Contemporary Nursing Issues, Trends, & Management 6th Edition by Barbara Cherry- Test Bank

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Contemporary Nursing Issues, Trends, & Management 6th Edition by Barbara Cherry- Test Bank

Chapter 02: The Contemporary Image of Professional Nursing

Test Bank

 

MULTIPLE CHOICE

 

  1. Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by 2020?
a. Positions that historically required registered nurses will be filled by unlicensed personnel.
b. The job growth rate for RNs will surpass job growth in all other occupations.
c. The need for hospital nurses will dramatically decrease.
d. Hospitals will finally achieve the required RN workforce.

 

 

ANS:  B

Correct: In 2020, the United States is projected to have only 64% of the registered nursing workforce required to meet the demand for RNs.

Incorrect:

  1. Unlicensed personnel will not be filling positions for nurses because this group does not have the education needed to provide such care.
  2. The need for hospital nurses will dramatically increase, not decrease.
  3. Hospitals will not have enough nurses as stated per statistics.

 

DIF:    Knowledge     REF:   p. 23

 

  1. What effect did the movie One Flew Over the Cuckoo’s Nest have on health care?
a. Funding for mental health care increased, allowing the point of care to change from the community to standardized institutional care.
b. The public and the nursing profession were made aware of the rights of vulnerable populations.
c. Nurses were seen as advocates for individuals who cannot advocate for themselves.
d. Funding for nursing traineeships was eliminated.

 

 

ANS:  B

Correct: One Flew Over the Cuckoo’s Nest reminded us that all individuals have rights and that it is the responsibility of the public and health care professionals to ensure that these rights are protected.

Incorrect:

  1. The context for the care of patients with mental disability did not change as a result of the movie.
  2. One Flew Over the Cuckoo’s Nest portrayed nurses as the enforcers of the system.
  3. Funding for nursing traineeships was not eliminated. Rather, the Nurse Training Act was established in 1964.

 

DIF:    Comprehension                              REF:   p. 25

 

  1. Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever during the Spanish-American War?
a. Florence Nightingale
b. Margaret Hoolihan
c. Clara Maas
d. Sairy Gamp

 

 

ANS:  C

Correct: Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever.

Incorrect:

  1. Florence Nightingale is the founder of professional nursing.
  2. Margaret Hoolihan is a character on a TV show, not an actual nurse.
  3. Sairy Gamp is a character in a Charles Dickens novel.

 

DIF:    Knowledge     REF:   p. 25

 

  1. A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates caring by holding a soldier’s head is an artistic representation of nurses who served in which war?
a. World War I
b. World War II
c. Spanish-American War
d. Vietnam War

 

 

ANS:  D

Correct: This statue represents the caring provided by nurses during the Vietnam War.

Incorrect:

  1. There is no statue that represents nursing during World War I.
  2. There is no statue that represents nursing during World War II.
  3. There is no statue that represents nursing during the Spanish-American War.

 

DIF:    Knowledge     REF:   p. 25

 

  1. What was the purpose of the Nurse Reinvestment Act of 2002?
a. Provided disability insurance to RNs who contract a life-threatening illness while on duty
b. Funded public service announcements that promote unlicensed caregivers as an alternative to professional nurses
c. Focused on nurse retention and safety enhancement grants
d. Provided pediatric nursing training grants

 

 

ANS:  C

Correct: This act provided nursing scholarships, public service announcements promoting nursing as a career, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants.

Incorrect:

  1. This act does not provide disability insurance to RNs.
  2. These funds do not promote unlicensed caregivers as an alternative to professional nurses.
  3. This act provides for geriatric training grants, not pediatric training grants.

 

DIF:    Knowledge     REF:   p. 23

 

  1. Potential nursing students are concerned about choosing a profession with job security and ask the recruiter, “Because more people are choosing nursing, will I have a job in a few years?” The recruiter answer that by 2025, on the basis of the U.S. Bureau of Labor Statistics prediction:
a. positions that have historically required RNs will be filled by foreign nurses.
b. the nursing shortage will increase twofold, the largest shortage in almost 50 years.
c. the need for hospital nurses will dramatically decrease as nurses reenter the profession.
d. hospitals will finally achieve the required RN workforce, reducing the need for more RNs.

 

 

ANS:  B

Correct: According to the U.S. Bureau of Labor Statistics, the nursing shortage is predicted to be twice as large as any previous shortage since Medicare and Medicaid in 1965.

Incorrect:

  1. The number of foreign nurses arriving in the United States is not sufficient to cure the shortage, and a large number of these nurses are unsuccessful on the NCLEX-RN®, resulting in an inability of foreign RNs to practice.
  2. Although slightly more than half of all nurses practice in hospitals, 84.8% of its licensed members are currently in nursing practice. Thus, reentering RNs will not dramatically reduce the shortage.
  3. Even by 2025, it is projected that the United States will need 260,000 more RNs than will be available.

 

DIF:    Comprehension                              REF:   p. 23

 

  1. Charles Dickens’ character Sairy Gamp:
a. portrayed nurses as trained professional individuals who put others before themselves.
b. chose nursing because she had no other avenue for employment.
c. was a prostitute who took advantage of sick old men.
d. characterized nurses as being at the forefront of technology and autonomy.

 

 

ANS:  B

Correct: Sairy Gamp endured nursing because of the lack of other opportunities.

Incorrect:

  1. Sairy Gamp did not portray a professional image of nursing, but that of an untrained caregiver who profited from the sick and dying.
  2. Sairy Gamp was a nurse who used her position to take advantage of her patients.
  3. Dickens’ portrayal of a nurse does not suggest that the nurse is at the forefront of technology and autonomy.

 

DIF:    Knowledge     REF:   pp. 23-24

 

  1. What does the Spirit of Nursing statue honor?
a. Florence Nightingale’s accomplishments in public health
b. Edith Cavell’s attempt to help the victims of the Tuskegee experiment seek treatment
c. Clara Maas, who found the cure for yellow fever during WWII
d. All military nurses for their bravery and compassion

 

 

ANS:  D

Correct: The statue the Spirit of Nursing was created to honor all military nurses.

Incorrect:

  1. The statue does not seek to honor Florence Nightingale.
  2. Nurse Rivers was the nurse who attempted to help the victims of the Tuskegee experiment.
  3. The statue does not honor Clara Maas, and Clara Maas did not find the cure for yellow fever.

 

DIF:    Knowledge     REF:   p. 24

 

  1. Although the media portrayed nursing in a negative light in M*A*S*H through the character of a promiscuous, uncaring nurse, it also provided Americans with a promising glimpse of:
a. nurses who can be promiscuous and still help doctors.
b. the fact that caring is not as important as the desire to serve one’s country.
c. the ability of nurses to cope with the dreadfulness of war by using humor.
d. the contributions of male military nurses.

 

 

ANS:  C

Correct: The sitcom M*A*S*H did show humor as a coping mechanism for nurses in a war setting.

Incorrect:

  1. M*A*S*H’s portrayal of promiscuous nurses has no merit because nurses assist physicians.
  2. The sitcom addressed both factors as part of the nurse’s role in the military.
  3. No male nurses were portrayed in the sitcom.

 

DIF:    Knowledge     REF:   p. 25

 

  1. With the crisis in health care and the nursing shortage, why is the image of nursing still important?
a. Nursing care is often delivered during a time of uncertainty, and the image of nurses during this time can reinforce trust in the nurse-patient relationship.
b. Physicians have a distinctive body of knowledge that identifies them as professionals, whereas nursing has yet to develop a unique body of knowledge on which to base practice.
c. Nurses must present a unified image if they hope to ever establish nursing as a profession.
d. The dynamic state of today’s health care requires nurses to move from a caring image to one of technologic competence.

 

 

ANS:  A

Correct: A person who seeks health care is entering a world of uncertainty. The nurse provides continuity and compassion and stabilizes the environment of the patient.

Incorrect:

  1. Nursing has a unique body of knowledge.
  2. Nursing is a profession. Unification will enhance the professional goals for nursing.
  3. Caring will always be part of the nursing image, and nurses have already moved into the technologic realm.

 

DIF:    Comprehension                              REF:   pp. 22-23

 

  1. Nurses can combat the nursing shortage by:
a. joining unions, which influence employers to provide incentives such as pay raises and free child care, thus encouraging the large percentage of nonworking nurses to return to the workforce.
b. demanding that the requirements of the qualifying examination for foreign nurses should be reduced, so they are eligible to sit for the licensure examination.
c. working more hours with a higher nurse/patient ratio.
d. advocating for funds to pay for nursing education and a safer work environment.

 

 

ANS:  D

Correct: Advocating for funds to pay for nursing education and a safer work environment is a positive strategy, as can be seen by results attained after the Reinvestment Act P.L. 107-205 provided $20 million for nursing scholarships, public service announcements, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This is the best defense against the nursing shortage. Nursing graduates in many states have increased in number, and enrollment in nursing schools is also on the rise.

Incorrect:

  1. Unions are not the answer to the nursing shortage. This approach would make access to health care more difficult, and the nursing shortage would only increase because efforts to attract nurses from younger generations would be reduced by the fact that funding for exposure to nursing would most likely decrease.
  2. Lowering standards would increase the chance for errors, cause patient care standards to become lower, and harm the image of nursing.
  3. As the acuity level of patients increases, the nurse/patient ratio should be lowered. Facts reveal that lower nurse/patient ratios reduce errors and decrease mortality rates.

 

DIF:    Application    REF:   p. 23

 

  1. The demographics of the twenty-first century nursing population indicate that:
a. individuals entering nursing are second-degree students who average 45 years of age.
b. more white nurses enter and obtain graduate degrees than any other ethnic group.
c. the highest level of nursing education for most RNs is an associate degree.
d. the majority of nurses practice in hospitals.

 

 

ANS:  D

Correct: Fifty-six percent of nurses practice in hospitals.

Incorrect:

  1. There is an influx of new graduates less than age 30, which has slowed the aging of the profession.
  2. More African-Americans are entering graduate school.
  3. The highest level of nursing education is most often the baccalaureate degree.

 

DIF:    Comprehension                              REF:   p. 28

 

  1. A nursing student asks, “I wonder if the reason that the nursing shortage is so severe is that registered nurses are unhappy with their jobs.” To research the answer, the National Survey of Registered Nurses was reviewed and found:
a. registered nurses change employers every year to prevent burnout and to keep the nursing shortage from increasing.
b. nursing faculty are aging or leaving academia due to increased work demands and generational difference from students.
c. practicing registered nurses are satisfied with their job and most remain with same employer they worked for the previous year.
d. registered nurses were the least satisfied with their job of all health care providers.

 

 

ANS:  C

According to the latest National Sample Survey of Registered Nurses (NSSR), 79.8% of practicing RNs were satisfied with their job and 88.4% were with the same employer as they had been in the preceding year (U.S. Department of Health and Human Services, 2010). Among all RNs, nursing faculty are the most satisfied (86.6%).

 

DIF:    Application    REF:   pp. 27-28

 

  1. A registered nurse is on break and checking emails. One email contains a picture of a celebrity who is a patient in the hospital, and on the same floor, where the nurse works. Included with the photo is a message, “check out my Facebook,” which contains additional photographs of the patient. The nurse immediately deletes the picture to prevent having to report the “friend” to supervisors. Based on the action of the nurse who received the message, which statement is correct?
a. The nurse is not at risk for having his/her license suspended since removing the photos made them temporary and invisible to all others.
b. Because the nurse did not send the message and immediately deleted the photo, there is no risk for discipline.
c. Failing to report receiving the message places the nurse at risk for discipline.
d. Because the patient is on the same floor as the one on which the nurse works, the information can be ethically and legally shared.

 

 

ANS:  C

Correct: Failing to report the image can result in discipline.

Incorrect:

  1. Removing a posting or a picture from a website does not make it unavailable because it is retrievable.
  2. Nurses who have received patient pictures and not immediately reported the problem have been subject to the same discipline as nurses who sent the pictures.
  3. Information posted on social media can be viewed by others who are not providing health care—even the public.

 

DIF:    Application    REF:   p. 26

 

  1. A nurse executive is concerned that the mortality rate in his/her hospital exceeds the national average and searches the literature finding Aiken’s 2011 Survey on the effects of nurse staffing and education on mortality, including work environment. If Aiken’s recommendations are followed, which change would be most effective?
a. Increasing staffing ratios to include more nurses of all levels of educational preparation on all shifts
b. Employing bachelor’s prepared nurses who participate in interprofessional rounds with attending physicians where their voices are heard
c. Ensuring nurse managers and administrators have at minimum a Master’s degree
d. Encouraging all unlicensed assistive personnel to attend educational programs to be certified

 

 

ANS:  B

Aiken (2011) found that simply increasing the number of RNs was not the only answer to reduce mortality. Increasing the number of BSN-prepared nurses along with developing a positive work environment had the most impact on reducing mortality. The impact on reducing mortality by increasing the educational level of nurse managers/administrators and certified unlicensed assistive personnel was not documented.

 

DIF:    Application    REF:   p. 29

 

  1. A student nurse signs the nurses’ notes in the patient’s record as, Mary Smith, RN (pending graduation 2015). According to the International Council of Nurses, which individual can use the title “nurse”?
a. Any student nurse who has completed at least 50% of the education program in which he or she is enrolled
b. Any graduate of an accredited nursing program who has taken the NCLEX-RN® and is waiting on test results
c. The nursing assistant who is assigned by the registered nurse to “help out” by performing health histories on newly admitted stable patients
d. An individual who has successfully passed the NCLEX-RN®

 

 

ANS:  D

Correct: According to the International Council of Nurses, the title “nurse” is reserved for the registered nurse. Only an individual who has passed the NCLEX-RN can use the title.

Incorrect:

  1. A student nurse should not use the title “nurse,” rather should indicate that he or she is a student nurse and sign accordingly.
  2. Until an individual is notified that he/she has passed the NCLEX-RN®, the title “nurse” is not used.
  3. The nursing assistant who accepts the “role” of the registered nurse may not use the title and is practicing outside the bounds of the role of certified UAP.

 

DIF:    Application    REF:   p. 29

 

  1. A physician complains to administration that the nurse working last evening is unethical, based on observing the nurse educate the patient about a new medication ordered. The physician demanded the nurse be reprimanded and reminded that only physicians have the educational background to teach patients about new medications. Which comment and action by the administrator would be most effective in changing nurse-physician relationships in this instance?
a. Inform the nurse, “You will be suspended for 3 days for going beyond your job description,” and enforce the 3-day suspension because the physician did not write the order to “teach the patient about the new medication”
b. Advise the physician that only nurses can teach patients about medications; the physician’s role is to only prescribe. No action will be taken against the nurse.
c. After investigating the situation, thank the physician while also providing information that patient education related to medication is within the scope of practice of registered nurses. Share the physician’s concern and administrator’s response with the nurse so both parties are aware of the resolution of the concerns.
d. Contact the patient’s family and ask, “Do you prefer that all teaching related to medications be performed by the physician rather than the nurse” to determine what action to take.

 

 

ANS:  C

Correct: Investigating the situation to provide evidence is the first step. Once the facts are known, action can be taken. In this instance, including the ethics committee would help ensure an unbiased decision.

Incorrect:

  1. The nurse should not be suspended unless an error occurred.
  2. Both physicians and nurses are prepared to teach patients.
  3. The patient’s family should not be involved at this point. The scope of practice of the RN allows for patient teaching.

 

DIF:    Application    REF:   pp. 29-30

 

  1. Which nurse best portrays nursing as a “knowledge worker”?
a. Nurse in matched scrubs with lab coat, hair back, small stud earrings
b. Nurse in mismatched scrubs, no lab coat, large hoop earrings
c. Nurse in white uniform with apron with no jewelry/hair back
d. Nurse with nose ring and eyebrow piercing with starched white uniform and cap

 

 

ANS:  A

Correct: Nursing scrubs have become a popular alternative to the traditional white uniform; clean wrinkle free matching scrubs presented a professional image. Small stud earrings reduce risk of injury to nurse when caring for confused or combative patients.

Incorrect:

  1. Mismatched scrubs may be interpreted as someone who doesn’t take an interest in the profession or lacks time management.
  2. White uniforms have been replaced by scrubs in most healthcare facilities. The apron was used by student nurses from the past who also were restricted from wearing jewelry. Having the hair pulled back continues today to adhere to infection control policies that prevent hair from entering sterile fields or falling in patients personal space. Many feel the white uniform is associated with a time when nurses had less voice in patient care and were “handmaidens” to physicians.
  3. Caps were discontinued due to infection control. Most healthcare agencies prohibit nurses from visible piercing other than one small stud earring per ear.

 

DIF:    Application    REF:   pp. 28-29

 

MULTIPLE RESPONSE

 

  1. According to current data related to the nursing shortage: (Select all that apply.)
a. salaries of nurses are competitive with those of other professionals such as teachers.
b. only 16.8% of nurses are minorities.
c. overall, nurses are satisfied with their jobs but leave the profession because of fear of contracting fatal diseases.
d. the employment opportunities for nurses continue to be strong.
e. staff nurses are returning to school to obtain certificates to teach nursing.

 

 

ANS:  B, D

Correct:

  1. Only 16.8% of nurses are minorities.
  2. RNs have one of the highest growth rates of employment of all occupations.

Incorrect:

  1. Salaries are not a problem related to the nursing shortage. Most facilities are willing to increase salaries and benefits for nurses.
  2. It has not been documented that nurses are afraid of contracting a fatal disease. Nurses take precautions to reduce this risk.
  3. There is a shortage of nursing faculty, and graduate education is required rather than certificates to teach nursing.

 

DIF:    Knowledge     REF:   p. 23 | p. 28

 

  1. A group of new graduate nurses is asked to speak to a group of politicians to describe the current state of professional nursing and how best to alleviate the nursing shortage. Which statements accurately portray professional nursing today and tomorrow? (Select all that apply.)
a. More RNs attain a bachelor’s degree than an associate degree or diploma.
b. Because of pressure to shorten length of stay in hospitals, more RNs practice in outpatient settings and home health than in acute care settings.
c. The most popular advanced practice specialty is nurse anesthesia.
d. White nurses are more likely to enter graduate school than nurses from other ethnic groups.
e. Nursing represents the largest health care professional group, followed by medical doctors.

 

 

ANS:  A, E

Correct:

  1. Recipients of BSN degrees represent the largest graduating educational profile (47.2%).
  2. Nurses make up the largest group of health care professionals.

Incorrect:

  1. Slightly more than half of all nurses practice in acute care hospitals.
  2. Nurse practitioners constitute the majority of advanced practice nurses (APRNs).
  3. Minority nurses are more likely to enter graduate school than white nurses.

 

DIF:    Comprehension                              REF:   p. 28

 

  1. Which actions would result in a greater number of nurses entering and staying in practice, given today’s state of nursing? (Select all that apply.)
a. Determine why few African-American women enter graduate school.
b. Provide incentives for minorities and men to enter nursing.
c. Obtain grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs.
d. Survey nurses to determine why their job satisfaction is lower than that of other health care professions.
e. Develop ad campaigns that target younger students.

 

 

ANS:  B, C, E

Correct:

  1. Core solutions to the nursing shortage include providing incentives for minorities and men to enter nursing.
  2. Core solutions to the nursing shortage include obtaining grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs.
  3. Core solutions to the nursing shortage include developing ad campaigns that target younger students.

Incorrect:

  1. Determining why few African-American women enter graduate school would not result in a greater number of nurses entering and staying in practice.
  2. Job satisfaction among nurses is currently high.

 

DIF:    Comprehension                              REF:   p. 23

 

  1. The Nurses of America’s media campaign raised awareness of which aspects of nursing? (Select all that apply.)
a. Nurses are expert clinicians.
b. A higher nurse/patient ratio is needed.
c. Nurses are invisible in the news media.
d. Nurses are caring.
e. Nurses are well paid.

 

 

ANS:  A, C

Correct:

  1. The campaign was designed to convey to the public that nurses are expert clinicians.
  2. A strategically important part of the campaign raised consciousness among nurses of the invisibility of nursing in the news media.

Incorrect:

  1. Lower nurse/patient ratios are needed.
  2. It was not a focus of the campaign to let the public know that nurses are caring.
  3. The campaign did not focus on the financial aspects of being a nurse.

 

DIF:    Comprehension                              REF:   pp. 27-28

 

OTHER

 

  1. Place the five most ethical professionals in descending order, according to the 2011 Gallop Poll ranking. Put a comma and space between each answer choice (for example: a, b, c, d).
  2. Police officers
  3. High school teachers
  4. Medical doctors
  5. Nurses
  6. Pharmacists

 

ANS:

d, e, c, b, a

Only in 2001 did firemen rank higher than the other four professions. In the 2011 Gallup poll on ethical professions, 84% of the public rated nurses as the most ethical; followed by pharmacists (73%), medical doctors (70%) high school teachers (62%), and police officer (54%).

 

DIF:    Comprehension                              REF:   p. 27

 

Chapter 14: Information Technology in the Clinical Setting

Test Bank

 

MULTIPLE CHOICE

 

  1. Consumers are concerned with security issues related to their confidential health information being placed in an electronic health record (EHR). However, when the security of the EHR is compared with that of paper-and-pencil records, the EHR is:
a. more secure.
b. less secure.
c. equivalent.
d. not comparable with the paper-and-pencil record.

 

 

ANS:  A

Correct: Computer-based patient record systems, such as EHRs, provide better protection than paper-based systems. The EHR allows only authorized users to view data, and access to records can be audited for inappropriate use.

Incorrect:

  1. With paper-and-pencil medical records there is no way to limit who views the health information or determine how often confidentiality is breached.
  2. The EHR must comply with strict laws and regulations related to confidentiality, as well as to the aforementioned security functions.
  3. The paper-and-pencil record cannot ensure the same level of security as found in computer-based systems.

 

DIF:    Comprehension                              REF:   p. 259

 

  1. During a search for the term informatics, when the nurse finds the domain “.edu,” the site is affiliated with a(n):
a. government agency.
b. commercial site.
c. educational institution
d. Internet service provider.

 

 

ANS:  C

Correct: The domain of an educational institution is .edu.

Incorrect:

  1. The domain of a government site is .gov.
  2. The domain of a commercial site is .com.
  3. The domain of an Internet service provider is .net.

 

DIF:    Knowledge     REF:   p. 264

 

  1. When paper-and-pencil medical records are compared with computer-based records:
a. paper-and-pencil records provide controls to determine who has viewed the health information.
b. information contained in a paper-and-pencil record has the capability of being more in-depth than that found in computer-based records.
c. patients have the right to know that the confidentiality of their records is strictly maintained, regardless of the type of medical record used.
d. patients must sign for each item of information released on the computer record.

 

 

ANS:  C

Correct: Regardless of the type of record used, the Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality of the patient’s medical information and imposes legal consequences for those who breech confidentiality.

Incorrect:

  1. The computer-based record has security controls that limit or prohibit entry by unauthorized users and that track attempts to access the record.
  2. Information in the computer-based record is more comprehensive than that found in a linear paper record.
  3. Patients may sign a release one time for information to be released to entities such as an insurance company.

 

DIF:    Application    REF:   p. 259

 

  1. A nurse is preparing a scholarly publication on the prevalence of hepatitis A worldwide. The most efficient and effective means of conducting an Internet search to gather information for this publication is to use:
a. a search engine such as Google or Yahoo.
b. a consumer health website.
c. a decision support system.
d. MEDLINE database.

 

 

ANS:  D

Correct: MEDLINE is one of the scientific and research scholarly databases, and it would be the most appropriate for use in gathering information for a scholarly publication.

Incorrect:

  1. If the information is broad and general, one would use a search engine such as Google or Yahoo.
  2. If the nurse is collecting data that are to be presented to the consumer, one would use a consumer health website.
  3. A decision support system allows for the input of data such as clinical manifestations and medications and, with the use of a link to a knowledge software system, is able to produce a decision.

 

DIF:    Application    REF:   p. 264

 

  1. A consumer is learning about electronic health records at a local health fair and states, “I am worried that someone can read my health information and I really don’t understand the difference between privacy and confidentiality.” The nurse explains that an example of confidentiality would be:
a. a pledge that states, “I will hold matters pertaining to my patients in strict intimacy.”
b. a patient who does not tell the physician that he has been treated for a sexually transmitted disease.
c. a teenager who sustains a broken arm and in the emergency department and withholds information about her use of recreational drugs.
d. locking medical records in cabinets to prevent unauthorized users from accessing patient information.

 

 

ANS:  A

Correct: Confidentiality is keeping private the personal information that was given to a health care provider, unless others have a legitimate need to know.

Incorrect:

  1. The right of an individual to keep information about himself or herself from being disclosed to anyone else, including the health care provider, is known as privacy.
  2. The patient has chosen not to divulge personal information to the health care provider; this is privacy.
  3. Locking medical records in cabinets pertains to controlled access, which is security.

 

DIF:    Application    REF:   p. 259

 

  1. A physician has installed a computer-based patient records system. An outside care provider who requests medical information must obtain the patient’s signed consent and then is assigned a password to gain access to the medical information. A monthly audit is conducted to determine for whom and for what purpose patient records have been accessed. This protection is referred to as:
a. privacy.
b. confidentiality.
c. security.
d. data capture.

 

 

ANS:  C

Correct: Security is the limitation of access to health care information through passwords and other precautions.

Incorrect:

  1. Privacy is the right of the patient or individual to not divulge personal information to the health care provider or others.
  2. Confidentiality is keeping personal matters of a patient private from those who do not have a legitimate need to know.
  3. Data capture refers to collecting and entering data into a computer system.

 

DIF:    Application    REF:   p. 259

 

  1. A nurse walks up to a computer in the hallway and presses the index finger to the sensor, thereby gaining access to patient data. A few moments later another nurse performs the same steps and is granted access. A visitor who is watching from a room walks over and places the index finger on the sensor, only to receive an “error and access denied” message. Security is being maintained by:
a. robot technology.
b. biometric technology.
c. telehealth.
d. ubiquitous computing.

 

 

ANS:  B

Correct: Biometric fingerprint identification uses personal characteristics to allow access to health information.

Incorrect:

  1. Robot technology includes the delivery of simulation for rehabilitation, couriers, and language translators and even can be used to interview and examine patients at a distance.
  2. Telehealth involves providing health care for patients located a distance from the provider.
  3. Ubiquitous computing refers to the era when computers are so immersed in everyday life that they become invisible to users.

 

DIF:    Application    REF:   p. 267

 

  1. A nurse who is teaching a class to introduce telehealth to the staff would include which example?
a. A robot performs menial housekeeping chores for an invalid patient.
b. A computer software program alerts the nurse or physician who is reviewing orders that an order for a new drug can cause synergy of the theophylline inhaler.
c. A physician speaks into a computer, and the admission history is recorded and saved in the patient file.
d. While a patient in Wyoming performs peritoneal dialysis, a nurse watches remotely from California to ensure that all steps are being followed correctly.

 

 

ANS:  D

Correct: Telehealth is the delivery of care to a patient who is at a distance from the health care provider.

Incorrect:

  1. Robotic technology involves the delivery of sensorimotor simulation for rehabilitation; language translators can be used to interview and examine patients at distance but is typically not a component of telehealth.
  2. Point-of-care drug references and alerts that can be downloaded into PDAs, and laptops may decrease drug errors. But this is not considered a component of telehealth.
  3. Voice communication systems, which include voice recognition, provide security through recognition of voice in dictation of histories, physicals, and notes related to patient progression.

 

DIF:    Application    REF:   p. 262

 

  1. An advanced practice nurse inputs into a computer software program the following clinical manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of consciousness. The computer diagnosis of fat emboli is generated by a system known as:
a. decision support.
b. telehealth.
c. robotic technology.
d. biometric technology.

 

 

ANS:  A

Correct: Decision support systems are computer-based information systems that include knowledge-based systems designed to support clinical decision making.

Incorrect:

  1. Telehealth allows the provider to treat patients from a distance through electronic submission of data.
  2. Robotic technology includes the delivery of sensorimotor simulation for rehabilitation, language translators, and technology to interview and examine patients at a distance.
  3. Biometric technology is the use of personal characteristics such as fingerprints and hair to gain access to a secure site that contains patient information.

 

DIF:    Application    REF:   p. 256

 

  1. A nurse is preparing a presentation using different websites to collect information. The nurse is concerned that contact information and the author’s credentials are not listed for one of the websites reviewed. Which criterion required to establish a reputable website is missing?
a. Authority
b. Objectivity
c. Usability
d. Currency

 

 

ANS:  A

Correct: Authority is the criterion that is related to the credentials and background that have prepared an author to publish on the subject.

Incorrect:

  1. Objectivity is the criterion that is related to the site’s purpose, intended audience, and sponsorship and to whether the information is fact or opinion.
  2. Usability is the criterion that is related to the maneuverability and overall arrangement of the website.
  3. Currency is the criterion that is related to updated information required because of the dynamic state of health care.

 

DIF:    Application    REF:   pp. 264-265

 

  1. A nurse is interested in locating reliable information concerning noninvasive blood glucose monitoring. Information is located, and the author is a scientist who conducted studies within the last year on the effectiveness of a particular noninvasive blood glucose monitor. The scientist received funding from a pharmaceutical company to support the studies. The URL indicates the pharmaceutical company site.com. The nurse is concerned about this information’s:
a. authority.
b. objectivity.
c. accuracy.
d. currency.

 

 

ANS:  B

Correct: Sites sponsored by organizations such as pharmaceutical companies may influence the content.

Incorrect:

  1. The author, in this case the researcher for the pharmaceutical company, has authority on the topic.
  2. Research studies are referenced.
  3. The study was conducted within the last year.

 

DIF:    Application    REF:   pp. 264-266

 

  1. A nurse providing care at the bedside receives an “alert” that a patient’s stat potassium level is 2.5 and digoxin (Lanoxin) is scheduled. The nurse holds the medication and prevents a possible complication. This feature of the Electronic Health Record is available through which core function of EHR?
a. Order entry/order management
b. Decision support
c. Patient support
d. Administrative support

 

 

ANS:  B

Correct: Decision support provides reminders about preventive practices, such as immunizations, drug alerts for dosing and interactions, and clinical decision making.

Incorrect:

  1. Order entry/order management eliminates lost orders and illegible handwriting, generates related orders automatically, monitors for duplicate or contradictory orders, and reduces time to fill orders.
  2. Patient support provides computer-based patient education and home monitoring where applicable.
  3. Administrative support includes functions related to scheduling systems, billing and claims management, insurance eligibility, and inventory management.

 

DIF:    Application    REF:   p. 256

 

  1. A nurse works on a unit where electronic health records (EHR) are being initiated and asks, “What is meant by ‘meaningful use’ standards that are in our education packet?” The best answer is that “meaningful use”:
a. identifies a set of EHR proficiencies and benchmarks that EHR systems must meet to be certain that they are functioning to their maximum capacity and meeting this standard allows companies/organizations to qualify for funds to defray cost of the EHR from Medicare.
b. refers to training competencies that all users must achieve to be able to access and transfer patient data/information.
c. refers to a requirement that at least 50% plus one of all patients have data entered into the EHR.
d. the requirement that rigorous confidentiality security is in place to protect all patient information from sources which have no right to the data.

 

 

ANS:  A

Correct: Meaningful use is “A defined set of EHR capabilities and standards that EHR systems must meet to ensure their full capacity is realized and for the users (hospitals and physician practices) to qualify for financial incentives from Medicare.”

Incorrect:

  1. Training is one part of operationalizing “meaningful use.”
  2. It is expected that all patient records will be entered into a HER, but as of yet, a set number of patients has not been determined.
  3. Confidentiality is a requirement for EHRs, along with security and privacy.

 

DIF:    Application    REF:   p. 260

 

  1. A nurse is caring for a patient who is to receive an antibiotic drug that causes severe skin damage when infiltrated. The order reads, “infuse over 1 hour by portacath.” The nurse accesses the Personal Digital Assistant for software that lists the steps to access a portacath. The nurse is using:
a. electronic health records.
b. point of care technology.
c. data management.
d. telehealth.

 

 

ANS:  B

Correct: Using a Personal Digital Assist device to access information at the bedside is considered  point-of-care technology. The nurse was able to retrieve the steps for accessing a portacath electronically while remaining at the bedside.

Incorrect:

  1. Electronic health record is the longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.
  2. Data management is the recording, storing, and presentation of a piece of patient data.
  3. Telehealth is use of telecommunications technology to assess, diagnose, and, in some cases, treat persons who are at a distance from the health care provider.

 

DIF:    Application    REF:   p. 262

 

  1. The Institute of Medicine (IOM) (2003) recommends that EHR systems offer eight functionalities. A patient has a severe allergy to eggs and penicillin. Which of the eight functions of the EHR would address sharing this information?
a. Health information and data capture
b. Results/data management
c. Provider order entry management
d. Clinical decision support

 

 

ANS:  A

Correct: The health information and data capture function includes information such as medical history, laboratory tests, allergies, current medications, and consent forms.

Incorrect:

  1. Results/data management function provides electronic reports of laboratory results and radiology procedures.
  2. Provider order entry management function eliminates lost orders and illegible handwriting, generates related orders automatically, monitors for duplicate or contradictory orders, and reduces time to fill orders.
  3. Clinical decision support function provides reminders about preventive practices, such as immunizations, drug alerts for dosing and interactions, and clinical decision making.

 

DIF:    Application    REF:   p. 256; Table 14-1

 

MULTIPLE RESPONSE

 

  1. A new nurse asks, “Since Electronic Medical Records can improve quality care by having seamless data available for a patient, why doesn’t everyone just replace paper and pencil charts”? Barriers to a universal health information infrastructure include the fact that: (Select all that apply.)
a. competition from individual companies to build EMR prevent a universal infrastructure.
b. cost is prohibitive even with federal funding for larger health care systems.
c. preventive health reminders for immunizations and yearly screenings such as mammograms are used in clinical decision making.
d. insurance companies have halted sharing of some patient data due to fear of law suits.
e. the full capacity of EHRs has not been realized with only Stage 1 of 3 nearing completion.

 

 

ANS:  A, E

Correct:

  1. It has been recommended that only a federal-based EMR would provide an infrastructure that allows access to comprehensive patient information.
  2. The first stage, years 2011 and 2012, forms the foundation for electronic data capture and information sharing.

Incorrect:

  1. Smaller organizations find cost to be a barrier even with federal funding.
  2. Clinical decision making is an opportunity rather than a barrier.
  3. Coordinated insurance billing and claims management and insurance eligibility are benefits rather than barriers.

 

DIF:    Application    REF:   pp. 260-261

 

  1. A nurse interested in quality improvement tools performed a search for cause and effect diagrams using www.ishikawa.com. A page opened that provided images and templates for performing fishbone diagrams. Which type of search did the nurse conduct?
a. Quick and dirty
b. Advanced
c. Brute force
d. Link searching

 

 

ANS:  C

Correct: Brute force is a method of searching where you type in what you think might logically be a web address and see what happens.

Incorrect:

  1. Quick and dirty searching can be useful when looking for information in an unfamiliar area. The search term is typed into a search engine such as Google (www.google.com) and results are reviewed to see which ones sound most promising.
  2. Advanced searching allows you to set specific limits on your searches such as by language, file type, and date.
  3. Link searching explores links from a reliable site found that connect to other relevant sites.

 

DIF:    Application    REF:   p. 263

 

COMPLETION

 

  1. Software programs that process data to produce or recommend valid choices are known as ______________.

 

ANS:

decision support systems

Decision support systems use software programs that process data to produce or recommend decisions by linking with an electronic knowledge base.

 

DIF:    Knowledge     REF:   p. 256

 

Chapter 28: NCLEX-RN® Examination

Test Bank

 

MULTIPLE CHOICE

 

  1. Graduates from approved schools of nursing cannot sign their charting as registered nurses (RNs) until they:
a. pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN®).
b. provide evidence of mental competency.
c. supply written proof of physical fitness.
d. have signed an employment contract with a health care facility.

 

 

ANS:  A

Correct: A compulsory license requirement must be met to legally practice or work as a registered nurse in any state or U.S. territory. Licenses are granted only after an applicant has successfully passed the NCLEX-RN® examination.

Incorrect:

  1. Licensure is designed to protect the public by providing safe practitioners, but it does not evaluate the individual candidate’s mental competency.
  2. Preadmission/preemployment physicals are part of the employment process; however, nurses with physical limitations may attain employment.
  3. Graduates cannot practice as registered nurses until they pass the NCLEX-RN® exam, even if they have signed an employment contract. Some graduates may not seek employment until after they have successfully completed the NCLEX-RN® and have become licensed.

 

DIF:    Comprehension                              REF:   p. 497

 

  1. Which statement concerning the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) exam is correct?
a. Graduates from all three types of nursing programs (diploma, associate degree, and baccalaureate degree) take the same examination.
b. The examination is scored on an interval scale rather than on a pass-fail basis.
c. The examination is offered twice a year in major urban areas.
d. The candidate has the option of choosing a pencil-and-paper format.

 

 

ANS:  A

Correct: The purpose of the NCLEX-RN® exam is to determine safe practice and the ability of candidates to perform at the entry level. Candidates from all three types of nursing programs must demonstrate the same competencies.

Incorrect:

  1. The examination is adapted according to the candidate’s ability to answer questions on the basis of degree of difficulty and area of the nursing process.
  2. The examination is offered at more than 3400 Pearson Professional Centers at a candidate’s convenience.
  3. The examination is computerized; however, special accommodations are available for qualifying candidates.

 

DIF:    Knowledge     REF:   p. 498

 

  1. Computerized adaptive testing implies that:
a. the candidate must be computer literate.
b. competency is determined on the basis of difficulty of questions, knowledge of the nursing process, and the number of questions answered correctly.
c. testing facilities have been adapted for the physically challenged candidate.
d. questions cannot be adapted to the needs of the student.

 

 

ANS:  B

Correct: Computerized adaptive testing is based on the measurement theory, by which the candidate must prove with a score of 95% that he or she is safe and knowledgeable at entry into the practice level.

Incorrect:

  1. Candidates are required only to click to record an answer or to type in numbers 1 through 5 when prioritizing; they may also ask for assistance at any time during the testing process. Fill-in-the-blank questions at present are limited to entry of numeric values for dosage calculations.
  2. Although accommodations are available for qualified candidates, computerized adaptive testing is based on how the examination is scored, not on accommodations made for the individual candidate.
  3. As a candidate answers questions on the examination, the computer adaptive testing adapts to the level of the candidate’s knowledge and skills.

 

DIF:    Comprehension                              REF:   p. 499

 

  1. On the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) exam, when the candidate is asked to set goals in collaboration with other members of the health care team, the nurse is being tested in the area of:
a. assessment.
b. planning.
c. analysis.
d. implementation.

 

 

ANS:  B

Correct: Setting goals is one of the first steps in the planning process.

Incorrect:

  1. Assessment involves data collection, as is achieved through diagnostic tests and physical assessment.
  2. Analysis is the “breakdown” of data to establish a nursing diagnosis.
  3. Implementation is carrying out the plan of care.

 

DIF:    Application    REF:   p. 505

 

  1. The length of the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) exam is based on the:
a. last four numbers of the candidate’s social security number.
b. location of testing.
c. candidate’s educational preparation.
d. performance of the candidate.

 

 

ANS:  D

Correct: The length of the examination is based on the ability of candidates to provide 95% confidence that they are safe practitioners and have acquired a minimal level of knowledge about the nursing process. The length of the examination ranges from 75 to 265 questions, and it takes up to 6 hours to complete.

Incorrect:

  1. A candidate’s social security number is not part of the evaluation process.
  2. The examination is administered at Pearson facilities, and the examination is comparable across the United States and its territories.
  3. All three types of nursing programs have the same criteria for success on the NCLEX-RN® exam.

 

DIF:    Application    REF:   p. 499

 

  1. The primary purpose of the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) exam is to:
a. ensure that practitioners have the minimum skills and knowledge needed to provide care that will produce the best patient care outcomes.
b. regulate nursing education.
c. determine the mandatory educational level required for nurses to practice.
d. accredit schools of nursing.

 

 

ANS:  A

Correct: The purpose of the NCLEX-RN® exam is twofold: (1) to safeguard the public from unsafe practitioners and (2) to determine whether candidates can perform entry level skills.

Incorrect:

  1. The NCLEX-RN® exam is based on a survey conducted to determine what skills entry level nurses must perform. This may indirectly guide education but is not the purpose of the NCLEX-RN® exam.
  2. All three types of nursing programs have the same criteria for success on the NCLEX-RN® exam.
  3. Accreditation is provided by the National League for Nursing and the American College of Nurses; however, accreditation may be withheld if a school’s pass rate on the NCLEX-RN® consistently falls below 85%.

 

DIF:    Comprehension                              REF:   p. 498

 

  1. A student nurse who is preparing to graduate and take the licensure examination asks, “What is compulsory licensure?” The appropriate response of the nursing advisor is which of the following?
a. All candidates wishing to take the licensure examination must pass a drug screen.
b. Candidates must not have a felony conviction.
c. To practice as an RN, the nurse must be licensed as an RN.
d. An impaired nurse must sign a legal document to acknowledge limitations on his or her practice.

 

 

ANS:  C

Correct: Licensure is a prerequisite for practice to ensure public safety.

Incorrect:

  1. Not all states require drug testing prior to licensure.
  2. Although a background check is performed on all candidates, state boards of nursing evaluate the type and disposition of the crime.
  3. Impaired nurses must complete a program as specified by the state board of nursing to address limitations, but this is not the meaning of compulsory licensure.

 

DIF:    Knowledge     REF:   p. 497

 

  1. The National Council of State Boards of Nursing determines acceptable National Council Licensure Examination for Registered Nurses (NCLEX-RN®) exam questions on the basis of:
a. the geographic location of the candidate.
b. research that indicates needed skills for positions in which most entry level nurses are employed.
c. surveys conducted by employers to determine the weaknesses of entry level nurses.
d. surveys of physicians performed to determine what nurses must know to provide safe care.

 

 

ANS:  B

Incorrect:

  1. Correct: Periodically, the National Council of State Boards of Nursing surveys health care providers to identify nursing care activities of entry level nurses.

Incorrect:

  1. All candidates in the United States and its territories take comparable examinations. Many states allow nurses once licensed to be licensed in another state without retaking the NCLEX-RN® exam; therefore, examinations cannot be geographically specific.
  2. The NCLEX-RN® exam focuses on the skills and knowledge most commonly required for entry level work, not on weaknesses.
  3. Nursing has its own body of knowledge; however, physicians may serve on advisory boards to suggest changes/additions to nursing preparation.

 

DIF:    Comprehension                              REF:   p. 499

 

  1. Although the NCLEX-RN® exam has new formats for questions, the most common format is the:
a. fill-in-the-blank item, because candidates are not provided with clues from distracters.
b. multiple-choice question item, which allows candidates to select the one correct answer.
c. multiple-response item, because these questions require a higher level of critical thinking.
d. hot-spot item, because these questions are written at the application level of Bloom’s analysis.

 

 

ANS:  B

Correct: Most NCLEX-RN® exam questions have three distracters and one correct answer, but the examination allows all four levels of Bloom’s taxonomy to be tested.

Incorrect:

  1. Currently, completion or fill-in-the-blank questions focus on entering the correct answer for dosage calculation problems.
  2. Only about 10% of the NCLEX-RN® exam contains alternate-format questions, which are most often written at a higher cognitive level.
  3. Prioritization is becoming more frequent on the NCLEX-RN® exam because it requires a higher level of critical thinking; however, it is not the most common type of question.

 

DIF:    Knowledge     REF:   p. 500

 

  1. When delegating care, the RN assigns one nurse to care for a patient with shingles and a different nurse to care for a patient with human immunodeficiency virus/acquired immunodeficiency disease syndrome (HIV/AIDS). This represents which category of nursing care?
a. Safe and effective care environment
b. Health promotion and maintenance
c. Psychosocial integrity
d. Teaching/learning

 

 

ANS:  A

Correct: The nurse is safeguarding the patient with immunosuppression from the possible transmission of an infection.

Incorrect:

  1. Health promotion and maintenance is focused on early detection and prevention of health-related problems.
  2. Psychosocial integrity focuses on the emotional, mental, and social well-being of clients.
  3. Teaching and learning are integrated processes that can be incorporated into the four categories of nursing care.

 

DIF:    Analysis         REF:   p. 503

 

  1. A patient is brought to the unit with mediastinal chest tubes with no fluctuation in the water seal chamber; arterial blood gas results reveal pH, 7.55; CO2, 55; HCO, 28 mEq/L, and O2, 98%. Carotid artery pulsation is visible with the head of the bed elevated and the use of tangential lighting. The first action of the nurse is to:

The above question represents which level of Bloom’s taxonomy?

a. Knowledge
b. Comprehension
c. Application
d. Analysis

 

 

ANS:  D

Correct: In analysis the candidate must make a judgment call after determining relationships among data.

Incorrect:

  1. Knowledge requires simply recalling information and does not require understanding or judgment.
  2. In comprehension the information is not restated but instead requires the candidate to make a judgment.
  3. In application the candidate is not being asked to apply information in a new context.

 

DIF:    Analysis         REF:   p. 502

 

  1. A candidate who is taking the NCLEX-RN® exam received only 75 questions before the test was stopped. She called her professor and stated, “I passed. I had to answer only 75 questions.” The professor correctly responds by saying:
a. “You are now officially licensed; you answered the more difficult questions correctly.”
b. “It is possible to receive only 75 questions and not be successful; however, we will keep a positive attitude.”
c. “If you were given only 75 questions, you will have to retest because this is not enough to determine competency.”
d. “You must have been extremely close to the passing standard because the computer shut off.”

 

 

ANS:  B

Correct: Seventy-five questions is the minimum number of questions that can determine 95% competency of the candidate; however, receiving 75 questions can indicate that the candidate passed and was able to answer a broad range of questions covering the nursing process at higher cognitive levels, or it can mean that the candidate failed, answered even the lowest cognitive level questions incorrectly, and was unprepared in area/s of the nursing process.

Incorrect:

  1. Although answering only 75 questions is promising and the applicant was most likely successful, it is not always an indication of passing.
  2. Seventy-five questions can determine 95% competency of the candidate.
  3. The computer would not shut off at 75 questions; it would continue until time runs out or the maximum number of questions is provided, should the candidate be close to the passing range.

 

DIF:    Application    REF:   p. 499

 

  1. On the basis of changes effective with the April 2010 test plan, candidates who take the NCLEX-RN® exam:
a. will have to answer more than 75 questions to be 95% certain that they are above the passing standard.
b. will be required to submit a 100-word essay on an important nursing topic to evaluate safe nursing practice.
c. should study and take practice examinations written at the application and analysis level to ensure that they can meet the higher standards of nursing care and health care delivery.
d. will have additional time to complete the examination because most questions will be prepared in the alternate format, thereby requiring critical thinking.

 

 

ANS:  C

Correct: In April 2007, the difficulty of the examination was increased, which would require higher cognitive level questions at the application and analysis level.

Incorrect:

  1. The difficulty of the questions, not the number of questions, has increased.
  2. Essays are not part of the new testing plan.
  3. The time limit is not affected by the new testing plan.

 

DIF:    Application    REF:   p. 502

 

  1. In the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) exam test plan, client needs form the organizing framework of the exam with questions in four categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiologic integrity. Certain processes are then integrated throughout the categories of client needs. Which process is integrated into all client need categories?
a. Teaching/learning
b. Health promotion
c. Infection control
d. Pharmacology

 

 

ANS:  A

Correct: Teaching and learning are the processes that are integrated, along with the nursing process, caring, communication, and documentation.

Incorrect:

  1. Health promotion is a category of client need.
  2. Infection control is a category of client need.
  3. Pharmacology is a category of client need.

 

DIF:    Comprehension                              REF:   p. 504

 

  1. Which action would help a student successfully prepare for the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) examination?
a. Make note cards that can easily be retrieved to list only facts.
b. Avoid timing oneself while studying and when in the actual testing mode to decrease anxiety.
c. Ask peers for help because they had the same resources; especially seek their help for difficult concepts requiring critical thinking.
d. Practice taking NCLEX-RN® exam–type questions and reviewing rationales for correct and incorrect answers.

 

 

ANS:  D

Correct: Practicing helps the student learn how questions are presented and what level of difficulty should be anticipated. Reviewing rationales for the answers is a teaching/learning opportunity that enables the student to judge whether the rationale used to answer the question is valid.

Incorrect:

  1. Students should focus on concepts rather than on isolated facts.
  2. Because the NCLEX-RN® exam is a timed examination, it is possible for a candidate to run out of time before demonstrating competency. Timing oneself during practice will reveal whether the candidate is spending too much time on questions.
  3. Faculty members or the facilitator of formal review courses are the best resource for difficult concepts requiring critical thinking. Peers may not understand the material as well as they think they do.

 

DIF:    Application    REF:   p. 506

 

  1. The nurse prepares to apply sterile gloves needed for a procedure. After introducing self and verifying patient information, the nurse performs hand hygiene. The nurse should open the outer package and then perform the following steps in order (items on left will be moved in correct order on the right):

Open inner package, taking care not to touch inner surface.

Put the glove on the nondominant hand using the sterile gloved hand.

Put glove on dominant hand by grasping folded cuff edge, touching only inside of cuff.

Adjust each glove carefully by sliding finders under the cuffs.

The above question represents which type of alternate-format question written at which level of Bloom’s taxonomy?

a. Drag-and-drop item, comprehension
b. Chart exhibit item, analysis
c. Multiple-response, application
d. Hot-spot item, knowledge

 

 

ANS:  A

Correct: The drag-and-drop format questions require the candidate to place options in a specific order, moving them from left to right using the mouse. The level is comprehension because it requires the student to have a fundamental level of understanding and summarize the material.

Incorrect:

  1. A chart exhibit requires the candidate to seek additional information in a patient’s chart.
  2. Multiple-response questions ask the candidate to check all responses that are correct for a given statement.
  3. The hot-spot question requires the candidate to identify one or more areas on a picture or graph.

 

DIF:    Analysis         REF:   pp. 501-502

 

  1. A graduate is preparing for the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) examination. Based on the latest practice survey, the candidate would focus the least amount of time on which content?
a. Stages of grief
b. Pharmacological pain management
c. Practices to promote rest and sleep
d. Prioritization of workload to manage time effectively

 

 

ANS:  A

Correct: The least amount of time was spent on psychosocial integrity activities (10%), with equal amounts spent on management of care (14%), basic care and comfort (14%) and pharmacologic and parental therapies (14%).

Incorrect:

  1. Pharmacologic pain management falls under the category of Pharmacologic and parental therapies (14%).
  2. Practices to promote rest and sleep fall under basic care (14%).
  3. Prioritization of workload would fall under management of care, which is 14%.

 

DIF:    Application    REF:   p. 503

 

  1. Which strategy would promote a high rate of success on the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) examination?
a. Since the exam is time limited, skip questions when unsure of the answer and return later if time permits.
b. Work quickly through the exam to answer as many questions as possible.
c. Mark questions that may need to have the answer reviewed to make it possible to quickly go back and make change after answering all questions.
d. Read the entire question and all possible answer options before selecting an answer.

 

 

ANS:  D

Correct: Candidates should carefully read the entire question and all answers before making a selection.

Incorrect:

  1. Candidates taking the NCLEX-RN® examination are not allowed to skip questions and return to them at a later time
  2. The goal of computerized adaptive testing CAT is to determine competency based on the level of difficulty of questions answered correctly rather than the number of questions answered correctly.
  3. Candidates are not allowed to change answers to questions once an answer has been selected and entered into the computer.

 

DIF:    Comprehension                              REF:   p. 500

 

  1. A candidate is taking the NCLEX-RN® when the computer turns off. The candidate was aware they had reached the 6-hour time limit. A count of completed questions had been recorded on the note pad, and 100 questions were answered. How will the exam be scored?
a. The computer will analyze the last 60 questions and if above the passing standard, the candidate passes.
b. The candidate will be administered an additional 50 questions to determine ability to reach the 95% confidence interval.
c. If the time runs out, the candidate automatically fails the exam because it is impossible to determine if candidate is safe.
d. The candidate has the option to complete a simulated examination to show competence.

 

 

ANS:  A

Correct: Run-out-of-time rule: if the candidate has answered the minimum number of questions, the computer analyzes the last 60 questions to determine if these questions were above or below the passing standard.

Incorrect:

  1. Additional questions will not be administered once the time limit is reached.
  2. The candidate’s score will be based on the last 60 questions since the minimum were answered.
  3. A simulated examination is not an option.

 

DIF:    Application    REF:   p. 499

 

The order reads: Administer 500 mg of Kefzol (cefazolin sodium) Intramuscular. Using information located on the medication vial above, the nurse will administer how many mL?

The above question represents which type of alternate-format question written at which level of Bloom’s taxonomy?

a. Multiple-response item, comprehension level
b. Hot-spot item, application level
c. Chart/exhibit item, analysis level
d. Drag-and-drop item, knowledge level

 

 

ANS:  C

Correct: The chart/exhibit presents the candidate with a chart or exhibit with information needed to answer the question. The question is at the analysis level since the candidate must calculate the correct amount to be given using a label requiring dilution.

Incorrect:

  1. Multiple-response questions ask the candidate to check all responses that are correct for a given statement.
  2. In the hot-spot item, students are presented with a figure on which they must indicate the answer by clicking the mouse over the area.
  3. The drag-and-drop format questions require the candidate to place options in a specific order, moving them from left to right using the mouse.

 

DIF:    Analysis         REF:   pp. 501-502

 

  1. “A patient with end-stage renal disease has a potassium level of 7.5 mEq/l. Based on this laboratory result, the nurse interprets which symptom as significant prompting which action?
  2. Drowsiness, stimulate the patient every 30 minutes
  3. Confusion, ask the patient to state their name and date of birth
  4. Irregular heartbeat, evaluate the patient’s capillary refill
  5. Muscle cramps, elevate the affected limb”

The above question in italics addresses which category of the NCLEX-RN® test plan and which level of Bloom’s taxonomy?

a. Physiologic adaptation, application level
b. Pharmacologic and parental therapy
c. Integrated processes
d. Basic care

 

 

ANS:  A

Correct: It is important to remember that candidates have specified laboratory values for which they must know the normal range and clinical manifestations when values are high, low, or critical. This question addresses an alteration in body system homeostasis. The student must know the normal lab value for potassium and common symptoms, as well as the correct nursing action.

Incorrect:

  1. No pharmacologic therapy was administered.
  2. Integrated processes include therapeutic communication and caring, which is not tested.
  3. Practices to promote rest and sleep fall under basic care (14%).

 

DIF:    Analysis         REF:   pp. 502-503

 

A patient presents with chest pain that increases when lying flat and low-grade fever. Assessment reveals muffled heart sounds, tachycardia, and 3+ edema in the lower extremities. The nurse asks the patient to learn forward, which eases respiratory efforts. The nurse then places the stethoscope at which area on the chest to facilitate auscultation?

The above question represents which type of alternate-format question written at which level of Bloom’s taxonomy?

a. Multiple-response item, comprehension level
b. Hot-spot item, analysis level
c. Chart exhibit item, application level
d. Drag-and-drop item, knowledge level

 

 

ANS:  B

Correct: This is a hot-spot item; students are presented with a figure on which they must indicate the answer by clicking the mouse over the area. The student would place the mouse over the left sternal border. It is analysis level because the student must take data from many sources to provide a complete assessment of the patient’s condition.

Incorrect:

  1. Multiple-response questions ask the candidate to check all responses that are correct for a given statement.
  2. A chart exhibit requires the candidate to seek additional information in a patient’s chart.
  3. The drag-and-drop format questions require the candidate to place options in a specific order, moving them from left to right using the mouse.

 

DIF:    Analysis         REF:   p. 500 | p. 502

 

COMPLETION

 

  1. The nurse prepares to apply sterile gloves needed for a procedure. After introducing self and verifying patient information, the nurse performs hand hygiene. The nurse should open the outer package and then perform steps in which order. Put a comma and space between each answer choice (for example: a, b, c, d).
a. Open inner package, taking care not to touch inner surface.
b. Put the glove on the nondominant hand using the sterile gloved hand.
c. Put glove on dominant hand by grasping folded cuff edge, touching only inside of cuff.
d. Adjust each glove carefully by sliding finders under the cuff.

 

 

ANS:

a, c, b, d

The nurse should open the inner package first, then put the glove on the dominant hand before the nondominant hand before adjusting the gloves.

 

DIF:    Application    REF:   p. 501

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