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Chapter 13 Care and Safety Standards, Competence, and Nurse Accountability
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Chapter 13: Care and Safety Standards, Competence, and Nurse AccountabilityClaywell: LPN to RN Transitions
MULTIPLE CHOICE
1. A new graduate has been working as an RN for 6 months and is no longer working with a
preceptor. However, she still frequently checks with an experienced nurse to validate that she
is following the rules and the policies she is still learning. The new graduate in this scenario
exhibits the actions of what theoretical level of skill?
a. Expert
b. Competent
c. Proficient
d. Novice
ANS: D
In general, a novice is rule driven, is a concrete thinker, and believes and trusts whomever has
authority or whatever direction is perceived to have come from someone in authority. Benner
(1984) suggests that with experience and practice, nurses advance through the different levels
of nursing knowledge—novice, competent, proficient, and expert.
DIF: Cognitive Level: Analysis
OBJ: Compare the theoretical classifications of nursing skill.
TOP: Classification of Nursing Skill
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
2. An RN has been working on a cardiac unit for 1 year and has settled comfortably into an
efficient, safe, and organized roNutine for each shift. However, whenever an urgent issue arises,
the nurse feels uncomfortable. It is most likely that this nurse is functioning at which skill
level?
a. Novice
b. Proficient
c. Competent
d. Expert
ANS: C
A competent nurse has some experience and has developed safe organizational skills to get
through the day’s tasks efficiently. Flexibility within the nursing role is difficult to manage at
this point, and when deviations from the schedule occur, the nurse generally has a feeling of
unease.
DIF: Cognitive Level: Analysis
OBJ: Compare the theoretical classifications of nursing skill.
TOP: Classification of Nursing Skill
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
3. Which action would indicate that the RN is practicing at the proficient level?
a. Asks another nurse to be present while a Foley catheter is inserted
b. Becomes frazzled when two patients are unexpectedly admitted at the same time
c. Thinks critically about situations and is able to anticipate patient needs
d. Assumes the role of charge nurse while managing a tough patient assignment
, ANS: C
A proficient nurse is experienced and has a beginning ability to recognize patterns and think
critically. This allows her to think critically about situations and anticipate the needs of her
patients. Novice nurses may ask the help of other more experienced nurses. Competent nurses
have developed skills and are routine driven, often struggling with flexibility. Expert nurses
are skilled critical thinkers and they handle challenges with ease.
DIF: Cognitive Level: Application
OBJ: Compare the theoretical classifications of nursing skill.
TOP: Classification of Nursing Skill
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
4. An RN has been practicing for 12 years in pediatrics. Peers often seek out this nurse to help
them with complex problems. This experienced nurse is assigned the patients with the highest
acuity, and the nurse accepts these assignments with confidence. This nurse is likely
practicing at which skill level?
a. Novice
b. Competent
c. Proficient
d. Expert
ANS: D
An expert nurse has had a great deal of experience and is flexible and adaptable, responding to
change with ease. According to Benner (1984), the expert nurse is a skilled critical thinker
who has gained experience and skills through practice.
DIF: Cognitive Level: Analysis
OBJ: Compare the theoretical clNassifications of nursing skill.
TOP: Classification of Nursing Skill
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
5. The nurse is working on a busy cardiac floor. While preparing medications, the nurse is
interrupted by a co-worker, who has a question about another patient. After administering the
medication, the nurse realizes that she gave the medication to the wrong patient. Which action
by the nurse would indicate accountability?
a. Shifting blame to the co-worker who interrupted her
b. Attempting to hide the medication error to avoid getting into trouble
c. Accepting partial responsibility for her own actions
d. Taking responsibility for her own actions and interventions by immediately
assessing the patient and reporting the error to a physician
ANS: D
Accountability is being answerable for the actions or interventions one performs as a nurse.
Immediately assessing the patient and reporting the error to a physician demonstrate
accountability. Shifting blame, attempting to hide the error, and accepting only partial blame
do not.
DIF: Cognitive Level: Application
OBJ: Describe accountability as it applies to nursing practice. TOP: Accountability
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
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