part of phase 3.

 

DIF:    Cognitive Level: Apply                  TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A chief nursing officer (CNO) has implemented a model for teamwork training in the facility. The model seems to be working in some areas but not in others. The best action by the CNO would be to
a. assess for formal and informal leaders who oppose the plan.
b. inform the staff that teamwork improves safety and is expected.
c. provide more education and training on benefits of the model.
d. rotate staff between areas with different levels of acceptance.

 

 

ANS:  A

The most important element of a teamwork training program is the support of both formal and informal leaders. The CNO should assess for any change agents within the facility who do not support the program and whose attitudes might be sabotaging the program.

Informing the staff that teamwork improves safety and is expected would be part of the educational process. This information, provided in isolation, might make the staff resentful that this is being forced upon them.

More education and training might be needed, but the CNO first needs to find out whether there are leaders who are not supportive of the plan.

Rotating staff members to different areas would create confusion and possibly decrease patient safety because nurses could be forced to work in areas in which they had no expertise.

 

DIF:    Cognitive Level: Apply                  TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The practicing nurse knows the following factor contributes to more patient injuries and death than the other factors.
a. Communication failures
b. High-technology equipment
c. Medication administration
d. Performing high-risk tasks

 

 

ANS:  A

Communication failures are the leading cause of preventable patient injuries and death, according to The Joint Commission.

High-technology equipment is not the leading cause of preventable patient injuries and death, according to The Joint Commission.

Medication administration is not the leading cause of preventable patient injuries and death, according to The Joint Commission.

Performing high-risks tasks is not the leading cause of preventable patient injuries and death, according to The Joint Commission.

 

DIF:    Cognitive Level: Remember           REF:   349

TOP:   Integrated Process: Communication and Documentation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A newly hired graduate nurse is asking the preceptor why the facility uses a standardized template for change-of-shift reports. The preceptor explains that this template is used to
a. decrease communication failures at a risky time.
b. decrease reports containing frivolous information.
c. ensure all nurses get the same patient information.
d. make it easier for nurses to remember what to say.

 

 

ANS:  A

Communication failures are the leading cause of patient injury and death, and change-of-shift or handoff reports are a time when communication failures often occur.

Eliminating frivolous information from shift reports would certainly be beneficial, because nurses are more likely to listen to reports that are to the point, but this is not the main reason for standardizing shift report.

Using a standardized handoff report does ensure that nurses all get the same information about their patients, but this is secondary to minimizing the chance of a communication failure during a high-risk time.

A minor benefit of using a standardized reporting format is that it makes it easier for nurses to remember what to say, but this is secondary to minimizing the chance of a communication failure during a high-risk time.

 

DIF:    Cognitive Level: Understand          REF:   350 | Table 20-3

TOP:   Integrated Process: Communication and Documentation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nurse is explaining to a student that SBAR is a type of
a. format for conducting a debriefing.
b. process for multidisciplinary meetings.
c. standardized patient chart template.
d. structured communication strategy.

 

 

ANS:  D

SBAR is a structured communication strategy and stands for situation, background, assessment, and recommendation.

SBAR is not a format for conducting debriefings.

SBAR is not a process used in multidisciplinary meetings.

SBAR is not a template for standardized patient charting.

 

DIF:    Cognitive Level: Understand          REF:   350 | Table 20-3

TOP:   Integrated Process: Communication and Documentation

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

MULTIPLE RESPONSE

 

  1. The nurse explains that benefits of the Patient Safety and Quality Improvement Act of 2005 include (Select all that apply.)
a. being able to learn from the mistakes of others.
b. finding trends amenable to quality improvement.
c. financial rewards to facilities that reduce errors.
d. having data that can be aggregated into trends.
e. tax breaks if facilities show quality improvement.

 

 

ANS:  A, B, D

One of the benefits that this act provides is being able to learn from others’ mistakes through sharing of information.

With information available, trends can be identified that can be resolved through program or process improvement activities.

Having a large pool of data means that trends can be identified.

This act does not provide financial rewards to facilities.

The act does not provide for tax breaks.

 

DIF:    Cognitive Level: Understand          REF:   345

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The nurse working in health care today understands the ways in which the Patient Affordable Care Act (ACA) will affect patient safety. Which are the ways this is true? (Select all that apply.)
a. Create incentives for hospitals to participate in Patient Safety Organizations (PSOs).
b. Exempt hospitals from participating in the Patient Safety and Quality Improvement Act.
c. Mandate that hospitals begin reporting safety events to Patient Safety Organizations (PSOs).
d. Permit hospitals to discipline employees for safety failures and near misses.
e. Require hospitals establish a patient safety evaluation system.

 

 

ANS:  A, C, E

Provisions of the ACA related to patient safety include creating incentives for hospitals to participate in PSOs, mandating reporting of safety events to PSOs, and requiring hospitals to establish patient safety evaluation systems.

Exemption from patient Safety and Quality Improvement Act is not a feature of the ACA.

Permitting disciplinary measures for errors and near misses is not a feature of the ACA.

 

DIF:    Cognitive Level: Understand          REF:   345

TOP:   Integrated Process: Teaching/Learning

MSC:  NCLEX Client Needs: Safe and Effective Care Environment: Safety and Infection Control

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