Answer Key 1
Answer Key
CHAPTER 1—THE EVOLUTION OF NURSING clinics, outpatient agencies, home health agen-
cies, insurance companies, HCP offices, and the
Matching military services offer additional opportunities.
1. b 14. Answer 1, 2, 4, 5: The LPN/LVN communi-
2. d cates findings to members of the health care
3. e team, demonstrates caring and empathy by
4. a using therapeutic communication skills with
5. f patients, administers care according to profes-
6. h sional standards and collects data from mul-
7. c tiple sources. The LPN/LVN would collaborate
8. g with the RN but would not independently cre-
9. j ate the care plan for a newly admitted patient.
10. i 15. Answer 3: Reports indicate that challenges
related to feelings of social isolation, stereotyp-
Multiple Choice ing about men who choose nursing, nursing
11. Answer 4: NAPNES would assist a nurse instructors’ inability to incorporate masculine
who is seeking information about LPN/LVN styles of caring into the curriculum, and a lack
standards. The purposes of NAPNES and Na- of male role models in the profession may be
tional Federation of Licensed Practical Nurses to blame for the high attrition of male nursing
(NFLPN) are to: students from nursing programs.
Set standards for practical/vocational nursing 16. Answer 4: Advance directives could include a
programs. health care power of attorney that states who
Promote and protect practical/vocational should make health care decisions if the per-
nursing. son is unable to make them. A “living will”
Educate and inform the general public about outlines wishes about end-of-life care. Ideally,
practical/vocational nursing. everyone should carefully consider advance
For issues related to interpersonal conflict, directives and have discussions with family
the nurse would first attempt assertive com- members, caregivers, and the health care team.
munication with those who are bullying or 17. Answer 2: One of the primary problems of
harassing. If this is unsuccessful, it would be early nineteenth-century hospitals was poor
appropriate to go up the chain of command. hygienic practice. Hospitals were dirty and
Issues with nursing students can be reported to overcrowded and care was mostly given by
the nursing instructor or the education liaison. untrained persons.
For job seeking, the nurse would use personal 18. Answer 4: The population is aging rapidly and
contacts, the Internet, or nurse recruiters. people with chronic illness are living longer.
12. Answer 4: Case management is a modified sys- There is an increased need for nursing services
tem to deliver care. The LPN/LVN assists the for this growing segment of the population.
RN to achieve desired outcomes. The RN se- 19. Answer 3: “Nightingale Nurses” improved pa-
lects the clinical pathway and coordinates and tient care and advanced the practice of nursing
plans patient care for individuals and groups through good hygiene, sanitation, patient ob-
of patients. Cross-training is another type of servation, accurate recordkeeping, nutritional
modified system of care. While cross-training improvement, and the introduction and use of
is intended to expand the role of the employee, new equipment.
the LPN/LVN must not exceed scope of prac- 20. Answer 1: The four major concepts are nurse,
tice and cannot be expected to assume RN patient, health, and environment.
responsibilities. 21. Answer 4: Poverty, homelessness, and unem-
13. Answer 2: Long-term care facilities employ the ployment are barriers to accessing health care.
majority of LPN/LVNs; however, hospitals,
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,2 Answer Key
22. Answer 2: Physiologic needs, such as eating always expect to get a private room with all
and oxygenation, are the first priority accord- amenities.
ing to Maslow. 29. Answer 3: Health care workers are entitled to
23. Answer 4: Adolescence is time when love and respect from patients and also expect patients
belonging to a peer group are very important. to be responsible for their own behavior.
Being part of a team is the best way to help him 30. Answer 3: LPN/LVNs never independently
meet this need. alter the plan of care without the supervision of
24. Answer 1, 3, 5: Patient can participate in smok- an RN.
ing cessation; stress, weight, and alcohol intake 31. Answer 4: For primary prevention, the nurse
reduction; and control over own body and would encourage wellness activities and pre-
health. Giving information about technology, emptive screening programs such colonoscopy
new medications, and costs may be of interest or glucose screening. Secondary prevention
to the patient, but these topics are less useful recognizes the presence of disease but seeks to
in helping the patient take an active role in her reduce the impact of the condition by encour-
own health. aging behaviors to promote health, such as
25. Answer 4: Unlicensed assistive personnel dietary modification for recurrent hyperglyce-
(UAP) are trained to assist patients with activi- mia. Tertiary prevention is applied by manag-
ties of daily living. The unit secretary orders ing care for those with serious health problems
supplies using electronic or hardcopy requisi- with the goal of improving the quality of life
tion forms. While the UAP or unit secretary can and reducing further loss of function.
direct visitors, extreme caution should be used
in giving out patient information. (Note to stu- Critical Thinking Activities
dent: Even acknowledging that a patient has 32.
been admitted to the hospital can be viewed :HOOQHVV ; ,OOQHVV
as a violation of confidentiality.) Taking vital
+LJKHVWOHYHORI 'LPLQLVKHGRULPSDLUHG
signs is acceptable; however, the pharmacist RSWLPDOKHDOWK VWDWHRIKHDOWK
generally restocks medications. Validating and
interpreting are nursing responsibilities. This patient has some health problems and
26. Answer 2: Economical use of time and materi- some changes in her life, but she has a rela-
als is the best way to contain costs for indi- tively high level of wellness. Her blood pres-
vidual patients. Malpractice insurance does not sure is under control and she has adapted to a
help to contain costs. While it is appropriate to major change (retirement), by taking on a new
question the HCP about safety issues, it is not challenge of volunteering. Her positive outlook
appropriate to question use of diagnostic test- on life allows her to find joy in the prospect of
ing. Diagnosis is an extremely complicated pro- sharing time with a new generation.
cess, which requires an extensive knowledge 33. a. Originally, the white pleated cap and the
about pathology. Referring patients to another apron signified respectability, cleanliness,
clinic shifts the financial burden to another part and servitude. Caps gradually became
of the health care system. symbolic of office and achievement and
27. Answer 1: Orem’s theory is based on helping were celebrated with capping ceremonies.
the patient to attain self-care. Nightingale’s Uniforms became more informal and
theory uses manipulation of the environment nurses complained that caps interfered
(i.e., patient’s pillows). Benner and Wrubel with care, caused hair loss, took too much
demonstrate caring by assisting the patient to time for washing and starching, and were a
cope. Parse’s theory encourages the patient to source of bacteria. Health care facilities and
participate in the health experience. nursing schools typically have dress codes
28. Answer 1, 2, 3, 4, 6: Under the terms of this for style of uniform and/or color. Staff
document, patients are assured that they can members are generally required to wear
expect high-quality hospital care, a clean and nametags and identification badges. Many
safe environment, involvement in their care nurses do not approve of mandatory dress
and the decision-making process, protection of codes. They argue that other health care
privacy, help when leaving the hospital, and professionals do not depend on uniforms
help with billing concerns. Patients cannot for their authority.
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, Answer Key 3
b. It is likely that as a nursing student and a Multiple Choice
soon-to-be nurse that looking professional 6. Answer 4: The student has initiated the nurse-
is important to you. You may feel anxious patient relationship and therefore has the duty
to be rid of your current student uniform to act. All students are cardiopulmonary resus-
for a variety of reasons. Freedom of choice, citation (CPR)-certified so the student has to
unattractive style, and not being marked perform the duty in a reasonable and prudent
as a student are frequent reasons cited by manner as would other nursing students. All of
students. From the patients’ point of view, the other options are also likely to be necessary.
they feel more comfortable and confident (Note to student: Discuss this situation with
when they are easily able to distinguish your clinical instructor for advice about visit-
nurses from other staff members. ing patients during the preclinical preparation
time.)
Next-Generation NCLEX™ (NGN) 7. Answer 4: A poor nurse-patient relationship
34. a. Answer 1 d, 2 i, 3 e, 4 c, 5 f, 6 a, 7 b, 8 g, 9 h: increases the likelihood that the patient will
Registered nurse (RN)—provides direct seek legal action and harm has to occur for lia-
patient care in the hospital and an RN from bility to be established. The family of the older
a home health agency would also be in- patient could seek damages, but that is less
volved in the care of this patient. likely if they understand that the nurse and fa-
LPN/LVN—works under the supervision cility will try their best to prevent falls but are
of the RN in providing patient care. unable to physically restrain patients for the
Physician or other HCPs—uses results of purpose of preventing falls. The angry patient
diagnostic testing and physical assessment may report the nurse to the supervisor, but
to determine the medical diagnosis and if no harm is sustained, then any legal action
prescribes treatment and medications. against the nurse will not be successful. The
Social worker—provides counseling and family who complained at 3:00 am may also be
referral to community resources. very angry. The nurse’s decision to wait must
Physical therapist—teaches and monitors be based on comprehensive assessment of the
exercise and will assist this patient in learn- patient to ascertain that there is nothing to war-
ing techniques for safe ambulation, bend- rant calling at 3:00 am. Careful documentation
ing, and lifting. is necessary. Making an incident report in all of
Dietitian—provides nutritional counseling. these situations would be a good idea.
Respiratory therapist—supervises oxygen 8. Answer 1, 2, 3, 4, 6: In a health care–related
administration and performs pulmonary case, items may include policies and proce-
assessments. dures, standards of care, medical records,
Unlicensed assistive personnel—assists the assignment sheets, personnel files, equip-
patient in the hospital and at home with ment maintenance records, birth certificates,
bathing and other activities of daily living. marriage certificates, medical bills, and other
Financial counselor—assists the patients documents pertinent to the issues at hand. The
in understanding the hospital bill and to UAP’s personal health records are confidential
make arrangements for paying out-of- and unrelated to the patient’s case.
pocket costs. 9. Answer 2: Early discharge and high levels
of patient acuity require excellent discharge
teaching so patients can perform self-care and
CHAPTER 2—LEGAL AND ETHICAL ASPECTS self-monitoring and are therefore less likely to
OF NURSING suffer harm. Being able to take a limited num-
ber of high-acuity patients would be ideal, but
Matching high acuity is the current trend. Having mal-
1. c practice coverage is good if litigation occurs;
2. e however, insurance payouts may actually be
3. a contributing to the problem. Ensuring account-
4. b ability of others is not possible.
5. d 10. Answer 1: Assess knowledge and readiness
to perform. Barriers may include knowledge
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, 4 Answer Key
deficit or feelings of anxiety or self-doubt. Go- and calling for help first are appropriate emer-
ing with her and observing performance and gency actions.
pulling her file would be appropriate after as- 17. Answer 1: Being competent and compassion-
sessment. Directing someone to do a task that ate are the best defenses. Knowing the legal
is beyond his or her ability and understanding definition may be helpful, but definitions are
is inappropriate supervision and the nurse abstractions and the nurse’s day is full of real-
would be liable for the UAP’s performance. world events. Obtaining malpractice insurance
11. Answer 2: The first action is to locate the RN in is likely to make the nurse feel better, but it
charge so that the blood can be started. HCPs does not decrease the chances of getting sued.
can supervise nurses and they know the poten- Validating nursing actions with another nurse
tial adverse reactions of blood products; how- is always beneficial, but this is not a realistic
ever, they are generally less familiar with the option for minute-to-minute care.
policies and procedures related to the actual 18. Answer 2: The nurse is assessing the wound
administration. Explaining the policy is appro- during the dressing change and documentation
priate, but the priority is patient care. should reflect the nurse’s attention to the stan-
12. Answer 1, 2, 3, 4: Do not include any informa- dard of care. Documenting the type of dressing
tion that identifies the patient. Information may be necessary for continuity of care and
such as the room number or the HCP’s name also for reimbursement. The other options are
may seem harmless but including those details incorrect.
could lead to speculation about the patient’s 19. Answer 4: Disciplinary defense insurance
identity. A clinical report must include infor- includes attorney; wage loss reimbursement;
mation such as vital signs and medical condi- travel, food, and lodging expenses; and le-
tion. If in doubt, the clinical instructor should gal fees when the nurse has to go before the
be consulted. board of nursing for disciplinary action. The
13. Answer 1: Patients must be at least 18 years old other types of insurance are for malpractice
to give consent. If younger than 18, the excep- protection.
tions are marriage; court-approved emancipa- 20. Answer 4: Regardless of years of experience,
tion; self-supporting and living apart from nurses should always seek instruction and
parents; military service; or for sexually trans- supervision for any unfamiliar procedures or
mitted infections, alcohol or drug abuse, sexual practices. Asking to be reassigned could be an
assault, or family planning. option if there is no time or personnel avail-
14. Answer 3: Policies about giving patient infor- able to supervise the new nurse. Reviewing
mation over the phone will vary. For example, the procedure might be an option if the nurse
some facilities may not allow acknowledg- is confident that the information is sufficient
ing that the patient is or is not there. Other to ensure safe performance. Giving feedback
facilities require that the patient have a list of about orientation might be useful to improve
people who are allowed to call for information. the orientation program, but it is not possible
Another variation is that selected callers are to cover all skills and all patient situations dur-
given a phone code to reach the patient. The ing orientation.
nurse should be familiar with hospital policy, 21. Answer 1: First, assess the patient’s feelings by
because the policies are designed to specifically encouraging expression. The patient may not
comply with Health Insurance Portability and understand the advance directives or may have
Accountability Act (HIPAA). issues that were triggered by the discussion.
15. Answer 3: Alert the HCP so the child can be The other options are also necessary.
examined for occult injury. The other options 22. Answer 2: The patient’s living will is the best
may also be used to investigate the possibility protection, because it reflects the patient’s
of child abuse. wishes. Policies and procedures and the Joint
16. Answer 2: Good Samaritan laws offer limited Commission may contain general guidance
liability, except in cases of gross negligence. about giving excellent care to patients, but will
A prudent nurse would know that moving a not offer any specific help in this situation. The
trauma victim could result in spinal cord in- Patient Self-Determination Act supports the
jury. Initiating cardiopulmonary resuscitation, use of living wills to define the individual’s
using available material to control bleeding choices about care and treatment.
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