Public Health Nursing 9th Edition Stanhope Test Bank

Chapter 03: The Changing U.S. Health and Public Health Care Systems Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition MULTIPLE CHOICE 1. In the United States, the majority of health care dollars are spent on: a. prescription drugs. b. hospital care. c. physician services. d. public health services (PHSs). ANS: B The largest share of health care expenditures goes to pay for hospital care, with physician services the next largest item. The money spent for PHSs is significantly lower than the other categories of expenditures. Other significant drivers of the increasingly high cost of health care include prescription drugs, technology, and chronic and degenerative disease. DIF: Cognitive level: Remembering REF: p. 48 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The number of uninsured Americans has dramatically increased because: a. Medicare took over payment of health care costs. b. with a declining population, the costs for health care rose. c. nursing salaries greatly increased, causing health care costs to rise. d. health insurance coverage was dropped from employment-based health plans. ANS: D Although the majority of Americans continue to obtain health insurance from their employer as a benefit, employment does not guarantee insurance. Employer-sponsored health insurance is sensitive to both the general economy and changes in health insurance premiums. As costs for insurance premiums rose, employers either shifted more of these costs to their employees or declined to offer employment-based health coverage at all. Medicare provides coverage only to the elderly and other special populations. The costs for health care are continuing to rise regardless of the size of the population. There has not been a significant change to nursing salaries, and a change in nursing salaries would not impact the number of uninsured Americans. DIF: Cognitive level: Understanding REF: p. 49 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is working with a community to decrease the occurrence of influenza. Which of the following U.S. Department of Health and Human Services (USDHHS; or simply HHS) goals is being applied? a. Strengthen Health Care b. Advance the Health, Safety, and Well-being of the American People c. Increase Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs d. Advance Scientific Knowledge and Innovation ANS: B One of the objectives of Advance the Health, Safety, and Well-being of the American People is to reduce the occurrence of infectious diseases. The goal of Strengthen Health Care focuses on improving health care services, quality, and coverage. The goal of Increase Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs focuses on improving programming and application of found data. The goal of Advance Scientific Knowledge and Innovation focuses on scientific discovery and application of the new knowledge. DIF: Cognitive level: Applying REF: p. 52 (Box 3-2) TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. According to the 1999 Institute of Medicine report, as many as 98,000 deaths each year could be attributed to: a. cardiovascular disease. b. obesity. c. medical error. d. drug overdose. ANS: C In 1999 it was thought that our health care system was expensive and that access and quality were not optimal, but we had not considered this important fact: many people die of preventable medical errors in the United States. This number is not the correct statistic for cardiovascular disease, obesity, or drug overdose. DIF: Cognitive level: Remembering REF: p. 49 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Residents of rural communities report that they must travel for long distances to obtain health care services. As a result, they seek health care only for emergencies and severe illnesses. Which aspect of the health care system in the United States is illustrated in this situation? a. Access to care b. Cost c. Quality d. Advances in technology ANS: A One significant problem is poor access to care. Access can refer to inability to pay for care and inability to access care. Cost refers to the health care expenditures that happen to pay for the services received. Quality refers to the quality of health care that is provided. Advances in technology refer to the medical advancements made to treat diseases. DIF: Cognitive level: Analyzing REF: pp. 48-49 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is exploring a job opportunity at a community health center. Which of the following expectations would the nurse have about the center? a. Would be located in a large metropolitan area b. Provides care only to the economically disadvantaged c. Offers comprehensive primary care services and supportive services d. Is used for preventive services such as flu shots ANS: C Community health centers serve the entire community for primary health care (PHC) services, regardless of income. They are located in a high need or medically underserved community, which can be urban or rural. DIF: Cognitive level: Applying REF: p. 49 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nursing program has initiated a recruitment campaign focusing on increasing the minority students in its program. Which of the following best describes the rationale for this program? a. The number of minority versus non-minority nurses should be equal. b. Minority health care professionals who share the same culture with the clients may provide more effective care. c. The profession should be more diverse. d. Minority nurses can mentor other nurses when providing care for diverse populations. ANS: B It is thought that increasing minority representation in the health workforce not only is a commitment to diversity, but also will improve the health care delivery system. Minority health professionals can be expected to practice in underserved areas at a greater rate and health professionals who share the same culture and language with the clients they serve can provide more effective care. It has been suggested that the number of minority nurses should be representative of the population served rather than there being equal numbers of minority and nonminority nurses. Minority nurses are able to mentor other nurses; however, is not the main reason that there is a focus on increasing recruitment of minorities. DIF: Cognitive level: Applying REF: p. 47 TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A community health nurse is utilizing telehealth. Which of the following best describes the rationale for its use? a. Enables clients to get nursing care in their homes b. Substitutes for health department delivered care c. Improves access to care in rural areas d. Replaces face-to-face care for those who cannot afford it ANS: C Telehealth provides increased access to health care by the use of a computer monitor and telephone line. It is useful for monitoring clients with chronic disease, but is not a substitute for health care. Telehealth may or may not be accompanied by home care nursing. DIF: Cognitive level: Applying REF: p. 47 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. One of the goals of the World Health Organization (WHO) is to: a. provide PHC services to everyone. b. prevent outbreaks of disease. c. prevent the transmittal of communicable disease among nations of the world. d. provide humanitarian support in times of disaster. ANS: A The WHO adopted a resolution in 1977 accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. This has been adapted to meet the needs of the new century and was deemed “Health for All in the 21st Century.” The focus of this initiative is PHC services. The WHO does not prevent outbreaks of disease, prevention, transmittal of disease, or provide humanitarian support. DIF: Cognitive level: Understanding REF: p. 54 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A public health agency is considering implementing an electronic health record. Which of the following best describes one of the benefits the agency will experience? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with the Joint Commission of Accreditation of Healthcare Organizations (JCAHO) standards ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors. There is no data to support that the agency will have improved client compliance or cost savings. Electronic medical records are not a requirement by JCAHO. DIF: Cognitive level: Applying REF: pp. 47-48 TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse interacts with a 25-year-old woman at a community health center who is obtaining a gynecological examination and birth control pills. Which of the following types of care is the client receiving? a. Tertiary health care b. Public health care c. PHC d. Specialized care ANS: C By definition, PHC includes basic health care services with the emphasis on prevention. Tertiary health care is highly specialized medical care. Public health care focuses on care for populations. Specialized care focuses on only one aspect of a patient’s health. DIF: Cognitive level: Applying REF: p. 50 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A client is receiving PHC services. Which of the following expectations would the client have? a. The care would be provided by a physician. b. Private insurance would be necessary to receive care. c. The emphasis of care provided would be on prevention. d. A referral would be made to a specialist after receiving services. ANS: C The focus of PHC is a broad range of services that are designed to be affordable for the recipients of the care and the governments who provide them. The emphasis of care is on prevention and the means of providing the care is based on practical, scientifically sound, culturally appropriate, and socially acceptable methods. All clients can receive PHC services regardless of insurance status. Those receiving primary care services may or may not need referral to a specialist. DIF: Cognitive level: Applying REF: p. 54 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse who was working in public health care has gotten a new job in primary care. Which of the following differences would be seen by the nurse in this new care setting? a. Focus on individuals b. Services provided by specialists c. Autonomy in the practice setting d. Community focused care is provided ANS: A Primary care focuses on individuals. It is also provided by generalists, is dominated by health care professionals, and is not community focused. DIF: Cognitive level: Analyzing REF: p. 47 & p. 54 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. What initiative began as a result of a resolution adopted by the WHO in 1977? a. Declaration of Alma Ata b. Medicare c. Healthy People d. PHC movement ANS: D The WHO adopted a resolution accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. The name of the resolution that was adopted was the Declaration of Alma Ata. Medicare began as part of the Social Security Act. The Healthy People initiative began as part of the 1979 Surgeon General’s Report addressing the health needs of Americans. DIF: Cognitive level: Understanding REF: p. 54 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. PHC in the United States: a. has dramatically improved since the passage of the Declaration of Alma Ata. b. focuses on the use of government-funded insurance programs. c. lacks community participation and a multidisciplinary health care delivery team. d. utilizes Preferred Provider Organizations to meet needs of the citizens. ANS: C Although PHC has been endorsed by the United States, it faces many challenges. PHC emphasizes broad strategies, community participation, self-reliance, and a multidisciplinary health care delivery team; however, this is not the primary method of health care delivery in the United States. DIF: Cognitive level: Understanding REF: p. 54 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A community health nurse reviews Healthy People 2020 when considering the health needs that will be addressed in the community. Which goal would the nurse find in this document? a. Promote healthy behaviors for children b. Cure cancer c. Eliminate health disparities d. Provide primary care to all citizens ANS: C Elimination of preventable disease, disability, injury, premature death; achievement of health equity; elimination of health disparities; and creation of social and physical environments that will promote good health and healthy development and behavior at every stage of life are the four major goals cited in Healthy People 2020. DIF: Cognitive level: Understanding REF: pp. 54-55 TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 17. An 80-year-old woman comes to the community health center with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. “Let’s go through these medications and see which ones we can delete.” b. “You can get these medicines at this clinic for free.” c. “Let’s see if we can get some help from Medicare to pay for these medications. I will refer you to our social worker.” d. “These medications are important. Do your best to pay for them.” ANS: C This elderly patient probably is eligible for benefits through Part C, the Medicare Advantage program, but often a patient needs help negotiating the system. The Medicare Advantage program incorporates private insurance plans into the Medicare program including HMO and PPO managed care models and private fee-for-service plans. In addition, Medicare Part D has been added to cover prescriptions. These plans receive payments from Medicare to provide Medicare benefits, including hospital, physician, and often, prescription drug benefits. Finding prescriptive coverage through an insurance plan is a better choice than eliminating medications, trying to get medications for free (which is only a short-term solution in most cases), and telling the client to find a way to pay for the medications when she does not have the resources. DIF: Cognitive level: Analyzing REF: p. 50 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nursing student is researching advanced practice nursing options. Which of the following discoveries would most likely be made by the nursing student? a. Nurse practitioners may work independently depending on the state practice act. b. Certified nurse midwives have limited prescriptive authority. c. Clinical nurse specialists typically provide primary care services. d. The Doctorate in Nursing Practice emphasizes the importance of research. ANS: A Nurse practitioners may work as independent practitioners and can be reimbursed by Medicare or Medicaid for services rendered. Certified nurse midwives have prescriptive authority in some form in all states. Clinical nurse specialists may provide primary care services, but often work in consultation, research, education, and administration. The Doctorate in Nursing Practice role is a clinical role. DIF: Cognitive level: Applying REF: p. 47 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nursing student interviews a member of the local congressional district to learn more about the health care system in the United States. Which statement made by the congressman would be accurate? a. “Managed care was short-lived because too many consumer groups endorsed the plans.” b. “Under managed care, clients had unlimited access to providers of their choice.” c. “Managed care failed because Americans were used to free access to providers of their choice.” d. “Managed care in the United States has been replaced by the Affordable Health Care for America Act.” ANS: C Managed care has not become prominent as the original concept outlined. Consumer groups were not only accustomed to freedom of choice and unlimited service, but they did not like the ideas of short-stay maternity care and denial of bone marrow transplantation for breast cancer patients, thus managed care failed in the United States. The Affordable Care Act has not replaced managed care. DIF: Cognitive level: Analyzing REF: p. 50 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. The federal agency of the public health system that is most involved with the health and welfare of United States citizens is the: a. Centers for Medicaid and Medicare Services. b. U. S. Department of Health and Human Services. c. U. S. Public Health Service (USPHS; or simply PHS). d. Health Resources and Services Administration. ANS: B The U. S. Department of Health and Human Services is charged with regulating health care and overseeing the health status of Americans. The Centers for Medicare and Medicaid Services develops and oversees the rules and regulations specific to these two insurance programs. The PHS is a major component of the Department of Health and Human Services. The PHS consists of eight agencies: (1) Agency for Healthcare Research and Quality, (2) Agency for Toxic Substances and Diseases Registry, (3) Centers for Disease Control and Prevention, (4) Food and Drug Administration, (5) Health Resources and Services Administration, (6) Indian Health Service, (7) National Institutes of Health, and (8) Substance Abuse and Mental Health Services Administration. DIF: Cognitive level: Understanding REF: p. 50 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse works to promote the passage of a public health law to protect the health of the community. Which of the following would the nurse most likely be promoting? a. Requiring all persons to have health insurance coverage b. Administering flu shots in the late fall and early winter c. Mandating immunizations for all children entering kindergarten d. Monitoring and licensing nuclear power plants ANS: C Public health laws protect the community. Required immunizations are an example. Requiring health insurance coverage would not protect the community. Administration of flu shots is not promotion of a law. Monitoring and licensing nuclear power plants are beyond the scope of public health. DIF: Cognitive level: Analyzing REF: p. 50 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is working in a state health department. Which of the following programs would the nurse most likely be working with? a. Senior health b. Dental services c. HIV/AIDS service d. Mental health ANS: C Typical programs in a state health department include: communicable disease service, HIV/AIDS service, and budget and finance. Senior health, dental health, and mental health are typically found in a local health department. DIF: Cognitive level: Applying REF: pp. 52-53 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse is employed by the Department of Homeland Security. Which of the following actions would be expected by this department? a. Prevention and protection against terrorist attacks b. Regulation of licensure of medical personnel c. Inspection of the safety of food and cosmetics d. Regulation of managed care organizations ANS: A The Department of Homeland Security was created after the terrorist attacks of September 11, 2001. Its mission is to prevent and deter terrorist attacks and to protect against and respond to threats and hazards to the nation. Regulating the licensure of medical personnel, inspecting the safety of food and cosmetics, and regulating managed care organizations are not responsibilities of this department. These activities are regulated by other state or federal government agencies. DIF: Cognitive level: Applying REF: pp. 50-52 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are some of the untoward events categorized in the Institute of Medicine (IOM) report about medical errors? (Select all that apply.) a. Wrong-site surgery b. Adverse drug events c. Improper transfusions d. Restraint related deaths e. Poor staffing patterns ANS: A, B, C, D The untoward events of wrong-site surgery, adverse drug events, improper transfusions, and restraint-related deaths are listed in the IOM report. Although poor staffing patterns may result in medical error, this is not one of the untoward events discussed in this report. DIF: Cognitive level: Understanding REF: p. 49 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is entering the health care workforce. Which of the following expectations should the nurse have for the workforce? (Select all that apply.) a. There is a shortage of nurses in the United States. b. Schools of nursing turn away qualified applicants due to lack of faculty and limitations of clinical sites. c. By 2016 there are expected to be 527,000 new nursing positions. d. More students are choosing laboratory science, pharmacy technology, and radiology technology over nursing. e. There is a shortage of physician specialists in the United States. ANS: A, B, C The first three options are true. The laboratory science, pharmacy technology, and radiology technology programs have all seen declining enrollments. There is a shortage of primary care physicians as more physicians are choosing to specialize. DIF: Cognitive level: Applying REF: p. 47 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care Chapter 07: Cultural Diversity in the Community Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition MULTIPLE CHOICE 1. Which statement about the nursing workforce is true? a. The nursing workforce is overwhelmingly white. b. The number of minority nurses meets the needs of the country’s demographics. c. The nursing workforce is becoming increasingly diverse with increasing minorities. d. Refugees make up a large part of the nursing workforce in some areas. ANS: A The nursing workforce is 83% white. Because of the large percentage of white nurses this does not meet the needs of the country’s demographics. Unauthorized immigrants and refugees do not make up a part of the nursing workforce. DIF: Cognitive level: Understanding REF: pp. 140-141 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The Refugee Act of 1980 had what effect on refugees who were immigrating into the United States? a. Allowed specific provisions for refugees from Southern and Eastern Europe b. Provided a uniform procedure for refugees to be admitted into the United States c. Permitted refugees to set up communities in or around major metropolitan areas d. Allowed refugees access to “green cards” that would allow them to work in the United States ANS: B The Refugee Act of 1980 provided a uniform procedure for refugees to be admitted into the United States. Refugees were immediately eligible to receive Temporary Assistance for Needy Families, Supplemental Security Income, and Medicaid. This procedure was in effect for all refugees not just those from specific countries. It did not provide “green card” access or permit development of specific communities for refugees. DIF: Cognitive level: Understanding REF: pp. 147-148 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A large portion of foreign-born residents of the United States: a. work in service-producing and blue-collar sectors. b. reside in rural areas. c. have a high school education. d. are refugees and nonimmigrants. ANS: A Two-thirds of the foreign-born population lives in or around major metropolitan areas and works in mainly service-producing and blue-collar sectors. They are also more likely to be poorer. The majority of foreign born are legal immigrants (85%). More than 54% of the foreign-born adults in the labor force have completed high school, which would not be considered a large portion. DIF: Cognitive level: Understanding REF: p. 147 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A 35-year-old man from Russia comes to the United States seeking asylum because of religious persecution in his native country. Which of the following best describes this type of immigrant? a. Legal immigrant b. Lawful permanent resident c. Refugee d. Unauthorized immigrant ANS: C Refugees are people who seek protection in the United States because of fear of persecution in their homeland. Legal immigrants are people who are not citizens but are legally allowed to live and work in United States, usually because they fulfill labor demands or have family ties. Lawful permanent resident is another name for legal immigrants. Unauthorized immigrants may have crossed a border into the United States illegally, or their legal permission to stay in the United States may have expired. DIF: Cognitive level: Applying REF: pp. 147-148 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A visitor from Japan comes to the United States for a 2-week vacation. Which of the following best describes this person? a. Nonimmigrant b. Refugee c. Legal immigrant d. Lawful permanent resident ANS: A A nonimmigrant is admitted for a limited duration for a specific purpose. Refugees are people who seek protection in the United States because of fear of persecution in their homeland. Legal immigrants are people who are not citizens but are legally allowed to live and work in United States, usually because they fulfill labor demands or have family ties. Lawful permanent resident is another name for legal immigrants. DIF: Cognitive level: Applying REF: p. 148 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is observing behaviors that may be defined by culture. Which of the following is the nurse most likely to observe? a. Speaking a dialect of a language in a local region b. Standing when an older adult gets on the bus to give him a seat c. Immigrating to the United States and seeking work d. An organizational structure of a cultural group ANS: B Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and is transmitted intergenerationally. Behaviors may be culturally determined, as illustrated in the correct response. This behavior is based on the value of respect of elderly people. Speaking a particular dialect in a local area would not fit the definition of culture. An organizational structure of a group is not an observable behavior. Immigrating to the United States does not demonstrate culture. DIF: Cognitive level: Analyzing REF: p. 141 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse states that the client has exhibited an explicit cultural behavior. Which of the following has the nurse most likely observed? a. Verbal communication b. Body language c. Use of titles d. Perception of health and illness ANS: A Explicit behaviors are straightforward and do not leave room for misinterpretation of what the person wants to communicate, such as when using verbal communication. Implicit behaviors are less exact and may be difficult to interpret, including body language, use of titles, and perception of health and illness. DIF: Cognitive level: Applying REF: p. 141 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is working with an immigrant population. Which of the following should be the first action taken by the nurse? a. Be aware of one’s own culture b. Become familiar with traditional practices of the immigrants c. Try to see things from the immigrant’s viewpoint d. Learn to speak the language of the immigrant population ANS: A Cultural competence is one of the core attributes of public health nurses. Nurses come from a variety of cultural backgrounds and have their own cultural traditions. Nurses also bring their biomedical beliefs and values to the practice environment that may differ from the client’s own beliefs and values. Because nurses recognize their own culture, they are better able to understand that there are differences among cultures. Being aware of one’s own culture should be done before completing the other tasks of increasing familiarity with traditional practices, trying to see things from the other’s point of view, or learning to speak the language. DIF: Cognitive level: Applying REF: p. 152 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. Which of the following statements about race is true? a. In the United States, children of biracial parents are usually assigned the race of the father. b. Ethnicity and race are synonymous terms. c. Individuals may be of the same race but of different cultures. d. No social significance is usually placed on race. ANS: C It is often a misconception that persons of the same race have the same culture. For example, African Americans may have been born in Africa, the Caribbean, North America, or elsewhere and have very different cultures. In the United States, children of biracial parents are usually assigned the race of the mother. Ethnicity is a contrasting term to race. Race is a characteristic that allows for some groups to be separated, treated as superior, and given access to power and other valued resources, while others are treated as inferior and have limited access to power and resources. DIF: Cognitive level: Understanding REF: p. 142 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is working with a population that exhibits a large amount of diversity. The nurse recognizes that skin color of individuals within this population is an example of: a. multiculturalism. b. ethnicity. c. race. d. culture. ANS: C Race is primarily a social classification that relies on physical markers. Multiculturalism is the blending of diverse cultures. Ethnicity is the shared feeling of peoplehood among a group of individuals and relates to cultural factors, such as nationality, geographic region, culture, ancestry, language, beliefs, and traditions. Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and transmitted intergenerationally. DIF: Cognitive level: Applying REF: p. 142 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A client shares with the nurse that her grandparents immigrated to the United States from Germany. Which of the following best describes what she has disclosed? a. Multiculturalism b. Ethnicity c. Race d. Culture ANS: B Ethnicity represents the identifying characteristics of culture, such as race, religion, or natural origin. Multiculturalism is the blending of diverse cultures. Race is primarily a social classification that relies on physical markers. Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and transmitted intergenerationally. DIF: Cognitive level: Applying REF: p. 142 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse implements nursing interventions considering the uniqueness of the person’s culture. Which of the following best describes this action? a. Cultural diversity b. Cultural knowledge c. Cultural competence d. Cultural awareness ANS: C Providing care based on the uniqueness of the client’s cultural norms and values is one of the three guiding principles of culturally competent nursing care. Cultural diversity refers to the degrees of variation represented among populations based on lifestyle, ethnicity, race, interest, across place, and place of origin across time. Cultural knowledge refers to the process of searching for and obtaining a sound educational understanding about culturally diverse groups. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. DIF: Cognitive level: Applying REF: pp. 151-152 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is unable to provide culturally competent care to a population within the community. Which of the following is an effect of this type of care? a. Enhanced communication b. Increased cost of health care c. Achievement of health indicators d. Improvement in client compliance ANS: B Care that is not culturally competent may increase health care costs and decrease positive client outcomes. Communication is inhibited through care that is not culturally competent. It is not possible to achieve health indicators if culturally competent care is not given. Client compliance decreases if culturally competent care is not provided. DIF: Cognitive level: Applying REF: p. 164 TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse is striving to be culturally competent. Which of the following actions would most likely be taken by the nurse? a. Respect individuals from different cultures and value diversity b. Immerse themselves in different cultures c. Design care for special ethnic groups d. Give explicit instructions to avoid client decision making ANS: A Nurses who strive to be culturally competent respect individuals from different cultures and value diversity. Immersing oneself in a different culture, designing care for special ethnic groups, and giving explicit instructions so the client does not have to make a decision does not demonstrate cultural competence. DIF: Cognitive level: Applying REF: p. 152 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse wants to obtain information on the alternative methods of health care her 45-year-old female client uses. Who would be the best person to ask about this? a. The husband of the client b. A community leader of the ethnic group c. The client herself d. The religious leader of the ethnic group ANS: C Clients provide a rich source of information about their own cultures. The client would be the preferred person to collect this information instead of the husband, community leader, or religious leader. DIF: Cognitive level: Analyzing REF: p. 154 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse has experienced a cultural encounter. Which of the following best describes what has happened? a. Sharing significant assessment findings with members of a racial minority b. Visiting the native land of the clients served at a community health center c. Telephoning the priest at a Hispanic church to discuss the health issues of a client d. Learning about traditional healing practices from an American Indian client ANS: D Cultural encounter refers to the process that permits nurses to seek opportunities to directly engage in cross-cultural interactions with clients of diverse cultures to modify existing beliefs about a specific cultural group and possibly avoid stereotyping. Learning about traditional healing practices is an example of a direct cultural encounter. This occurs when a nurse engages in cross-cultural interactions. Sharing significant assessment findings demonstrates the nurse sharing information, not an engagement with the population. When visiting a native land, there may not be interaction with any other culture. Telephoning a priest at a Hispanic church does not demonstrate an interaction, but rather the nurse calling the priest to accomplish a nursing task. DIF: Cognitive level: Applying REF: p. 155 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse demonstrates cultural desire to provide culturally competent care. Which of the following actions would be taken by the nurse? a. Relying on a textbook for information about an ethnic group b. Bringing a translator to the local community clinic c. Taking Spanish classes in the evening at a local college d. Judging others using his or her own cultural values ANS: C Cultural desire refers to the nurse’s intrinsic motivation to want to engage in the elements necessary to provide culturally competent care. The activity that suits the definition of cultural desire is one that a nurse would want to do instead of being directed to do so, referring to the intrinsic motivation of the nurse. Relying on a textbook for information, bringing a translator, and judging others do not demonstrate the definition of cultural desire as they are not demonstrating the intrinsic motivation of the nurse. DIF: Cognitive level: Applying REF: pp. 155-156 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. To meet a client’s needs, it is sometimes necessary to integrate into the client’s care a culturally relevant practice that lacks scientific utility. Which of the following best describes this action? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterning ANS: A Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help people of a particular culture to accept nursing strategies, or to negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values so they can maintain, promote, and restore health. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial. DIF: Cognitive level: Applying REF: p. 159 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A Mexican American mother insists on using special candles to help her daughter’s ear infection. The nurse asks the mother if she would also give her daughter antibiotics. Which of the following best describes the action of the nurse? a. Cultural accommodation b. Cultural repatterning c. Culture brokering d. Cultural awareness ANS: A This means that the nurse supports and facilitates the use of cultural practices with interventions from the biomedical health care system. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial. Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. DIF: Cognitive level: Applying REF: p. 159 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse supports the use of traditional home remedies in conjunction with Western medicine to promote healthy behaviors. Which of the following is being demonstrated by the nurse? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterning ANS: C Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial. DIF: Cognitive level: Analyzing REF: pp. 158-159 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 21. A city council discusses how former city laws promoted segregation in the community years ago. Which of the following was being demonstrated when segregation occurred? a. Prejudice b. Cultural imposition c. Racism d. Stereotyping ANS: C Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and self-worth. Prejudice is the emotional manifestation of deeply held beliefs about a group. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another country. Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences. DIF: Cognitive level: Applying REF: pp. 156-157 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. The nurse labels a patient an alcoholic because of his ethnicity. Which of the following best describes this action by the nurse? a. Stereotyping b. Prejudice c. Racism d. Ethnocentrism ANS: A Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences. Prejudice is the emotional manifestation of deeply held beliefs about a group. Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and self-worth. Ethnocentrism is the belief that one’s own cultural group determines the standards by which another group’s behavior is judged. DIF: Cognitive level: Applying REF: p. 156 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse advocates and intervenes between the health care system and the client’s cultural beliefs on behalf of the client. Which of the following best describes the nurse’s action? a. Cultural accommodation b. Culture brokering c. Cultural preservation d. Cultural repatterning ANS: B Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial. DIF: Cognitive level: Applying REF: pp. 159-160 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. A nurse believes that the best treatment for illness is the use of Western medicine and alternative therapies should not be used for healing. Which of the following best describes what has happened? a. Ethnocentrism b. Cultural imposition c. Racism d. Stereotyping ANS: A Ethnocentrism is the belief that one’s own cultural group determines the standards by which another group’s behavior is judged. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another culture. Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior on the basis of intelligence, morals, beauty, inheritance, and self-worth. Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences. DIF: Cognitive level: Applying REF: p. 157 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. The tendency to ignore all differences between cultures and to act as though the differences do not exist is defined as: a. cultural conflict. b. culture shock. c. cultural blindness. d. cultural imposition. ANS: C Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from the individual’s culture. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another country. DIF: Cognitive level: Understanding REF: p. 157 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. A nurse resigns from a position in a hospital to accept a job in a community setting. After starting the new job, the nurse feels helpless and confused, wondering if this was the right career choice. Which of the following terms best describes how the nurse is feeling? a. Cultural conflict b. Cultural relativism c. Culture shock d. Culture brokering ANS: C Culture shock can happen to individuals within their own culture when they are having experiences such as starting a new job or career. Culture shock is brought on by anxiety from losing familiar signs and symbols of social interaction. Feelings associated with culture shock are helplessness, discomfort, and disorientation. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Cultural relativism recognizes that clients have different approaches to health, and that each culture should be judged on its own merit and not on the nurse’s personal beliefs. Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients. DIF: Cognitive level: Applying REF: p. 158 TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A client comes into the clinic and tells the nurse he goes to an acupuncturist for pain. The nurse says he should take pain medication instead. Which of the following best describes the action taken by the nurse? a. Cultural conflict b. Cultural blindness c. Cultural relativism d. Cultural imposition ANS: D This is an example of cultural imposition—the act of imposing one’s cultural beliefs, values, and practices on individuals from another culture. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. Cultural relativism recognizes that clients have different approaches to health, and that each culture should be judged on its own merit and not on the nurse’s personal beliefs. DIF: Cognitive level: Applying REF: p. 157 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 28. Hispanics tend to believe that the needs of the family take priority over those of the individual. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Environmental control ANS: C Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Environmental control refers to the person’s relationship with nature and to plan and direct factors in the environment that affect them. DIF: Cognitive level: Applying REF: p. 145 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. In the Vietnamese culture, individuals may focus on wishes and memories of their ancestors and look to them to provide direction for current situations. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Perception of time ANS: D Perception of time is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. DIF: Cognitive level: Applying REF: pp. 144-145 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 30. Asians may perceive illness as disharmony with other forces and that medicine is only able to relieve the symptoms rather than cure the disease. They may look to naturalistic solutions and acupuncture to resolve or cure health problems. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Environmental control ANS: D Environmental control refers to the ability of individuals to control nature and to influence factors in the environment that affect them. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. DIF: Cognitive level: Applying REF: p. 145 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 31. Research has shown that Asian men tend to have a greater sensitivity than white Europeans to codeine, and they experience significantly weaker effects from the drug. Which of the following types of cultural variations is being demonstrated? a. Biological variations b. Personal space c. Social organization d. Perception of time ANS: A Biological variations are the physical, biological, and physiological differences that exist between racial groups and distinguish one group from another. Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. Perception of time is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future. DIF: Cognitive level: Applying REF: p. 143 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is planning a refugee outreach clinic at the neighborhood health center. Which of the following considerations should be made by the nurse in order to provide culturally competent care? (Select all that apply.) a. Their own background, beliefs, and knowledge may be significantly different from those of the people receiving care. b. Language barriers may interfere with efforts to provide assistance. c. Certain risk factors may be present for a given population. d. Certain groups may use nontraditional healing practices. e. Introduction of the American culture will be an important part of the encounter. ANS: A, B, C, D When working with immigrants, it is important to be aware of one’s own beliefs while realizing that language barriers may exist, that different populations experience different risk factors and illnesses, and that nontraditional healing practices may be used. It would not be appropriate to impose the American culture into the encounter. DIF: Cognitive level: Applying REF: pp. 148-149 TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse will be using an interpreter during a client encounter. Which of the following considerations should be made by the nurse? (Select all that apply.) a. It is appropriate to use family members as interpreters. b. Written materials should be available in the client’s primary language. c. Observe the interpreter’s gestures to assure client understanding. d. The gender, age, and educational level of the interpreter should be evaluated. e. The nurse should face the interpreter when speaking. ANS: B, D Family members should be used with caution. The client’s gestures and nonverbal messages should be observed to assure understanding. Written materials should be available in the client’s primary language. The gender, age, educational level, socioeconomic status, religion, and dialect should all be considered when selecting the proper interpreter. The nurse should face the client during the dialogue, not the interpreter. DIF: Cognitive level: Applying REF: p. 149 (How to Box) TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care Chapter 15: Evidence-Based Practice Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition MULTIPLE CHOICE 1. Evidence-based public health (EBPH) is: a. an integration of the best available nursing expertise. b. derived from community principles to fit the area where it is practiced. c. a health endeavor that makes informed use of evidence. d. comprised of only public health records. ANS: C EBPH is a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods. EBPH includes more than public health records. EBPH is not an integration of nursing expertise. EBPH is not derived from community principles. DIF: Cognitive level: Understanding REF: p. 343 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is using clinical experience and client preference to guide clinical decision making. Which of the following is being demonstrated by the nurse? a. Evidence-based practice b. Internal evidence c. Research utilization d. External evidence ANS: B Internal evidence refers to the use of the nurse’s clinical experiences and the client’s preferences. Evidence-based practice includes the best available evidence from a variety of sources, including research studies, nursing experience and expertise, and community leaders. Research utilization is the process of transforming research knowledge into practice and the use of research to guide clinical practice. External evidence includes research and other evidence, like reports and professional guidelines. DIF: Cognitive level: Applying REF: p. 343 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. The term evidence-based was first used in: a. Canada. b. Great Britain. c. the United States. d. Australia. ANS: A The term evidence-based was first attributed to Gordon Gyatt, a Canadian physician at McMaster University in 1992. Great Britain, the United States, and Australia did not use this term before it was used in Canada. DIF: Cognitive level: Remembering REF: p. 343 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse providing care in the 1970s follows a process when making clinical decisions. Which of the following processes would have been used? a. Evidence-based nursing practice b. The science of medicine c. Evidence-based medicine d. Research utilization ANS: D Research utilization projects in the 1970s provided a guide to clinical practice. The term evidence-based was not used until 1992, and was first applied to medicine before it was used in nursing. There was a growing consensus in the 1970s among nursing leaders that scientific knowledge should be used as a basis for nursing practice, so there was a shift away from the practice of medicine. DIF: Cognitive level: Analyzing REF: pp. 343-344 TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse makes clinical judgments based upon trial and error and past clinical experiences. Which of the following problems can result from using these data sources in clinical decision making? a. Not all sources of information are reliable. b. Authority always leads to faulty decision making. c. Ethical knowledge is not taken into account. d. Trial and error has led to poor outcomes. ANS: A Nurses have always used various resources for problem solving. However, not all of these resources are reliable and all have not consistently produced desired outcomes. Authority does not always lead to faulty decision making. Ethical knowledge should be taken into account when making clinical judgments. Trial and error may or may not lead to poor outcomes. DIF: Cognitive level: Applying REF: p. 345 TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is looking for evidence-based practice to support the methods used to facilitate smoking cessation. Which of the following types of evidence would be the best for the nurse to examine? a. Scientific literature found in systematic reviews b. Double-blind randomized controlled trial c. Quasi-experimental studies d. Expert opinion ANS: A Because it is difficult to find or perform randomized controlled trials in the community, other types of evidence have been highlighted as the best evidence in public health literature upon which to base EBPH practice; scientific literature found in systematic reviews is one type that is recommended. Although randomized controlled trials are the highest level of evidence with quasi-experimental studies and expert opinion both being lower on the list of evidence. It would not be possible to implement randomized control trials or quasi-experimental studies when studying smoking cessation. Expert opinion would not be as helpful when looking at methods that have literature that support their use. DIF: Cognitive level: Applying REF: p. 345 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. Which type of research is defined as the gold standard of evidence in evidence-based practice? a. Clinical expertise b. Randomized controlled trials c. Case studies d. Systematic review ANS: B The double blind randomized controlled trial generally provides the highest level of evidence, followed by other randomized controlled trials. Clinical expertise, case studies, and systematic reviews are not at the top of the hierarchy of evidence. DIF: Cognitive level: Understanding REF: p. 345 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A public health nurse (PHN) would like to incorporate evidence-based practice into the clinical practice at the health department. According to Melnyk and Fineout-Overholt et al., which of the following steps should the nurse take first? a. Integrating the evidence with clinical expertise b. Cultivating a spirit of inquiry c. Asking clinical questions d. Searching for the best evidence ANS: B According to Melnyk and Fineout-Overholt et al., the first step is step 0: Cultivating a spirit of inquiry. Integrating evidence with clinical expertise is step 4. Asking clinical questions is step 1. Searching for the best evidence is step 2. DIF: Cognitive level: Applying REF: p. 346 TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A summary of the research evidence that relates to a specific question and to the effects of an inter