Chapter 01: Nursing Today
Potter et al.: Fundamentals of Nursing, 10th Edition

MULTIPLE CHOICE

	1.	Which nurse most likely kept records on sanitation techniques and the effects on health?
a.	Florence Nightingale	
b.	Mary Nutting	
c.	Clara Barton	
d.	Lillian Wald	

ANS:	A
Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. Mary Nutting, Clara Barton, and Lillian Wald came after Nightingale, each contributing to the nursing profession in her own way. Mary Nutting was instrumental in moving nursing education into universities. Clara Barton founded the American Red Cross. Lillian Wald helped open the Henry Street Settlement.

DIF:	Understand (comprehension)	
OBJ:	Discuss the influence of social, historical, political, and economic changes on nursing practices.	TOP:	Evaluation	MSC:	Health Promotion and Maintenance

	2.	The nurse prescribes strategies and alternatives to attain expected outcome. Which standard of nursing practice is the nurse following?
a.	Assessment	
b.	Diagnosis	
c.	Planning	
d.	Implementation	

ANS:	C
In planning, the registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. During assessment, the registered nurse collects comprehensive data pertinent to the patient’s health and/or the situation. In diagnosis, the registered nurse analyzes the assessment data to determine the diagnoses or issues. During implementation, the registered nurse implements (carries out) the identified plan.

DIF:	Understand (comprehension)	
OBJ:	Discuss the development of professional nursing roles.	TOP:	Planning
MSC:	Management of Care	

	3.	An experienced medical-surgical nurse chooses to work in obstetrics. Which level of proficiency is the nurse upon initial transition to the obstetrical floor?
a.	Novice	
b.	Proficient	
c.	Competent	
d.	Advanced beginner	

ANS:	A
A beginning nursing student or any nurse entering a situation in which there is no previous level of experience (e.g., an experienced operating room nurse chooses to now practice in home health) is an example of a novice nurse. A proficient nurse perceives a patient’s clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. A competent nurse understands the organization and specific care required by the type of patients (e.g., surgical, oncology, or orthopedic patients). This nurse is a competent practitioner who is able to anticipate nursing care and establish long-range goals. A nurse who has had some level of experience with the situation is an advanced beginner. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care.

DIF:	Apply (application)		
OBJ:	Discuss the development of professional nursing roles.	TOP:	Evaluation
MSC:	Management of Care	

	4.	A nurse assesses a patient’s fluid status and decides that the patient needs to drink more fluids. The nurse then encourages the patient to drink more fluids. Which concept is the nurse demonstrating?
a.	Licensure	
b.	Autonomy	
c.	Certification	
d.	Accountability	

ANS:	B
Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. To obtain licensure in the United States, the RN candidate must pass the NCLEX-RN®. Beyond the NCLEX-RN®, the nurse may choose to work toward certification in a specific area of nursing practice. Accountability means that you are responsible, professionally and legally, for the type and quality of nursing care provided.

DIF:	Apply (application)		
OBJ:	Discuss the roles and career opportunities for nurses.	TOP:	Implementation
MSC:	Management of Care	

	5.	A nurse prepares the budget and policies for an intensive care unit. Which role is the nurse implementing?
a.	Educator	
b.	Manager	
c.	Advocate	
d.	Caregiver	

ANS:	B
A manager coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or facility. As an educator, you explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient’s progress in learning. As a patient advocate, you protect your patient’s human and legal rights and provide assistance in asserting these rights if the need arises. As a caregiver, you help patients maintain and regain health, manage disease and symptoms, and attain a maximal level function and independence through the healing process.

DIF:	Apply (application)		
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Implementation
MSC:	Management of Care	

	6.	The nurse has been working in the clinical setting for several years as an advanced practice nurse. However, the nurse has a strong desire to pursue research and theory development. To fulfill this desire, which program should the nurse attend?
a.	Doctor of Nursing Science degree (DNSc)	
b.	Doctor of Philosophy degree (PhD)	
c.	Doctor of Nursing Practice degree (DNP)	
d.	Doctor in the Science of Nursing degree (DSN)	

ANS:	B
Some doctoral programs prepare nurses for more rigorous research and theory development and award the research-oriented Doctor of Philosophy (PhD) in nursing. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. The DNP is a practice doctorate that prepares advanced practice nurses such as nurse practitioners.

DIF:	Understand (comprehension)	
OBJ:	Describe educational programs available for professional registered nurse (RN) education.
TOP:	Teaching/Learning		MSC:	Management of Care	

	7.	A nurse attends a workshop on current nursing issues provided by the American Nurses Association. Which type of education did the nurse receive?
a.	Graduate education	
b.	Inservice education	
c.	Continuing education	
d.	Registered nurse education	

ANS:	C
Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions. After obtaining a baccalaureate degree in nursing, you can pursue graduate education leading to a master’s or doctoral degree in any number of graduate fields, including nursing. Inservice education programs are instruction or training provided by a health care facility or institution. Registered nurse education is the education preparation for an individual intending to be an RN.

DIF:	Apply (application)		
OBJ:	Describe educational programs available for professional registered nurse (RN) education.
TOP:	Teaching/Learning		MSC:	Management of Care	

	8.	A nurse identifies gaps between local and best practices. Which Quality and Safety Education for Nurses (QSEN) competency is the nurse demonstrating?
a.	Safety	
b.	Patient-centered care	
c.	Quality improvement	
d.	Teamwork and collaboration	

ANS:	C
Quality improvement identifies gaps between local and best practices. Safety minimizes risk of harm to patients and providers through both system effectiveness and individual performance. Patient-centered care recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Teamwork and collaboration allows effective functioning within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making.

DIF:	Understand (comprehension)	
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Evaluation
MSC:	Management of Care	

	9.	A nurse has compassion fatigue. What is the nurse experiencing?
a.	Lateral violence and intrapersonal conflict	
b.	Burnout and secondary traumatic stress	
c.	Short-term grief and single stressor	
d.	Physical and mental exhaustion	

ANS:	B
Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress. Compassion fatigue may contribute to what is described as lateral violence (nurse-nurse interactions, not intrapersonal). Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue. Stressors, not a single stressor, contribute to compassion fatigue. Physical and mental exhaustion describes burnout only.

DIF:	Understand (comprehension)	
OBJ:	Discuss the influence of social, historical, political, and economic changes on nursing practices.	TOP:	Assessment	MSC:	Health Promotion and Maintenance

	10.	A patient is scheduled for surgery. When getting ready to obtain the informed consent, the patient tells the nurse, “I have no idea what is going to happen. I couldn’t ask any questions.” The nurse does not allow the patient to sign the permit and notifies the health care provider of the situation. Which role is the nurse displaying?
a.	Manager	
b.	Patient educator	
c.	Patient advocate	
d.	Clinical nurse specialist	

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

DIF:	Apply (application)		
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Evaluation
MSC:	Management of Care	

	11.	The patient requires routine gynecological services after giving birth to her son, and while seeing the nurse-midwife, the patient asks for a referral to a pediatrician for the newborn. Which action should the nurse-midwife take initially?
a.	Provide the referral as requested.	
b.	Offer to provide the newborn care.	
c.	Refer the patient to the supervising provider.	
d.	Tell the patient that is not allowed to make referrals.	

ANS:	B
The practice of nurse-midwifery involves providing independent care for women during normal pregnancy, labor, and delivery, as well as care for the newborn. After being apprised of the midwifery role, if the patient insists on seeing a pediatrician, the nurse-midwife should provide the referral. The supervising provider is an obstetric provider, not a pediatrician. A nurse-midwife can make referrals.

DIF:	Analyze (analysis)		
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Implementation
MSC:	Management of Care	

	12.	The nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). Which activity is appropriate for a CRNA?
a.	Manages gynecological services such as PAP smears.	
b.	Works under the guidance of an anesthesiologist.	
c.	Obtains a PhD degree in anesthesiology.	
d.	Coordinates acute medical conditions.	

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

DIF:	Understand (comprehension)	
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Implementation
MSC:	Management of Care	

	13.	A nurse teaches a group of nursing students about nurse practice acts. Which information is most important to include in the teaching session about nurse practice acts?
a.	Protects the nurse.	
b.	Protects the public.	
c.	Protects the provider.	
d.	Protects the hospital.	

ANS:	B
The nurse practice acts regulate the scope of nursing practice and protect public health, safety, and welfare. They do not protect the nurse, provider, or hospital.

DIF:	Understand (comprehension)	
OBJ:	Discuss the influence of social, historical, political, and economic changes on nursing practices.	TOP:	Teaching/Learning		MSC:	Management of Care

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

ANS:	C
Nurses can influence policy decisions at all governmental levels. One way is to get involved by participating in local and national efforts. This effort is critical in exerting nurses’ influence early in the political process. Legislation is not beyond the nurse’s control. National program can have bearing on state politics. The question is focusing on legislation and health care costs, not nursing care.

DIF:	Analyze (analysis)		
OBJ:	Discuss the influence of social, historical, political, and economic changes on nursing practices.	TOP:	Evaluation	MSC:	Management of Care	

	15.	A nurse is using a guide that provides principles of right and wrong to provide care to patients. Which guide is the nurse using?
a.	Code of ethics	
b.	Standards of practice	
c.	Standards of professional performance	
d.	Quality and safety education for nurses	

ANS:	A
The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. The standards of practice describe a competent level of nursing care. The ANA Standards of Professional Performance describe a competent level of behavior in the professional role. Quality and safety education for nurses addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments.

DIF:	Understand (comprehension)	
OBJ:	Discuss the influence of social, historical, political, and economic changes on nursing practices.	TOP:	Implementation		MSC:	Management of Care

	16.	A graduate of a baccalaureate degree program plans to start working as a registered nurse (RN) in the emergency department. Which action must the nurse take first?
a.	Obtain certification for an emergency nurse.	
b.	Pass the National Council Licensure Examination.	
c.	Take a course on genomics to provide competent emergency care.	
d.	Complete the Hospital Consumer Assessment of Healthcare Providers Systems.	

ANS:	B
Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associate degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Certification can be obtained after passing the NCLEX and working for the specified amount of time. Genomics is a newer term that describes the study of all the genes in a person and interactions of these genes with one another and with that person’s environment. Consumers can also access Hospital Consumer Assessment of Healthcare Providers Systems (HCAHPS) to obtain information about patients’ perspectives on hospital care.

DIF:	Remember (knowledge)	
OBJ:	Describe educational programs available for professional registered nurse (RN) education.
TOP:	Implementation		MSC:	Management of Care	

	17.	While providing care to a patient, the nurse is responsible, both professionally and legally, for the appropriateness and proper execution of the care. Which concept does this describe?
a.	Autonomy	
b.	Accountability	
c.	Patient advocacy	
d.	Patient education	

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

DIF:	Remember (knowledge)	
OBJ:	Discuss the influence of social, historical, political, and economic changes on nursing practices.	TOP:	Evaluation	MSC:	Management of Care	

	18.	A nurse is teaching the staff about Benner’s levels of proficiency. In which order should the nurse place the levels from beginning level to ending level?
1. Expert
2. Novice
3. Proficient
4. Competent
5. Advanced beginner
a.	2, 4, 5, 1, 3	
b.	2, 5, 4, 3, 1	
c.	4, 2, 5, 3, 1	
d.	4, 5, 2, 1, 3	

ANS:	B
Benner’s levels of proficiency are as follows: novice, advanced beginner, competent, proficient, and expert.

DIF:	Understand (comprehension)	
OBJ:	Discuss the development of professional nursing roles.	TOP:	Teaching/Learning
MSC:	Management of Care	

MULTIPLE RESPONSE

	1.	A nurse is preparing a teaching session about contemporary influences on nursing. Which examples should the nurse include? (Select all that apply.)
a.	Human rights	
b.	Affordable Care Act	
c.	Demographic changes	
d.	Medically underserved	
e.	Decreasing health care costs	

ANS:	A, B, C, D
Multiple external forces affect nursing, including the need for nurses’ self-care, Affordable Care Act (ACA) and rising (not decreasing) health care costs, demographic changes of the population, human rights, and increasing numbers of medically underserved.

DIF:	Understand (comprehension)	
OBJ:	Discuss the influence of social, historical, political, and economic changes on nursing practices.	TOP:	Teaching/Learning		MSC:	Management of Care

	2.	After licensure, the nurse wants to stay current in knowledge and skills. Which programs are the most common ways nurses can do this? (Select all that apply.)
a.	Master’s degree	
b.	Inservice education	
c.	Doctoral preparation	
d.	Continuing education	
e.	National Council Licensure Examination retakes	

ANS:	B, D
Continuing education programs help nurses maintain current nursing skills, gain new knowledge and theory, and obtain new skills reflecting the changes in the health care delivery system. Inservice education programs are provided by a health care facility to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can help the nurse stay current. Master’s degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. National Council Licensure Examination retakes are not to keep current; this test is taken to enter RN practice.

DIF:	Understand (comprehension)	
OBJ:	Describe educational programs available for professional registered nurse (RN) education.
TOP:	Teaching/Learning		MSC:	Management of Care	

	3.	A nurse wants to become an advanced practice registered nurse. Which options should the nurse consider? (Select all that apply.)
a.	Patient advocate	
b.	Nurse administrator	
c.	Certified nurse-midwife	
d.	Clinical nurse specialist	
e.	Certified nurse practitioner	

ANS:	C, D, E
Although all nurses should function as patient advocates, “advanced practice nurse” is an umbrella term for an advanced clinical nurse such as a certified nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or certified nurse-midwife. A nurse administrator is not an example of advanced practice.

DIF:	Understand (comprehension)	
OBJ:	Describe the roles and career opportunities for nurses.	TOP:	Teaching/Learning
MSC:	Management of Care	

	4.	The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to “float” two of its nurses to the oncology unit if oncology can “float” a nursing assistant to the orthopedic unit to help with obtaining vital signs. Which concepts does this situation entail? (Select all that apply.)
a.	Autonomy	
b.	Informatics	
c.	Accountability	
d.	Political activism	
e.	Teamwork and collaboration	

ANS:	A, C, E
Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. When nurses work together, this is teamwork and collaboration. Informatics is the use of information and technology to communicate, manage knowledge, mitigate error, and support decision making. Political activism usually involves more than day-to-day activities such as unit staffing.

DIF:	Analyze (analysis)		
OBJ:	Discuss the influence of social, historical, political, and economic changes on nursing practices.	TOP:	Evaluation	MSC:	Management of Care