Question 1

A group of nursing students are discussing the impact of nonnursing theories in clinical practice. The students would be correct if they chose which theory to prioritize patient care?

Accepted Answer

Maslow's hierarchy of needs specifies the psychological and physiologic factors that affect each person's physical and mental health. The nurse's understanding of these factors helps with formulating Nursing diagnoses that address the patient's needs and values to prioritize care. Erikson's Psychosocial Theory of Development and Socialization is based on individuals' interacting and learning about their world. Nurses use concepts of developmental theory to critically think in providing care for their patients at various stages of their lives. Rosenstock (1974) developed the psychological Health Belief Model. The model addresses possible reasons for why a patient may not comply with recommended health promotion behaviors. This model is especially useful to nurses as they educate patients.

Question 2

The nurse is preparing to discharge a patient admitted with fever of unknown origin. The patient states, "I never got past the fifth grade in school. Don't read much. Never saw much sense in it. But I do OK. I can read most stuff. But my doctor explains things good and doesn't think that my sickness is serious." Considering this patient response, what action should the nurse carry out?

Accepted Answer

Low health literacy is associated with increased hospitalization, greater emergency care use, lower use of mammography, and lower receipt of influenza vaccine. A goal of patient education by the nurse is to inform patients and deliver information that is understandable by examining their level of health literacy. The more understandable health information is for patients, the closer the care is coordinated with need.

Question 3

The nursing student develops a plan of care based on a recently published article describing the effects of bed rest on a patient's calcium blood levels. When creating the plan of care, the nursing student has the obligation to consider which action?

Accepted Answer

Evidence-based practice (EBP) is an integration of the best-available research evidence with clinical judgment about a specific patient situation. The nurse assesses current and past research, clinical guidelines, and other resources to identify relevant literature. The application of EBP includes critically appraising the evidence to assess its validity, designing a change for practice, assessing the need for change and identifying a problem, and integrating and maintaining change while monitoring process and outcomes by reevaluating the application of evidence and assessing areas for improvement.

Question 4

The nurse identifies which nurse established the American Red Cross during the Civil War?

Accepted Answer

Clara Barton practiced nursing in the Civil War and established the American Red Cross. Dorothea Dix was the head of the U.S. Sanitary Commission, which was a forerunner of the Army Nurse Corps. Linda Richards was America's first trained nurse, graduating from Boston's Women's Hospital in 1873, and Lena Higbee, superintendent of the U.S. Navy Nurse Corps, was awarded the Navy Cross in 1918.

Question 5

The nurse is delegating frequent blood pressure (BP) measurements for a patient admitted with a gunshot wound to a licensed practical nurse (LPN). When delegating, the nurse understands which fact?

Accepted Answer

The RN retains ultimate responsibility for patient care, which requires supervision of those to whom patient care is delegated. In the process of collaboration, the nurse delegates certain activities to other health care personnel. The RN needs to know the scope of practice or capabilities of each health care member for delegation to be effective and safe.

Question 6

The nurse administers a medication to the patient and then realizes that the medication had been discontinued. The error is immediately reported to the physician. The nurse recognizes which term that identifies complying with the standards of professional performance?

Accepted Answer

Guiding the nurse's professional practice are ethical behaviors. Ethics is the standards of right and wrong behavior. The main concepts in nursing ethics are accountability, advocacy, autonomy (be independent and self-motivated), beneficence (act in the best interest of the patient), confidentiality, fidelity (keep promises), justice (relate to others with fairness and equality), nonmaleficence (do no harm), responsibility, and veracity (be truthful). Ethical guidelines direct the nurse's decision making in routine situations and in ethical dilemmas. Socialization to professional nursing is a process that involves learning the theory and skills necessary for the role of nurse. A profession provides services needed by society. Additionally, practitioners' motivation is public service over personal gain (altruism). Members of a profession have autonomy in decision making and practice and are self-regulating in that they develop their own policies in collaboration with one another.

Question 7

The nursing instructor is researching the five proficiencies regarded as essential for students and professionals. The nursing instructor identifies which organization would be found to have added safety as a sixth competency?

Accepted Answer

The Institute of Medicine report, Health Professions Education: A Bridge to Quality (2003), outlines five core competencies. These include patient-centered care, interdisciplinary teamwork, use of evidence-based medicine, quality improvement, and use of information technology. QSEN added safety as a sixth competency. The Essentials of Baccalaureate Education for Professional Nursing Practice are provided and updated by the American Association of Colleges of Nursing (AACN) (2008). The document offers a framework for the education of professional nurses with outcomes for students to meet. The National League for Nursing (NLN) outlines and updates competencies for practical, associate, baccalaureate, and graduate nursing education programs.

Question 8

The nursing student is taking a class in Nursing Research. In class the student has learned which term that identifies the most abstract level of knowledge?

Accepted Answer

A metaparadigm, as the most abstract level of knowledge, is defined as a global set of concepts that identify and describe the central phenomena of the discipline and explain the relationship between those concepts. For example, the metaparadigm for nursing focuses on the concepts of person, environment, health, and nursing. The next level of knowledge is a philosophy, which is a statement about the beliefs and values of nursing in relation to a specific phenomenon such as health. The third level of knowledge is a nursing conceptual framework, or model, which is a collection of interrelated concepts that provides direction for nursing practice, research, and education. The fourth level of nursing knowledge is a nursing theory, which represents a group of concepts that can be tested in practice and can be derived from a conceptual model.

Question 9

A newly licensed registered nurse is curious about the scope of care that he or she has in caring for patients undergoing conscious sedation. Which would be the best source of information for this nurse?

Accepted Answer

Nurse practice acts provide the scope of practice defined by each state or jurisdiction and set forth the legal limits of nursing practice. Nursing organizations enable the nurse to have access to current information and resources as well as a voice in the profession. Nursing organizations include the ANA, the NLN, the ICN, Sigma Theta Tau International Honor Society of Nursing, and the National Student Nurses Association (NSNA).

Question 10

The nurse is caring for a patient who refuses two units of packed red blood cells. When the nurse notifies the health care provider of the patient's decision, the nurse is acting in which role?

Accepted Answer

As the patient's advocate, the nurse interprets information and provides the necessary education. The nurse then accepts and respects the patient's decisions even if they are different from the nurse's own beliefs. The nurse supports the patient's wishes and communicates them to other health care providers. A nurse manages all of the activities and treatments for patients. In the role of change agent, the nurse works with patients to address their health concerns and with staff members to address change in an organization or within a community. The nurse ensures that the patient receives sufficient information on which to base consent for care and related treatment. Education becomes a major focus of discharge planning so that patients will be prepared to handle their own needs at home.

Question 11

The nurse manager is interviewing graduate nurses to fill existing staffing vacancies. When hiring graduate nurses, the nurse manager realizes that they will probably not be considered "competent" until they complete which task?

Accepted Answer

Benner's model identifies five levels of proficiency: novice, advanced beginner, competent, proficient, and expert. The student nurse progresses from novice to advanced beginner during nursing school and attains the competent level after approximately 2 to 3 years of work experience after graduation. To obtain the RN credential, a person must graduate from an approved school of nursing and pass a state licensing examination called the National Council Licensure Examination for Registered Nurses (NCLEX-RN) usually taken soon after completion of an approved nursing program.

Question 12

A nursing student is preparing study notes from a recent lecture in nursing history. The student would credit Florence Nightingale for which definition of nursing?

Accepted Answer

Florence Nightingale's (1860) concept of the environment emphasized prevention and clean air, water, and housing. This theory states that the imbalance between the patient and the environment decreases the capacity for health and does not allow for conservation of energy. Hildegard Peplau (1952) focused on the roles played by the nurse and the interpersonal process between a nurse and a patient. Virginia Henderson described the nurse's role as substitutive (doing for the person), supplementary (helping the person), or complementary (working with the person), with the goal of independence for the patient. Martha Rogers (1970) developed the Science of Unitary Human Beings. She stated that human beings and their environments are interacting in continuous motion as infinite energy fields.

Question 13

The nurse recognizes which nursing theorist who described the relationship between the nurse and the patient as an interpersonal and therapeutic process?

Accepted Answer

Hildegard Peplau focused on the roles played by the nurse and the interpersonal process between a nurse and a patient. The interpersonal process occurs in overlapping phases: (1) orientation, (2) working, consisting of two subphases: identification and exploitation, and (3) resolution. Betty Neuman's Systems Model includes a holistic concept and an open-system approach. The model identifies energy resources that provide for basic survival, with lines of resistance that are activated when a stressor invades the system. Virginia Henderson described the nurse's role as substitutive (doing for the person), supplementary (helping the person), or complementary (working with the person), with the ultimate goal of independence for the patient. Imogene King developed a general systems framework that incorporates three levels of systems: (1) individual or personal, (2) group or interpersonal, and (3) society or social. The theory of goal attainment discusses the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space. In this theory, both the nurse and the patient work together to achieve the goals in the continuous adjustment to stressors.

Question 14

During a staff meeting, the nurse manager announces that the hospital will be seeking Magnet status. To explain the requirements for this award, the nurse manager will contact which organization?

Accepted Answer

The American Nurses Credentialing Center (ANCC) awards Magnet Recognition to hospitals that have shown excellence and innovation in nursing. The ANA is a professional organization that provides standards of nursing practice. The National League for Nursing (NLN) outlines and updates competencies for practical, associate, baccalaureate, and graduate nursing education programs. The Joint Commission is the accrediting organization for health care facilities in the United States.

Question 15

The prospective student is considering options for beginning a career in nursing. Which degree would best match the student's desire to conduct research at the university level?

Accepted Answer

Doctoral nursing education can result in a Doctor of Philosophy (PhD) degree. This degree prepares nurses for leadership roles in research, teaching, and administration that are essential to advancing nursing as a profession. Associate Degree in Nursing (ADN) programs usually are conducted in a community college setting. The nursing curriculum focuses on adult acute and chronic disease; maternal/child health; pediatrics; and psychiatric/mental health nursing. ADN RNs may return to school to earn a bachelor's degree or higher in an RN-to-BSN or RN-to-MSN program. Bachelor's degree programs include community health and management courses beyond those provided in an associate degree program. A newer practice-focused doctoral degree is the Doctor of Nursing practice (DNP), which concentrates on the clinical aspects of nursing. DNP specialties include the four advanced practice roles of NP, CNS, CNM, and CRNA.

Question 16

A nurse is caring for a patient who lost a large amount of blood during childbirth. The nurse provides the opportunity for the patient to maintain her activity level while providing adequate periods of rest and encouragement. Which nursing theory would the nurse most likely choose as a framework for addressing the fatigue associated with the low blood count?

Accepted Answer

Roy's Adaptation Model is based on the human being as an adaptive open system. The person adapts by meeting physiologic-physical needs, developing a positive self-concept-group identity, performing social role functions, and balancing dependence and independence. Stressors result in illness by disrupting the equilibrium. Nursing care is directed at altering stimuli that are stressors to the patient. The nurse helps patients strengthen their abilities to adapt to their illnesses or helps them to develop adaptive behaviors. Watson's theory is based on caring, with nurses dedicated to health and healing. The nurse functions to preserve the dignity and wholeness of humans in health or while peacefully dying. Parse's theory is called the Human Becoming School of Thought. Parse formulated the Theory of Human Becoming by combining concepts from Martha Rogers' Science of Unitary Human Beings with existential-phenomenologic thought. This theory looks at the person as a constantly changing being, and at nursing as a human science. Martha Rogers (1970) developed the Science of Unitary Human Beings. She stated that human beings and their environments are interacting in continuous motion as infinite energy fields.

Question 17

A patient is being discharged from the hospital with wound care dressing changes. The nurse recommends a referral for home health nursing care. The nurse is using which standard of practice?

Accepted Answer

As a care provider, the nurse follows the nursing process to assess patient data, prioritize Nursing diagnoses, plan the care of the patient, implement the appropriate interventions, and evaluate care in an ongoing cycle. In recommending a referral, the nurse is, in effect, planning care.

Question 18

The nursing student is writing a paper about the direct patient care role of advanced practice nurses. Which advanced practice role would the student include in the report?

Accepted Answer

There are four specialties in which nurses provide direct patient care in advanced practice roles: certified nurse midwife (CNM), nurse practitioner (NP), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA). Four additional advanced practice roles that do not always involve direct patient care are clinical nurse leader (CNL), nurse educator, nurse researcher, and nurse administrator.

Question 19

The nurse is determining the patient care assignments for a nursing unit. The nurse knows which responsibility may be delegated to the licensed practical nurse?

Accepted Answer

LPNs, or LVNs in California and Texas, are not RNs. They complete an educational program consisting of 12 to 18 months of training, and then they must pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN) to practice as an LPN/LVN. They are under the supervision of an RN in most institutions and are able to collect data but cannot perform an assessment requiring decision making, cannot formulate a Nursing diagnosis, and cannot initiate a care plan. They may update care plans and administer medications except for certain IV medications.

Question 20

When a nursing class volunteers to serve hot meals at a local homeless shelter on a Saturday afternoon, which term identifies this focus on serving the community?

Accepted Answer

A profession provides services needed by society. Additionally, practitioners' motivation is public service over personal gain (altruism). Service to the public requires intellectual activities, which include responsibility. This accountability has legal, ethical, and professional implications. Members of a profession have autonomy in decision making and practice and are self-regulating in that they develop their own policies in collaboration with one another. As the patient's advocate, the nurse interprets information and provides the necessary education. The nurse then accepts and respects the patient's decisions even if they are different from the nurse's own beliefs.

Quiz 1: Nursing, Theory, and Professional Practice