- A nurse manager is discussing the RN’s scope of practice with a new hire. Which statement, made by the new hire, is not true of the RN’s scope of practice?
| a. | “A nurse may be disciplined by the Board of Nursing for practicing beyond his or her scope of practice.” |
| b. | “Scope of practice is legally defined by the American Nurses Association.” |
| c. | “Scope of practice defines the responsibilities of nurses.” |
| d. | “Scope of practice can be found in state nurse practice acts.” |
ANS: B
The RN’s scope of practice is legally defined by state nurse practice acts, not the ANA. A nurse may be disciplined by the Board of Nursing. The scope of practice defines the responsibilities of nurses and can be found in state nurse practice acts.
DIF: Cognitive Level: Application REF: Page 94
OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN.
TOP: Scope of Practice
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- The nursing student is reviewing the different organizations that provide services for nurses. She interprets the American Nurses Credentialing Center as:
| a. | an association that provides accreditation for baccalaureate and higher degree nursing education programs. |
| b. | the unifying body for the state boards of nursing. |
| c. | an association that offers certification in many nursing specialties. |
| d. | an organization that offers the national licensure examination. |
ANS: C
The American Nurses Credentialing Center offers certification in many nursing specialties. The Commission on Collegiate Nursing Education provides nursing school accreditation. The National Council of State Boards of Nursing is the unifying body for the state boards of nursing. NCLEX is the national licensure examination implemented by the National Council of State Boards of Nursing.
DIF: Cognitive Level: Analysis REF: Page 93
OBJ: Recognize the differences in the educational preparation of the LPN/LVN and RN.
TOP: Educational Preparation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- The student is studying the history of nursing education. She is able to identify which nursing degree program as the first one in the United States for RNs?
| a. | Associate’s degree |
| b. | Bachelor’s degree |
| c. | Diploma degree |
| d. | Master’s degree |
ANS: C
The first nursing degree program in the United States was the diploma, which began in 1872. The associate’s, bachelor’s, and master’s nursing programs came later.
DIF: Cognitive Level: Synthesis REF: Page 90
OBJ: Recognize the differences in the educational preparation of the LPN/LVN and RN.
TOP: Educational Preparation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- Which function falls within the LPN/LVN’s scope of practice?
| a. | Formulating the plan of care |
| b. | Collecting data |
| c. | Selecting nursing diagnoses |
| d. | Setting goals, objectives, and outcomes |
ANS: B
One of the many functions of the LPN/LVN is that of data collector. Formulating the plan of care; selecting nursing diagnoses; and setting goals, objectives, and outcomes are not in the scope of practice for the practical nurse and must be performed by an RN.
DIF: Cognitive Level: Application REF: Page 94
OBJ: Compare and contrast the professional roles of the LPN/LVN and the RN.
TOP: Professional Roles
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- Which of the following is an example of professional advocacy in nursing?
| a. | Charting and writing up a medication error |
| b. | Writing up a nursing assistant for excessive absences |
| c. | Writing one’s senator concerning mandatory overtime |
| d. | Mentoring a new graduate RN who is new to the unit |
ANS: C
Writing one’s senator concerning mandatory overtime is professional advocacy. Charting and writing up a medication error, writing up a nursing assistant, and mentoring a new graduate are expectations of the RN.
DIF: Cognitive Level: Application REF: Pages 82-83
OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.
TOP: Role Elements
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- The RN is caring for the following patients. Which patient and task are most appropriate to assign to the LPN/LVN?
| a. | A 34-year-old female patient who will need discharge teaching |
| b. | A 40-year-old postoperative male patient who needs a dressing change |
| c. | A 64-year-old female patient who needs a bed bath |
| d. | A 79-year-old patient whose plan of care needs to be updated |
ANS: B
The LPN/LVN is skilled in dressing changes. The nursing assistant is skilled in giving a bed bath. Discharge teaching and updating the plan of care are tasks that must be performed by the RN.
DIF: Cognitive Level: Application REF: Page 94
OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN.
TOP: Professional Roles
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- The charge nurse is creating assignments for the oncoming shift. She notices that today staffing consists of three RNs and one LPN. Which assignment would be most appropriate for the LPN?
| a. | Acute MI: needs preparation for the catheter lab |
| b. | Flu-like symptoms: needs reassessment of vital signs every hour |
| c. | Possible stroke: needs anticoagulation therapy |
| d. | Dehydration: needs IVF boluses and IV antiemetics |
ANS: B
The most appropriate assignment for the LPN would be the patient with flu-like symptoms. The LPN can perform basic assessment and data collection and can meet the basic needs of the patient. The RNs should be assigned the patients with acute MI, possible stroke, and dehydration, all of whom require critical thinking and a higher level of care.
DIF: Cognitive Level: Application REF: Page 94
OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN.
TOP: Professional Roles
- The RN understands that the National League for Nursing (NLN) delineates three professional roles of the associate degree nurse when she lists all of the following except:
| a. | manager of care. |
| b. | team player. |
| c. | provider of care. |
| d. | member of profession. |
ANS: B
The NLN delineates the following as professional roles of the associate degree nurse: manager of care, provider of care, and member of the profession. For all three of these roles, the nurse follows the nursing process. The NLN does not delineate being a team player as a professional role.
DIF: Cognitive Level: Application REF: Page 91
OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN.
TOP: Registered Nursing
- An LPN/LVN in RN school is experiencing frustration because the expectations of her as a nurse at work are very different from her role as a student in nursing school, and fulfilling both is confusing at times. She has an appropriate understanding of her situation when she states that it is known as:
| a. | role conflict. |
| b. | dissociative behavior. |
| c. | coping mechanism. |
| d. | license confusion. |
ANS: A
Role conflict may occur when expectations or requirements of competing roles are incompatible.
DIF: Cognitive Level: Application REF: Page 81
OBJ: Discuss the concept of role transition from practical nurse to registered nurse.
TOP: Role Transition MSC: NCLEX: Psychosocial Integrity
- A nurse manager is teaching a class about the different role elements of RNs. If she has an adequate understanding, she can state that a care provider is:
| a. | “a nurse who medically manages patients.” |
| b. | “an RN who carries out interventions that assist patients to meet positive outcomes.” |
| c. | “a nurse who seeks out new endeavors.” |
| d. | “a nurse who seeks out positive changes in the best interest of his or her patients.” |
ANS: B
Care provider is the role element of the RN when interventions are provided.
DIF: Cognitive Level: Application REF: Page 82
OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.
TOP: Role Transition MSC: NCLEX: Caring
- A student is preparing for an exam on the different role elements of an RN. She is prepared for the exam when she can state that all of the following are elements of the RN role except:
| a. | collaborator. |
| b. | manager. |
| c. | counselor. |
| d. | therapist. |
ANS: D
Although there are many therapists involved in the collaborative care of the patient, RNs are not therapists. Collaborator, manager, and counselor are identified elements of the RN role.
DIF: Cognitive Level: Application REF: Pages 82-83
OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.
TOP: Role Transition MSC: NCLEX: Caring
- An RN has called the physician to explain that the patient is having second thoughts about a procedure and would like to learn more about the alternatives before proceeding. In this instance the RN is enacting the element of the RN role known as:
| a. | counselor. |
| b. | researcher. |
| c. | advocate. |
| d. | mentor. |
ANS: C
The registered nurse’s role as advocate requires the nurse to be a protector willing to shield the client and family from harm. In assuming this duty, the nurse chooses to provide complete, honest information to those in his or her care and to speak up against any harmful or unnecessary forces that could impede progress toward a healthy state. A client advocate agrees to “take the side” of the health care recipient and “stand up for” the patient’s rights to autonomy and self-determination.
DIF: Cognitive Level: Application REF: Page 83
OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.
TOP: Role Transition
MSC: NCLEX: Safe, Effective Care Environment: Management of Care
- An RN student is discussing formal role socialization with her nursing professor. The professor believes the RN student has a good understanding when she states that formal role socialization:
| a. | “can occur in any informal setting.” |
| b. | “occurs during patient teaching.” |
| c. | “does not occur in the classroom setting.” |
| d. | “only occurs spontaneously.” |
ANS: B
Formal professional role socialization is planned rather than happening spontaneously or vicariously. It involves planned educational experiences, such as performing physical assessment, developing nursing diagnoses for a patient’s care plan, or doing patient teaching.
DIF: Cognitive Level: Application REF: Page 80
OBJ: Describe the process of professional socialization from practical nurse to that of registered nurse. TOP: Role Transition MSC: NCLEX: Psychosocial Integrity
- The student understands that the LPN/LVN role differs from the RN role in many areas. She shows understanding when she can state that the LPN/LVN and RN are similar in which area?
| a. | Educational preparation |
| b. | Thinking skills |
| c. | Assessment skills |
| d. | Basic psychomotor skills |
ANS: D
LPN/LVNs and RNs have similar preparation in basic psychomotor skills such as wound care, urinary catheterization, patient hygiene, and so on. It is the critical thinking and assessment skills that go beyond the basic task that make a difference.
DIF: Cognitive Level: Application REF: Pages 85-86
OBJ: Compare and contrast differences in role responsibilities of practical and registered nurses.
TOP: RN to LPN/LVN Role Comparison MSC: NCLEX: Nursing Process
- A student in an LPN to RN transition program is at the clinical site and monitoring the vital signs of a patient receiving blood. At 15 minutes into the infusion, the patient begins to complain of itching and shortness of breath. It is evident that the student nurse is developing critical thinking skills when she does which of the following?
| a. | Stops the infusion, calls for the patient’s nurse, and reports a possible reaction to the blood. |
| b. | Calls for the patient’s nurse and asks whether she can slow the infusion down. |
| c. | Continues with routine monitoring and reports the patient’s condition as unremarkable. |
| d. | Calls for the patient’s nurse and asks whether she can speed up the infusion to deliver the blood faster. |
ANS: A
The student nurse is developing critical thinking skills of an RN when she connects the idea that the shortness of breath and itching are linked to the infusion and quickly takes action to prevent further harm to the patient.
DIF: Cognitive Level: Application REF: Page 86
OBJ: Discuss the concept of role transition from practical nurse to registered nurse.
TOP: Role Transition
- Which action defines the nurse as a care provider in an inpatient setting?
| a. | Holding an information session on diabetes management and prevention |
| b. | Running a blood pressure screening in the lobby of the hospital |
| c. | Assisting new parents after the delivery of preterm twins |
| d. | Handing out pamphlets on how to lower cholesterol |
ANS: C
The nurse who assists new parents after the delivery of preterm twins is an example of a care provider role within the inpatient setting. Outpatient care provider roles include promotion and restoration of health through the use of screenings and interventions.
DIF: Cognitive Level: Application REF: Page 82
OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.
TOP: Care Provider Role
- The nurse would assume the care provider role of educator during which action?
| a. | Leading a hand washing initiative to reduce infection rates |
| b. | Answering a new mother’s questions about breastfeeding |
| c. | Working with colleagues to transfer a patient into a rehab center |
| d. | Requesting more pain medications for a patient who is recovering from a total hip replacement |
ANS: B
The nurse assumes the care provider role of educator when she answers a new mother’s questions about breastfeeding. Leading a hand washing initiative refers to a change agent. Working with colleagues to transfer a patient refers to the collaborator role. The nurse functions as an advocate when he or she requests more medication for a patient recovering from surgery.
DIF: Cognitive Level: Application REF: Page 83
OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.
TOP: Role Elements
- A nurse on a postsurgical unit is alarmed by the number of postoperative infections that have been reported for her unit over the last year. The nurse acquires data from other hospitals and begins observing the health care team to determine the hand washing rates. This nurse is functioning in which care provider role?
| a. | Manager |
| b. | Change agent |
| c. | Researcher |
| d. | Counselor |
ANS: C
The nurse who researches the infection rate and begins data gathering by observing is functioning in the researcher role. Managers oversee change, change agents initiate change, and counselors assist patients and families with psychosocial needs.
DIF: Cognitive Level: Application REF: Page 84
OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.
TOP: Role Elements
- The RN utilizes problem-solving skills to do all of the following except:
| a. | establish mutual goals with the patient and family. |
| b. | formulate a care plan. |
| c. | assist patients to achieve expected outcomes in the plan of care. |
| d. | oversee implementation and evaluation of the plan. |
ANS: C
The LPN/LVN typically assists patients to achieve expected outcomes in the plan of care. The RN utilizes problem-solving skills to formulate a plan of care, establish mutual goals, and oversee the implementation and evaluation of the plan.
DIF: Cognitive Level: Application REF: Page 88
OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN.
TOP: Care Planning
MULTIPLE RESPONSE
- The registered nurse takes on different care provider roles in the health care setting. Which roles could the nurse assume when caring for a patient who has just been diagnosed with cancer? (Select all that apply.)
| a. | Counselor |
| b. | Educator |
| c. | Advocate |
| d. | Collaborator |
| e. | Medical power of attorney |
ANS: A, B, C, D
The nurse functions in the care provider roles of counselor, educator, advocate, and collaborator when caring for this patient. The nurse would not take on the role of medical power of attorney for the patient.
DIF: Cognitive Level: Application REF: Pages 82-84
OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.
TOP: Role Elements
Chapter 07: The Nurses, Ideas, and Forces That Define the Profession
Test Bank
MULTIPLE CHOICE
- It has been said that Florence Nightingale revolutionized nursing. Which example supports this statement?
| a. | She encouraged men to become nurses. |
| b. | She encouraged nurses to serve physicians in order to learn from them. |
| c. | She instituted changes that affected patient survival rates. |
| d. | She organized nursing in America. |
ANS: C
When she learned of the lack of medical and nursing care for British troops during the Crimean War (1853-1856), Nightingale organized a group of 38 nurses to travel to the Crimea in southern Russia. Despite societal opposition, she and her team reached the Crimean battlefields in 1854. They found overcrowding in the hospitals, no medical supplies, and limited space for the sick and injured. Using her own funds, Nightingale obtained supplies, cleaned up the unsanitary conditions, and established laundries to wash linens. At the end of 6 months, Nightingale and her nurses had decreased the death rate from 42% to 2%.
DIF: Cognitive Level: Application REF: Page 100
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- A student is studying the history of nursing. Which statement made by the student would be correct if she had an adequate understanding of America’s first trained nurse?
| a. | “America’s first trained nurse reduced student nurses’ working hours.” |
| b. | “As America’s first trained nurse, Isabel Hampton Robb promoted licensure exams.” |
| c. | “America’s first trained nurse worked to create associate degree programs.” |
| d. | “America’s first trained nurse was Linda Richards.” |
ANS: D
Linda Richards is known as America’s first trained nurse. Isabel Hampton Robb reduced student nurse working hours and promoted licensure exams. Mildred Montag worked to create associate degree programs as a shorter route into nursing.
DIF: Cognitive Level: Application REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- Which is the dominant focus of patient care in the current health care environment?
| a. | To increase cost to increase profit |
| b. | To contain rising costs |
| c. | To ignore rising costs |
| d. | To manage care according to cost |
ANS: B
The dominant focus of patient care in the current health care environment is to contain rising costs. Hospitals, faced with financial difficulties, are merging into large health care systems. Managed care, an insurance-based approach to reducing costs, has invaded patient care in every setting. Nurses are challenged to deliver quality nursing care in an environment that limits consumers’ options.
DIF: Cognitive Level: Evaluation REF: Page 107
OBJ: Describe the effect of managed care and merging health care services on the nursing profession. TOP: Nursing in the Current Health Care Environment
- What is the function of Continuous Quality Improvement?
| a. | To improve staff compliance with training |
| b. | To assist staff in building on nursing skills |
| c. | To assess patient care, from admission to discharge |
| d. | To improve collaboration of staff |
ANS: C
Continuous Quality Improvement involves assessing patient care, beginning with point-of- entry into the health system through discharge or transitional care.
DIF: Cognitive Level: Analysis REF: Pages 108-109
OBJ: Discuss the role of nursing in quality improvement of patient care.
TOP: Quality Improvement in Nursing
- Florence Nightingale contributed to nursing in many different ways. The student nurse has an understanding of the history of nursing when she does which of the following?
| a. | Educates another student about the efforts of Florence Nightingale to promote research |
| b. | States that Nightingale is responsible for minor contributions to the early education of nurses |
| c. | Believes that Nightingale was not involved in the theory of nursing |
| d. | States that Nightingale did not assist in the development of the nursing process |
ANS: A
The student shows an understanding of the history of nursing when he or she educates another student on the research efforts of Nightingale. Nightingale is responsible for major contributions to education of nurses, began the development of the nursing process, and served a large role in the development of nursing theory.
DIF: Cognitive Level: Application REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- A student understands the contributions of Clara Barton when she states, “Clara Barton
| a. | is known as the Lady with the Lamp.” |
| b. | fought for women’s rights.” |
| c. | is known as the Angel of the Battlefield.” |
| d. | was America’s first trained nurse.” |
ANS: C
Clara Barton is known as the Angel of the Battlefield, Lavinia Dock fought for women’s rights, Florence Nightingale is known as the Lady with the Lamp, and Linda Richards was America’s first trained nurse.
DIF: Cognitive Level: Application REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- Which action by the nurse shows the use of the nursing process?
| a. | The nurse works with the health care team to set outcomes and plan interventions for the patient. |
| b. | The same nurse admits the patient and then discharges him the next day. |
| c. | The nurse works with the patient to set outcomes and plan interventions. |
| d. | The nurse sends the provider in for an immediate assessment of the patient. |
ANS: C
In the nursing process, nurses work with patients to set expected outcomes and plan interventions to meet these outcomes.
DIF: Cognitive Level: Application REF: Page 107
OBJ: Understand concept of the nursing process.
TOP: Health Maintenance and Disease Prevention
- What is the major social factor that has developed the role of nursing to what it is today?
| a. | Society’s attitude toward the role of women |
| b. | Society’s lack of qualified health providers |
| c. | Society’s lack of resources to pay for health care |
| d. | Society’s lack of education about health care |
ANS: A
Society’s attitude toward the role of women is a major social factor that has developed the role of nursing.
DIF: Cognitive Level: Application REF: Page 102
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- _____ defined nursing as “that care which puts a person in the best possible condition for nature to restore or to preserve health, and to prevent or to cure disease or injury.”
| a. | Barton |
| b. | Nightingale |
| c. | Breckenridge |
| d. | Dix |
ANS: B
This definition is as quoted form Nightingale’s Notes on Nursing, written in 1860.
DIF: Cognitive Level: Knowledge REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- The nurse responsible for promotion of associate degree programs is:
| a. | Lavinia Dock. |
| b. | Mildred Montag. |
| c. | Linda Richards. |
| d. | Lillian Wald. |
ANS: B
Mildred Montag promoted associate degrees as a way for nurses to enter the field of nursing in a shorter time period. Lavinia Dock fought for women’s rights and the right to vote. Linda Richards, America’s first trained nurse, improved nursing education. Lillian Wald cared for tenement families by establishing a visiting nurse service.
DIF: Cognitive Level: Knowledge REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
MULTIPLE RESPONSE
- Based on what you know, what events would you select to show the contributions that Isabel Hampton Robb made to nursing? (Select all that apply.)
| a. | Established a visiting nurse service |
| b. | Reduced student working hours |
| c. | Wrote a book on the history of nursing |
| d. | Promoted licensure exams |
| e. | Fought for women’s rights and the right to vote |
ANS: B, D
Isabel Hampton Robb reduced student working hours and promoted licensure exams. Mary Adelaide Nutting wrote a book on the history of nursing, Lillian Wald established a visiting nurse service, and Lavinia Dock fought for women’s rights and the right to vote.
DIF: Cognitive Level: Evaluation REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- The “graying of America” is estimated to include 65 million older Americans by 2030. What current evidence supports the need for increased nursing knowledge of geriatrics and home health care? (Select all that apply.)
| a. | The elderly utilize more health care dollars per person than younger members of society. |
| b. | The elderly rely minimally on Social Security. |
| c. | The elderly have chronic illnesses. |
| d. | The elderly typically have fewer years of schooling. |
| e. | Some elderly are widowed and need assistance with care. |
ANS: A, C, D, E
The elderly currently utilize more health care dollars per person than the younger members of society. They typically rely heavily on Social Security, have chronic illnesses, have fewer years of schooling, and are widowed.
DIF: Cognitive Level: Analysis REF: Page 106
OBJ: Understand factors influencing practice. TOP: Aging Population
MATCHING
Match each nurse with her contribution.
| a. | Clara Barton |
| b. | Florence Nightingale |
| c. | Lillian Wald |
| d. | Mary Breckenridge |
- Organized the American Red Cross
- Established a visiting nurse service
- Organized a frontier nurses organization
- Established nursing as a profession
- ANS: A DIF: Cognitive Level: Knowledge REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- ANS: C DIF: Cognitive Level: Knowledge REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- ANS: D DIF: Cognitive Level: Knowledge REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
- ANS: B DIF: Cognitive Level: Knowledge REF: Page 104
OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing
