Craven Ch 1, 2, 3, 4,

Question 1

According to Patricia Benner’s From Novice to Expert, there are five distinct levels of proficiency. Micah is a nurse with 3 years of experience who is now able to analyze his patient’s heart failure as conceptually related to the renal failure and anemia that are present rather than as separate issues. Which level most appropriately describes his proficiency?

A. Competent
B. Expert
C. Novice
D.Advanced beginner

Answer 1

D. Advanced beginner is identified as being the first 5 years after graduation from nursing school and is described as seeing situations in parts to seeing them more conceptually, or as a whole.

Question 2

Marcy is aware that nursing responsibilities are related to standards of professional performance. Which are included in these standards? Select all that apply.

A. Collaboration
B. Performances appraisal
C. Outcomes identification
D. Quality of practice

Answer 2

a, b, d. Collaboration, performance appraisal, and quality of care are all elements of professional performance. Other elements include education, collegiality, ethics, research, and use of resources.

Standards of care designate professional nursing responsibilities such as assessment, diagnosis, outcome identification, planning, implementation, and evaluation.

Question 3

A nurse is found to have performed procedures outside her scope of practice. Identify which element is true related to nursing scope of practice.

A. Scope of practice is defined by each state’s nurse practice act.

B. The ANA sets requirements for licensure.

C. Scope of practice is defined by CNEA-accredited school curricula.

D. Reciprocity explains the relationship between scope of practice and state licensure.

Answer 3

a. The nurse practice act of each state defines the practice of nursing within that area.

Question 4

An antibiotic is ordered that the patient has had an allergic reaction to in the past. Which would be an appropriate nursing action as determined by the professional nursing role? Select all that apply.

A. Identify that the antibiotic is inappropriate.

B. Document the allergy and call the physician.

C. Administer the drug as ordered.

D. Complain to other nurses about the physician’s poor judgment.

Answer 4

a, b. The nurse should use his or her knowledge of the sciences to make safe judgments on the patient’s behalf. The nurse should also communicate the patient’s needs in written and oral form.

Question 5

A patient reports frustration that she has been unable to sleep while in the hospital and that she is exhausted. The nurse also notes that the patient has an unreliable social support network, has poor confidence in her ability to care for herself after discharge, and is at risk for a fall. Which of these issues would take priority according to Maslow’s hierarchy of human needs?

A.Sleep

B.Fall risk

C.Social support

D.Doubt related to self-care

Answer 5

a. Sleep is part of the foundation of Maslow’s hierarchy, included in physiologic need.

Safety (fall risk), love and belonging (family, friends, social support), and self-esteem (lack of confidence in self-care abilities) are later considerations according to this model.

Question 6

Which intervention demonstrates the nurse’s fulfillment of a standard of nursing practice?

A.Preparing to give an end-of-shift report

B.Acting as a preceptor for a senior nursing student

C.Assessing a newly admitted patient for potential fall risks

D.Requesting an interpreter when providing education to a non–English-speaking patient

Answer 6

c. The ANA’s standards include two lists: standards of practice and standards of professional performance. Measurement criteria are printed in the ANA book Nursing: Scope and Standards of Practice (2015). The standards of practice list designates professional nursing responsibilities such as assessment, diagnosis, outcome identification, planning, implementation, and evaluation. Standards of professional performance include culturally congruent practice such as requesting an interpreter; collaboration such as providing an end-of-shift report; and leadership when acting as a preceptor for a nursing student.

Question 7

Which nursing action demonstrates the role nurses play in addressing collaborative problems arising from delegated medically prescribed interventions?

A.Recognizing that a patient is having an allergic reaction to a prescribed medication and holding the next scheduled dose

B.Noting in the plan of care for an immobile patient that repositioning must occur every 2 hours

C.Requesting a dietary consult for a patient newly diagnosed with type 2 diabetes

D.Raising the head of the bed of a patient reporting difficulty breathing

Answer 7

a. When a provider delegates actions (provider-prescribed interventions) that require nurses to use their own judgment, nurses are addressing collaborative problems. For example, although providers must prescribe medications, they rely on the judgment of nurses to hold a dose of that medication when appropriate.

Initiating a turn and positioning schedule, requesting a dietary consult, and placing a patient in respiratory distress in a high Fowler position are all independent nursing actions that do not require collaboration.

Question 8

Your nurse manager informs you he is using the tool “Asking Why 5 Times” to investigate medication error in which you were involved. What was the nurse manager doing?

A.Conducting root cause analysis

B.Applying concepts of just culture

C.Assessing outcomes for CMS

D.Using bundles of care

Answer 8

a. The tool “Asking Why 5 Times” is used in root cause analysis.

Question 9

Which description of value-based purchasing is most accurate?

A.Ensuring “never events” never occur
B.Conducting a thorough investigation to analyze the root cause of all errors
C.Adjusting reimbursement based on measurement of processes, outcomes, and patient satisfaction
D.Determining the actual cost of care to calculate reimbursement

Answer 9

c. CMS adjusts hospital reimbursement based on adherence to guidelines for processes and outcomes of care and patient satisfaction.

Although ensuring “never events” never occur is a goal of healthcare, it is not the basis for value-based purchasing (VBP). Conducting root cause analysis of errors and determining cost of care are not related to VBP.

Question 10

Which statement about patient safety is correct?
A.Physicians have sole responsibility for patient safety.
B.Safe patient care is the same as quality care.
C.High scores on HCAHPS surveys indicate patient safety.
D.Nurses play an important role in keeping patients safe.

Answer 10

d. Nurses are uniquely prepared to help keep patients safe, and their presence at the bedside 24 hours every day puts them in a position to monitor for and intervene as needed for safety.

Question 11

You have been asked to participate in a committee writing a policy for the care of a patient with an indwelling catheter. What is most important to include?

A.Information retrieved from a website directed toward the lay public
B.The nationally recognized catheter-associated urinary tract infection prevention bundle
C.The policy from a well-respected nearby hospital
D.Information from a nursing textbook that is more than 10 years old

Answer 11

b. The nationally recognized bundle of care is the most important to include

Question 12

Which statement is true about latent errors?
A.They are errors whose effects are not known for a long time.
B.Latent errors cause minimal effects to patients.
C.Latent errors are traceable to a particular individual.
D.They are errors that are due to system issues.

Answer 12

d. Latent errors are those due to systems issues; active errors are those attributable to an individual. The effects of latent errors may be apparent immediately and may certainly cause significant harm to patients.

Question 13

A novice nurse has made what is considered a human error while performing as medication nurse on a busy long-term care nursing unit. What intervention implemented by the unit’s nurse manager would be most appropriate in this situation to help prevent similar errors in the future?

A.The incident is recorded in the nurse’s permanent employee file.
B.The nurse is asked to identify and discuss the factors that contributed to the making of the error.
C.The nurse manager provides a verbal warning to the nurse and explains that another error will result in disciplinary action.
D.The nurse is told by the nurse manager that everyone makes mistakes occasionally but to be more careful in the future.

Answer 13

b. As human beings, healthcare personnel will make errors.

Question 14

What nursing action best demonstrates an activity focused on the safety goal of reducing the risk of healthcare-associated infections (HAIs)?

A.Providing an in-service on the appropriate technique to be used when providing indwelling catheter care
B.Monitoring all visitors for presence of possible infections and restricting visitation when appropriate
C.Formulating an institutional policy requiring all employees to be vaccinated yearly against the flu
D.Assessing all patients for history of infections within the previous 12 months

Answer 14

a. A common source of HAIs is an indwelling catheter.

Question 15

A nurse is working in an organization that prescribes and supports Plan B (“the morning after pill”) as a form of contraception. In analyzing the nurse’s role and moral values, the nurse should consider which of the following? Select all that apply:
A.Is the nurse affirming the patient’s desires?
B.Is the nurse upholding the ethics of the profession?
C.What are the nurse’s beliefs/biases related to this medication?
D.What are the consequences and alternatives of giving or not giving this medication?

Answer 15

a, b, c, d. All questions posed should be considered in evaluating values in relation to the professional nursing role.

Question 16

A patient with esophageal cancer is no longer able to consume foods by mouth and is now fed via a gastric feeding tube. The patient is withdrawn and states, “My family used to have big dinners with friends, family, lots of laughter, and loud conversation.” Which of the patient’s values are apparent and best describe the behavior? Select all that apply:
A.Independence and individuality
B.Family role
C.Socialization
D.Human nature

Answer 16

c. Socialization during mealtime is the value that is described by the patient’s statement and subsequent withdrawal related to not being able to eat.

Question 17

A nurse is caring for a patient with leg ulcers. The nurse assesses that these are related to venous stasis, but when asked, the patient reports that there is someone “shooting lasers through the floor” in the apartment. In order to progress with wound treatment, what must the nurse understand about resolving value conflicts? Select all that apply:
A.It is necessary to establish common ground about therapy goals.
B.Further exploration of the patient’s belief system may be needed to identify beliefs related to care.
C.The nurse may need to answer patient questions related to care.
D.The nurse may need to examine personal values related to mental health and care.

Answer 17

a, b, c, d. All of the statements should be considered in resolving value conflicts and establishing a therapeutic relationship between the nurse and patient.

Question 18

A nurse in the transplant ICU is caring for a teenager following a liver transplant as a result of a Tylenol overdose. The patient also superseded another ICU patient (reformed alcoholic) who subsequently died without the transplant. The patient does not want treatment and states: “I just want to die.” The nurse questions the principles of healthcare ethics in this case. Which principle would be most in question?
A.Beneficence
B.Nonmaleficence
C.Autonomy
D.Justice

Answer 18

d. Justice would be in question because the patient is not willing to receive medical therapies to support the transplanted liver after another patient died waiting to receive the same organ.

Question 19

A nurse fails to observe and document a patient’s change in neurologic status, ultimately resulting in the patient’s death from a stroke. Which type of malpractice is most relevant?
A.Fraud
B.Breach of duty
C.Negligence by commission
D.Battery

Answer 19

b. Breach of duty is the failure to conform to the standard of practice, thus creating a risk for a person that a reasonable person would have foreseen. The nurse may be accused of breach of duty whenever reasonably accepted standards of nursing care are not met, such as failure to observe and monitor a patient’s condition.

Question 20

The nurse is caring for a patient who had a surgical repair to a fractured tibia. The nurse uses a gait belt while ambulating the patient for the first time. Which ethical responsibility is the nurse promoting?
A.Beneficence
B.Justice
C. Nonmaleficence
D.Veracity

Answer 20

c. Nonmaleficence means the nurse is avoiding doing harm to patient, removing the patient from harm, and preventing harm from happening to the patient. It is a strong proactive duty for all healthcare professionals. In this case, the nurse is taking precautions to prevent the patient from falling by using a belt to hold the patient during ambulation.

Question 21

The nurse tells the patient that pain medication is prescribed to be administered every 4 hours when needed and promises the patient that a pain assessment will be performed. The nurse assesses the patient’s level of pain and the need for pain relief every hour. Which ethical responsibility to the patient is the nurse practicing?
A.Beneficence
B.Fidelity
C.Justice
D.Nonmaleficence

Answer 21

b. Fidelity is keeping one’s promise. The nurse promises the patient that the prescribed medication would be administered when needed and makes sure to assess the patient every hour just in case the patient needs pain relief.

Question 22

A nurse is evaluating the medical center’s approach to mobilizing secretions in patients with tracheotomies. Which would be the benefit to using EBP? Select all that apply:
A.EBP is evaluated based on outcome studies.
B.Practitioner knowledge and personal experience are insufficient.
C.EBP integrates clinical expertise with external evidence.
D. Hospitals can utilize experts in their facility.
E.Provide cost-saving, quality care.

Answer 22

a, b, c, e. Evidence-based practice (EBP) is based on outcome studies, recognizes that pathophysiologic reasoning and personal experience are not sufficient, and involves the incorporation of individual clinical expertise with the best available external evidence from systematic research. The goal of EBP is to provide the highest quality individualized care based on thorough assessment, history taking, sound research evidence, clinical proficiency, and information from the patient on values and care preferences to ensure favorable outcomes. EBP standardizes practice and methods based on research, thus discouraging facilities to follow a single practitioner’s recommendations.

Question 23

Which of the following are ethical and legal issues related to the research process that are evaluated by IRBs? Select all that apply:
A.Blinded participation
B.Privacy and dignity
C.Balance between benefits and risk
D.Protection from mental and physical suffering
E.Cost of the research to the organization

Answer 23

b, c, d. Institutional review boards evaluate these elements as well as the ability to withdraw from the investigation at any time, self-determination, anonymity, confidentiality, and fair treatment. Study subjects must be informed of the risks and benefits of a study and voluntarily consent. Blinded participation is a technique used by researchers to increase the validity of the results, but use of blinded participation is not evaluated by the IRB.

Question 24

Nursing research includes systematic inquiry into which of the following?
A.Clinical practice
B.Education
C.Administration
D.All of the above

Answer 24

d. Nursing research includes clinical practice problems, modes of patient care, nursing education, and administration.

Question 25

Bundling findings to improve care is now a nursing standard in the care of patients with heart failure and has been shown to reduce readmission rates. This is one example of which of the following research aspects?
A.Qualitative and quantitative data collection
B.Disseminating research results
C.Classifying nursing phenomena
D.Translation of research to practice

Answer 25

d.Translation of research forms the foundation for evidence-based protocols and interventions that increase the quality of nursing care and improve patient outcomes

Question 26

A nurse is conducting a research study of postoperative pain medications. What should be done first?
A.Develop a theoretical framework.
B.Define a hypothesis.
C.Review the literature.
D.Gather participants.

Answer 26

c. Review of existing literature is the first step of conducting research, followed by developing a theoretical framework, formulating a problem statement or hypothesis, proceeding with the study, and disseminating findings.

Question 27

Which focuses would be considered priorities by the nurse engaged in active nursing research? Select all that apply:
A.Evaluating the perceived well-being of patients

B.Identifying ethical frameworks used when questioning participants regarding issues considered confidential

C.Identifying means by which side effects associated with antipsychotic medication therapy can be minimized

D.Evaluating the effectiveness of a newly designed tool to assess cognitive impairment in nonverbal patients

E.Analyzing various cost saving strategies related to intensifying motivation of college students to act as participants in research projects

Answer 27

a, b, c, d. Each of these examples matches identified priorities for nursing research: promoting health and well-being, ensuring ethical principles are followed in research, meeting care needs of vulnerable populations, and developing tools to measure nursing care. Analyzing various cost saving strategies related to intensifying motivation of college students to act as participants in research projects is not identified as a nursing research priority.

Question 28

Which statement made by a nursing student using websites as informational resources demonstrates an understanding of appropriate site selection criteria?
A.“I was familiar with both the authors since they have authored a textbook I’m currently using.”
B.“This website is recommended by many people in my class as a reliable source.”
C.“The website is easy to use and well designed for quick access to articles.”
D.“I’m new to using websites, so I used the first one listed when I searched.”

Answer 28

a. Websites can prove to be excellent informational resources, but they need to be rigorously evaluated for authenticity, accuracy, objectivity, and currency.