Evolution of Nursing Thought and Action

Identify the choice that best completes the statement or answers the question.

____ 1. What is the most influential factor that has shaped the nursing profession?

1)
Physicians’ need for handmaidens
2)
Societal need for health care outside the home
3)
Military demand for nurses in the field
4)
Germ theory influence on sanitation

____ 2. Which of the following is an example of an illness prevention activity? Select all that apply.

1)
Encouraging the use of a food diary
2)
Joining a cancer support group
3)
Administering immunization for HPV
4)
Teaching a diabetic patient about his diet

____ 3. Which of the following contributions of Florence Nightingale had an immediate impact on improving patients’ health?

1)
Providing a clean environment
2)
Improving nursing education
3)
Changing the delivery of care in hospitals
4)
Establishing nursing as a distinct profession

____ 4. All of the following are aspects of the full-spectrum nursing role. Which one is essential for the nurse to do in order to successfully carry out all the others?

1)
Thinking and reasoning about the client’s care
2)
Providing hands-on client care
3)
Carrying out physician orders
4)
Delegating to assistive personnel

____ 5. Which statement pertaining to Benner’s practice model for clinical competence is true?

1)
Progression through the stages is constant with most nurses reaching the proficient stage.
2)
Progression through the stages involves continual development of thinking and technical skills.
3)
The nurse must have experience in many areas before being considered an expert.
4)
The nurse’s progress through the stages is determined by years of experience and skills.

____ 6. Which of the following best explains why it is difficult for the profession to develop a definition of nursing?

1)
There are too many different and conflicting images of nurses.
2)
There are constant changes in health care and the activities of nurses.
3)
There is disagreement among the different nursing organizations.
4)
There are different education pathways and levels of practice.

____ 7. Nurses have the potential to be very influential in shaping health care policy. Which of the following factors contributes most to nurses’ influence?

1)
Nurses are the largest health professional group.
2)
Nurses have a long history of serving the public.
3)
Nurses have achieved some independence from physicians in recent years.
4)
Political involvement has helped refute negative images portrayed in the media.

____ 8. Nursing was described as a distinct occupation in the sacred books of which faith?

1)
Buddhism
2)
Christianity
3)
Hinduism
4)
Judaism

____ 9. The American Red Cross was established by:

1)
Louisa May Alcott.
2)
Clara Barton.
3)
Dorothea Dix.
4)
Harriet Tubman.

____ 10. Which of the following is the most important reason to develop a definition of nursing?

1)
Recruit more informed people into the nursing profession
2)
Evaluate the degree of role satisfaction
3)
Dispel the stereotypical images of nurses and nursing
4)
Differentiate nursing activities from those of other health professionals

____ 11. Which of the following provides evidence-based support for the contribution that advanced practice nurses (APNs) make within health care?

1)
Reduced usage of diagnostics using advanced technology
2)
Decreased number of unnecessary visits to emergency department
3)
Improved patient compliance with prescribed treatments
4)
Increased usage of complementary alternative therapies

____ 12. Which of the following is an example of what traditional medicine and complementary and alternative medicine therapies have in common?

1)
Both can produce adverse effects in some patients.
2)
Both use prescription medications.
3)
Both are usually reimbursed by insurance programs.
4)
Both are regulated by the FDA.

____ 13. Of the following, the biggest disadvantage of having nursing assistive personnel (NAP) help nurses is that the nurse:

1)
Must know what aspects of care can legally and safely be delegated to the NAP.
2)
May rely too heavily on information gathered by the NAP when making patient-care decisions.
3)
Is removed from many components of direct patient care that have been delegated to the NAP.
4)
Still maintains responsibility for the patient care given by the NAP.

____ 14. An older adult has type 1 diabetes. He can perform self-care activities but needs help with shopping and meal preparation as well as with blood glucose monitoring and insulin administration. Which type of healthcare facility would be most appropriate for him?

1)
Acute care facility
2)
Ambulatory care facility
3)
Extended care facility
4)
Assisted living facility

____ 15. The nurse in the intensive care unit is providing care for only one patient, who was admitted in septic shock. Based on this information, which care delivery model can you infer that this nurse is following?

1)
Functional
2)
Primary
3)
Case method
4)
Team

____ 16. Which healthcare worker should the nurse consult to counsel a patient about financial and family stressors impacting healthcare?

1)
Social worker
2)
Occupational therapist
3)
Physician’s assistant
4)
Technologist

____ 17. Which type of managed care allows patients the greatest choice of providers, medications, and medical devices?

1)
Health maintenance organization
2)
Integrated delivery network
3)
Preferred provider organization
4)
Employment-based private insurance

____ 18. A patient who underwent a total abdominal hysterectomy is assisted out of bed as soon as her vital signs are stable. This intervention is most likely being directed by a:

1)
Critical pathway.
2)
Nursing care plan.
3)
Case manager.
4)
Traditional care model.

____ 19. Which member of the healthcare team typically serves as the case manager?

1)
Occupational therapist
2)
Physician
3)
Physician’s assistant
4)
Registered nurse

____ 20. Which of the following is considered a primary care service?

1)
Providing wound care
2)
Administering childhood immunizations
3)
Providing drug rehabilitation
4)
Outpatient hernia repair

____ 21. Which of the following nursing activities represent direct care? Choose all that apply.

1)
Bathing a patient
2)
Administering a medication
3)
Documenting an assessment
4)
Making work assignments for the shift

____ 22. An 80-year-old patient fell and fractured her hip and is in the hospital. Before the fall, she lived at home with her husband and managed their activities of daily living very well. The goal is for the patient to recover from the injury and return to her home. The hospital is ready to discharge her because she has exceeded the recommended length of stay in a hospital. However, she cannot walk or care for herself yet, and she will require lengthy physical therapy and further monitoring of her medications and her physical and mental status. To which type of facility should she be transferred?

1)
Nursing home
2)
Rehabilitation center
3)
An outpatient therapy center
4)
None of these; she should receive home healthcare

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Which of the following are examples of a health promotion activity? Select all that apply.

1)
Helping a client develop a plan for a low-fat, low-cholesterol diet
2)
Disinfecting an abraded knee after a child falls off a bicycle
3)
Administering a tetanus vaccination after an injury from a car accident
4)
Distributing educational brochures about the benefits of exercise

Matching

Match the nursing role listed on the left with the appropriate activity listed on the right. Each activity has only one correct answer.

1)
Planning the unit’s staffing schedule
2)
Participating on a committee to develop a program to teach schoolchildren proper handwashing
3)
Teaching the client about a scheduled test
4)
Discussing new medication at a staff meeting
5)
Discussing with the physician the client’s reasons for not wanting the recommended surgery.

____ 1. Direct Care Provider

____ 2. Client Advocate

____ 3. Manager

____ 4. Change Agent

Match the event with the appropriate year. Each item has only one correct answer.

1)
Nursing programs become affiliated with religious groups
2)
Start of public health nursing with the founding of the Henry Street Settlement
3)
First formal nursing education in United States
4)
First hospital
5)
Establishment of the Army Nursing Service
6)
Disassociation of nursing from religious orders
7)
Florence Nightingale cared for the soldiers of the Crimean War

____ 5. 1st century AD

____ 6. 15th to 19th century

____ 7. 1854

____ 8. 1861

____ 9. 1873

____ 10. 1893

Match the nursing organization with its function in the nursing profession.

1)
Responsible for setting and maintaining nursing education standards
2)
Developed Code for Nurses and the Standards of Clinical Nursing Practice
3)
Responsible for publishing Image
4)
Honor society for nursing
5)
Represents nursing and promotes nursing leadership worldwide

____ 11. American Nurses Association (ANA)

____ 12. National Student Nurses Association (NSNA)

____ 13. National League for Nursing (NLN)

____ 14. International Council of Nursing (ICN)

____ 15. Sigma Theta Tau International (STTI)

True/False

Indicate whether the statement is true or false.

____ 1. The nurse caring for a patient undergoing minor surgery as an outpatient provides the same type of care as for a hospitalized patient undergoing the same procedure.

Completion

Complete each statement.

1. ____________________ is a health program, administered by the state and funded by federal and state governments to provide care for low-income people.

2. ____________________ is a federal insurance-type program designed to fund health care for people age 65 years and older, the disabled, and those with end-stage renal disease from the high cost of healthcare.

Chapter 1. Evolution of Nursing Thought and Action

Answer Section

MULTIPLE CHOICE

1. ANS: 3

The physician’s handmaiden was/is a nursing stereotype rather than an influence on nursing.

Although there has been need for health care outside the home throughout history, this has more influence on the development of hospitals than on nursing; this need provided one more setting for nursing work. Throughout the centuries, stability of the government has been related to the success of the military to protect or extend its domain. As the survival and well-being of soldiers is critical, nurses provided health care to the sick and injured at the battle site. Germ theory and sanitation helped to improve health care but did not shape nursing.

PTS: 1 DIF: Moderate REF: V1, pp. 8-9 KEY: Cognitive level: Recall

2. ANS: 3

Although cancer is a disease, it is assumed that a person joining a support group would already have the disease; therefore, this is not disease prevention, but treatment. Illness prevention activities focus on avoiding a specific disease. A food diary is a health promotion activity. Teaching a diabetic patient about diet is a treatment for diabetes; the patient already has diabetes, so it cannot prevent diabetes.

PTS: 1 DIF: Moderate

REF: V1, pp. 19-20; high level, not directly stated in text

KEY: Client need: HPM | Cognitive level: Application

3. ANS: 1

Improved sanitation greatly and immediately reduced the rate of infection and mortality in hospitals. The other responses are all activities of Florence Nightingale that improved health care or nursing, but the impact is long range, not immediate.

PTS: 1 DIF: Easy

REF: V1, p. 3; student must infer from content | V1, p. 7; student must infer from content

KEY: Client need: SECE | Cognitive level: Application

4. ANS: 1

A substantial portion of the nursing role involves using clinical judgment, critical thinking, and problem solving, which directly affect the care the client will actually receive. Providing hands-on care is important; however, clinical judgment, critical thinking, and problem solving are essential in order to do it successfully. Carrying out physician orders is a small part of a nurse’s role; it, too, requires nursing assessment, planning, intervention, and evaluation. Many simple nursing tasks are being delegated to nursing assistive personnel; delegation requires careful analysis of patient status and the appropriateness of support personnel to deliver care. Another way to analyze this question is that none of the options of providing hands-on care, carrying out physician orders, and delegating to assistive personnel is required in order for the nurse to do think and reason about a client’s care; so the answer must be 1.

PTS: 1 DIF: Difficult REF: V1, p. 11

KEY: Cognitive level: Analysis

5. ANS: 2

Movement through the stages is not constant. Benner’s model is based on integration of knowledge, technical skill, and intuition in the development of clinical wisdom. The model does not mention experience in many areas. Years of experience is not mentioned in the model.

PTS: 1 DIF: Moderate REF: V1, pp. 15-16

KEY: Cognitive level: Recall

6. ANS: 2

The conflicting images of nursing make it more important to develop a definition; they may also make it more difficult, but not to the extent that constant change does. Health care is constantly changing and with it come changes in where, how, and what nursing care is delivered. Constant changes make it difficult to develop a definition. Although different nursing organizations have different definitions, they are similar in most ways. The different education pathways affect entry into practice, not the definition of nursing.

PTS: 1 DIF: Moderate REF: V1, p. 11; ”How is Nursing Defined?”

KEY: Cognitive level: Analysis

7. ANS: 1

Nurses are trusted professionals and the largest health professional group. As such they have political power to effect changes. If nursing was a small group, there would be little potential for power in shaping policies, even if all the other answers were true. Serving the public, while positive, does not necessarily help nurses to be influential in establishing health policy. Independence from physicians, although positive, does not necessarily make nurses influential in establishing health care policy. Refuting negative media, although positive, does not necessarily make nurses influential in establishing health care policy.

PTS: 1 DIF: Moderate REF: V1, p. 24

KEY: Cognitive level: Analysis

8. ANS: 3

The Vedas, the sacred books of the Hindu faith, described Indian health care practices and were the earliest writings of a distinct nursing occupation.

PTS: 1 DIF: Easy REF: V1, p. 4 KEY: Cognitive level: Recall

9. ANS: 2

Louisa May Alcott was an American novelist who wrote Little Women in 1868. Clara Barton was an American teacher, nurse, and humanitarian who organized the American Red Cross after the Civil War. Dorothea Dix was an American activist who acted on behalf of the indigent population with mental illness. She was credited for establishing the first psychiatric institution. Harriet Tubman was an African American abolitionist and Union spy during the Civil War. After escaping captivity, she set up a network of antislavery activists, known as the Underground Railroad.

PTS: 1 DIF: Easy REF: V1, p. 9 KEY: Cognitive level: Recall

10. ANS: 4

Nursing organization leaders think it is important to develop a definition of nursing to bring value and understanding to the profession, differentiate nursing activities from those of other health professionals, and help student nurses understand what is expected of them. A definition of nursing would not be likely to increase the number of informed people recruited into nursing. A definition of nursing would do little to improve the nurse’s role satisfaction. Although a definition of nursing might contribute to fighting stereotypes of nursing, other more powerful influences (e.g., media portrayals) exist to counteract it.

PTS: 1 DIF: Easy

REF: V1, pp. 11-12; students must infer from content KEY: Cognitive level: Recall

11. ANS: 3

Studies demonstrate that APNs have improved patient outcomes over those of physicians, including increased patient understanding and cooperation with treatments and decreased need for hospitalizations. No well-known, scientific studies support APNs’ effect on the use of advanced technology. No well-known, scientific studies support APNs’ effect on the frequency of emergency department visits. No well-known, scientific studies support APNs’ effect on the use of alternative therapies.

PTS: 1 DIF: Moderate REF: V1, p. 23 KEY: Cognitive level: Recall

12. ANS: 1

Both traditional and complementary therapies can produce adverse effects in some patients. Many medications are derived from herbs, but the alternative treatments usually use the herbs, not prescription medication. Insurance programs do not necessarily reimburse alternative treatments because many are not supported by sound scientific research methodology. Alternative medications are not regulated by the FDA.

PTS: 1 DIF: Moderate REF: V1, pp. 22-23

KEY: Cognitive level: Recall

13. ANS: 2

All of the options may be disadvantages to using NAPs, but making decisions based on another’s information is the greatest drawback because of the potential for negatively affecting patient care. Treatment decisions based on incorrect information may cause harm to the patient.

PTS: 1 DIF: Difficult

REF: V1, pp. 23-24; students must conclude from content

KEY: Cognitive level: Analysis

14. ANS: 4

Assisted living facilities are intended for those who are able to perform self-care activities but who require assistance with meals, housekeeping, or medications. Acute care facilities focus on preventing illnesses and treating acute problems. These facilities include physicians’ offices, clinics, and diagnostic centers. Ambulatory care facilities provide outpatient care. Clients live at home or in nonhospital settings and come to the site for care. Ambulatory care facilities include include private health and medical offices, clinics, surgery centers, and outpatient therapy centers. Extended care facilities typically provide long-term care, rehabilitation, wound care, and ongoing monitoring of patient conditions.

PTS: 1 DIF: Easy REF: V1, p. 20

KEY: Client need: SECE | Cognitive level: Application

15. ANS: 3

The nurse is following the case method model of nursing care. In this model, one nurse cares for one patient during a single shift. When the functional nursing model is employed, care is compartmentalized, and each task is assigned to a staff member with the appropriate knowledge and skills. In primary nursing, one nurse plans the care for a group of patients round-the-clock. The primary nurse assesses the patient and develops the plan of care. When he or she is working, he or she provides care for those patients that he or she is responsible for. In his or her absence, the associate nurses deliver care. Although the nurse in this case could possibly be a primary nurse, there are not enough data to confidently infer that. If the team nursing approach is utilized, a licensed nurse (RN or LVN) is paired with a nursing assistant. The pair is then assigned to a group of patients.

PTS: 1 DIF: Moderate

REF: ESG, Chapter 1, “Healthcare Delivery Systems, Expanded Discussion,” “What Models of Care are Used to Provide Nursing Care?”

KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Analysis

16. ANS: 1

The social worker coordinates services and counsels patients about financial, housing, marital, and family issues impacting healthcare. The occupational therapist helps patients regain function and independence for activities of daily living. Physician’s assistants work under the physician’s direction to diagnose certain diseases and injuries. Technologists provide a variety of specific functions in hospitals, diagnostic centers, and emergency care. For example, laboratory technologists aid in the diagnosis and treatment of patients by examining blood, urine, tissue, and body fluids. Radiology technologists perform x-rays and other diagnostic testing.

PTS: 1 DIF: Moderate

REF: ESG, Chapter 1, “Healthcare Delivery Systems, Expanded Discussion,” “What Healthcare Providers Will You Work With?”

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Comprehension

17. ANS: 3

Health Maintenance Organizations allow the patient to choose a primary care provider within the organization to coordinate his care. This type of program will only reimburse medical care when the patient has first obtained a referral from the primary provider. Preferred Provider Organizations are a form of managed care that allows the patient a greater choice of providers, medications, and medical devices within the designated list. Integrated Delivery Networks combine providers, health care facilities, pharmaceuticals, and services into one system, and the patient must remain within the system to receive care. Employment-based Private Insurance is not a managed care organization.

PTS: 1 DIF: Easy

REF: ESG, Chapter 1, “Healthcare Delivery Systems, Expanded Discussion,” “How Do Healthcare Policy and Reform Efforts Affect Care?”

KEY: Client need: SECE | Cognitive level: Analysis

18. ANS: 1

This patient’s care is most likely being directed by a critical pathway. A critical pathway is a multidisciplinary approach to care that sequences interventions over a length of stay for a given case type, such as total abdominal hysterectomy. Using this model, the patient can be assisted out of bed as soon as her vital signs are stable. Using the traditional model, the nurse would have to obtain a physician’s order to assist the patient out of bed after surgery. The nursing care plan guides nursing care but cannot specify when the patient can get out of bed postoperatively without a physician’s order. When case management is used, care is coordinated by the case manager across the healthcare setting, but the case manager does not direct each care intervention.

PTS: 1 DIF: Moderate

REF: ESG, Chapter 1, “Healthcare Delivery Systems, Expanded Discussion,” “How Do Healthcare Policy and Reform Efforts Affect Care?”

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application

19. ANS: 4

Typically, registered nurses serve as case managers for patients with specific diagnoses. Their role is coordinator of care across the healthcare system. The occupational therapist, physician, and physician’s assistant all serve on the healthcare team and take direction from the case manager.

PTS: 1 DIF: Easy

REF: ESG, Chapter 1, “Healthcare Delivery Systems, Expanded Discussion,” “What Healthcare Providers Will You Work With?” KEY: Client need: SECE | Cognitive level: Recall

20. ANS: 2

Primary care services focus on health promotion and disease prevention; administering childhood immunizations is one such service. Providing wound care and drug rehabilitation are examples of tertiary care services. Outpatient hernia repair surgery is an example of a secondary care service.

PTS: 1 DIF: Moderate

REF: ESG, Chapter 1, “Healthcare Delivery Systems, Expanded Discussion,” “Categories of Health Care?” KEY: Client need: SECE | Cognitive level: Application

21. ANS: 1

Direct care involves personal interaction between the nurse and clients (e.g., giving medications, dressing a wound, or teaching a client about medicines or care). Nurses deliver indirect care when they work on behalf of an individual, group, family, or community to improve their health status (e.g., restocking the code blue cart [an emergency cart], ordering unit supplies, or arranging unit staffing).

PTS: 1 DIF: Easy REF: V1, p. 19

KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Comprehension

22. ANS: 2

A skilled nursing facility primarily provides skilled nursing care for patients who can be expected to improve with treatment. For example a patient who no longer needs hospitalization may transfer to a skilled nursing facility to get skilled care until she is able to return home. A nursing home provides custodial care for people who cannot live on their own but are not sick enough to require hospitalization. It provides a room, custodial care, and opportunity for recreation. She cannot ambulate or perform activities of daily living, so outpatient therapy and home care would not be appropriate.

PTS: 1 DIF: Moderate REF: V1, p. 20

KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Application

MULTIPLE RESPONSE

1. ANS: 1, 4

Health promotion includes strategies that promote positive lifestyle changes. Disinfecting an abraded knee is a treatment/intervention for an injury. Administering a vaccination is a disease prevention and treatment activity.

PTS: 1 DIF: Moderate REF: V1, p. 19; high level, not directly stated in text

KEY: Client need: HPM | Cognitive level: Application

MATCHING

1. ANS: 3 PTS: 1 DIF: Moderate

REF: V1, p. 13; must recognize examples not provided in content

KEY: Cognitive level: Application

2. ANS: 5 PTS: 1 DIF: Moderate

REF: V1, p. 13; must recognize examples not provided in content

KEY: Cognitive level: Application

3. ANS: 1 PTS: 1 DIF: Moderate

REF: V1, p. 13; must recognize examples not provided in content

KEY: Cognitive level: Application

4. ANS: 2 PTS: 1 DIF: Moderate

REF: V1, p. 13; must recognize examples not provided in content

KEY: Cognitive level: Application

5. ANS: 4 PTS: 1 DIF: Difficult