Contemporary Nursing Issues, Trends, & Management 6th Edition by Barbara Cherry- Test Bank

Chapter 03: The Influence of Contemporary Trends and Issues on Nursing Education Test Bank MULTIPLE CHOICE 1. A current trend is for students to be evaluated to determine whether they demonstrate competence in the actual client care environment or with a standardized patient. This process occurs in addition to or instead of traditional pencil-and-paper evaluations. This type of evaluation is referred to as: a. core practice competencies. b. continuing competence. c. distance learning. d. performance-based assessment. ANS: D Correct: Performance-based assessment is the evaluation of abilities based on an objective demonstration of specific required competencies. This may include performance in actual or simulated situations. Incorrect: a. Core practice competencies consist of the abilities and skills currently required for program completion and nursing practice. b. Continuing competence is required in many states for relicensure and recertification. c. Distant learning occurs when courses are delivered through some electronic format such as a web-based course. The course may be presented a great distance from the student, who is never required to attend a class at a physical location. DIF: Knowledge REF: p. 43 2. One of the major trends that currently influences nursing education and practice is: a. increased technology in the field of critical care. b. a narrowing scope of practice for nurses. c. incivility or disregard of others’ rights in social interactions. d. a decrease in ethnicity due to international programs allowing students to study from a distance. ANS: C Correct: Incivility has escalated with the use of text-messaging during class and academic dishonesty. Incorrect: a. Critical care is not the only area in which technology is increasing and does not have a major influence on nursing education. b. The scope of practice is becoming broader, including community and global settings. d. The number of diverse ethnic minorities and illegal immigrants is increasing. DIF: Application REF: p. 45 3. Although the use of technology and the Internet provides nursing faculty and students with unlimited resources and current information, an outcome associated with this trend is that: a. users of electronic resources spend a disproportionate amount of time looking for pertinent content. b. additional time is available to study and revise curricula because special skills are not needed to access information via the Internet. c. immediate results and outcomes are expected from students and faculty, thus enhancing time management. d. skills that require problem solving and reflective abilities are developed. ANS: A Correct: Students can easily become distracted by pursuit of the intriguing web of links they encounter while they search websites to complete assignments or find pertinent content. Incorrect: b. Students must learn to become computer literate and competent. Success in nursing courses and practice depends on these skills. c. With unlimited information available to them, students may actually take more time to navigate web-based resources than is needed for review of traditional print-based resources. d. Learning from the Internet helps students develop skills in analytic thinking, decision making, and reflective judgment. DIF: Analysis REF: pp. 38-39 4. A new trend in nursing education that is consistent with real-world practice is focused on: a. outcomes. b. objectives. c. goals. d. subjective appraisals. ANS: A Correct: Outcomes and criteria establish real expectations for clinical practice and have a powerful influence on nursing education and practice at all levels. Outcomes are used in all areas of nursing in the nursing process. Incorrect: b. Objectives refer to knowledge that the student is expected to attain. c. Goals are client focused. d. Subjective appraisals are not used in real-world practice. DIF: Knowledge REF: p. 43 5. The practice of nurses, nursing students, and faculty is affected by demographic changes due to: a. the growing percentage of adults ages 50 to 55 years. b. increasing numbers of obese children and adults. c. changes by which families are becoming more nuclear. d. social programs that are essentially eliminating poverty. ANS: B Correct: The United States is experiencing an epidemic of obesity with major consequences for health and the health care system. a. The percentage of adults ages 50 to 65 years is not increasing. The number of very old adults is increasing. c. Even the definition of family has changed radically, as evidenced by single individuals living with other single individuals, single-parent households, and same-sex couples (with and without children). d. The number of families who remain uninsured, jobless, homeless, and surviving in poverty is increasing. DIF: Knowledge REF: p. 45 6. The first university to offer nursing graduates a baccalaureate degree was: a. Columbia Teachers College. b. Yale University. c. Harvard University. d. the New York Regents Program. ANS: B Correct: In 1924, Yale University offered the first separate Department of Nursing, whose graduates earned a baccalaureate degree. Incorrect: a. Columbia Teachers College was the first to offer a doctor of education degree. c. Harvard University does not offer a baccalaureate program in nursing. d. The New York Regents Program is a distance mobility program. DIF: Knowledge REF: p. 52 7. Which nursing model is referred to as the “class without walls”? a. Articulation b. Career ladder (2 + 2) c. External degree d. Second degree ANS: C Correct: An external degree does not require attendance and provides no course classes; it enrolls thousands and is accessible regardless of geographic location. Incorrect: a. Articulation is the format of a program, or refers to what the student must do to complete the program. b. The 2 + 2 option is for LPN or RN students to continue their education to RN or BSN, respectively. d. A second degree is a degree that is pursued after the first degree has been obtained. DIF: Knowledge REF: p. 54 8. In preparing students for professional nursing practice in the twenty-first century, where should the emphasis be placed? a. Care coordination, direct care for complex clients, and outcomes evaluation b. Chemistry, biostatistics, and computer programming c. Illness care, hospice, and ethics d. Psychomotor skills, obstetrics, and epidemiology ANS: A Correct: Caring for complexities in practice, coordinating care, and focusing on outcomes evaluation are the tasks that reflect the direction in which nursing is heading. Incorrect: b. As supplemental courses to nursing, these are essential, but they do not represent an area of emphasis for professional nursing. c. Illness care, hospice, and ethics are currently components of programs that are preparing students for professional nursing. d. Psychomotor skills, obstetrics, and epidemiology are limited in scope. DIF: Application REF: p. 43 | p. 53 | p. 56 9. A standardized means of determining initial proficiency at the entry level into nursing is: a. certification in medical-surgical nursing. b. the National Certification Licensure Examination (NCLEX®). c. comprehensive instructor-constructed examinations. d. the ability of the student to answer questions concerning the care provided to a patient during the senior nursing courses. ANS: B Correct: NCLEX® is the national licensure examination that is based on the minimal level of safety required for a nurse to enter practice. Incorrect: a. Certification in medical-surgical nursing is attained through a specialty examination for AACN certification that can be taken only by registered nurses. c. Instructor-constructed examinations are based on instructors’ knowledge and experience and are not used for entry into practice. d. The ability of the student to answer questions related to the care provided to a patient during the senior nursing courses describes a nonstandardized means of determining initial proficiency. DIF: Knowledge REF: p. 52 10. Which trend is an effect of the nursing shortage on nursing education? a. Only devoted qualified nurses are continuing to provide bedside nursing because of the complexity of care required, resulting in excellent preceptorships for students. b. The number of applicants to nursing programs has risen, but enrollment is limited because of a decrease in the number of available scholarships and grants. c. With an increase in the number of nurses who are entering graduate school to escape bedside nursing, students will soon enjoy a lower faculty/student ratio. d. Students may be assigned to preceptors who have not yet developed expertise in the field of interest. ANS: D Correct: Qualified preceptors are few. Incorrect: a. There is a shortage of nurses qualified at the bedside who are available to serve as preceptors for students. b. Nursing enrollments are limited because of a shortage of faculty. c. Nurses are not entering graduate school to escape bedside nursing but to pursue advanced practice degrees. DIF: Analysis REF: pp. 48-49 11. The NCLEX® examination is created and administered by the: a. American Association of Colleges of Nursing (AACN). b. American Nurses Association (ANA). c. National Council of State Boards of Nursing (NCSBN). d. National League for Nursing (NLN). ANS: C Correct: The NCSBN coordinates licensure activities on a national level and creates and administers the licensure examination (NCLEX®). Incorrect: a. The AACN is an organization of deans and directors of baccalaureate and higher degree nursing programs that establishes standards for programs and is concerned with legislative issues that pertain to professional nursing education. b. The ANA is the major national nursing organization concerned with broad scope practice issues, standards of practice, scope of practice, ethics, legal issues, and employment; it consists of a federation of state nurse associations. d. The NLN is a national organization of nurse educators that has a long-standing commitment to four types of basic programs: LPN, diploma, ADN, and BSN. DIF: Knowledge REF: p. 55; Box 3-1 12. A potential nursing student is visiting the website of some nursing programs and notes that the school states, “The curriculum is built on the Essentials of Baccalaureate Education to ensure that this nursing program meets the standards set for educating nurses at the baccalaureate level.” Which organization oversees professional nursing programs and establishes these essentials? a. American Association of Colleges of Nursing (AACN) b. American Nurses Association (ANA) c. National Council of State Boards of Nursing (NCSBN) d. National League for Nursing (NLN) ANS: A Correct: The AACN publishes the Journal of Professional Nursing, The Essentials of Baccalaureate Education, and other related documents pertaining to the BSN and higher degree education. Incorrect: b. The ANA is a major national organization that is concerned with a broad scope of practice issues. c. The NCSBN is the organization of all state boards of nursing that coordinates licensure activities at the national level. d. The NLN is the national organization of nurse educators that has a long-standing commitment to four types of basic programs: LPN, diploma, ADN, and BSN. DIF: Knowledge REF: p. 40; Box 3-2 | p. 45 13. A student is planning to enroll in prerequisite courses after graduating from high school and is researching options for nursing programs. During a career fair the student compares different types of nursing education programs and discovers that: a. diploma programs focus on family and community, with an emphasis on health promotion. b. most practicing RNs graduated from diploma programs because this was the first type of RN program. c. baccalaureate programs focus on technical and hands-on nursing skills in diverse community settings. d. master’s programs such as that for the clinical nurse leader provide entry into practice with a focus on interdisciplinary and bedside nursing care for complex client populations. ANS: D Correct: A clinical nurse leader oversees the care coordination of groups of clients and actively provides direct client care in complex situations, evaluates client outcomes, and has the decision-making authority to change care plans when necessary. Incorrect: a. Diploma programs do not focus on community, with an emphasis on health promotion, although baccalaureate programs do have this focus. b. Most of today’s practicing RNs graduated from ADN programs. c. BSN programs focus on the care of clients, with greater emphasis on the family and community and on health promotion and illness prevention. DIF: Application REF: p. 53 14. When preparing to complete a competency exam involving a neurologic assessment in a simulation laboratory, the nurse reviews the critical elements, which consist of: a. those steps that result in life or death of a client. b. required criteria that must be incorporated into the assessment for the desired outcome. c. fundamental strategies unique to complex dynamic care environments. d. objective data that can be used to determine the likelihood that the client will recover. ANS: B Correct: Critical elements include the application of mandatory principles that must be used according to established practice standards. Incorrect: a. Critical elements work to achieve desired outcomes for the client. c. Critical elements are not strategies. d. Critical elements are based on the application of mandatory principles, not on objective data, to determine the likelihood that the client will recover. DIF: Comprehension REF: p. 39 15. An RN with a diploma preparation wants to participate in decisions about health care and decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering self-scheduling and a self-paced curriculum. This nurse is taking advantage of: a. educational mobility. b. a traditional nursing program. c. training for advanced practice nursing. d. credit by examination. ANS: A Correct: Education mobility is the progressive movement from one level or type of education to another—in this instance, diploma to BSN. Programs are aimed to make the transition possible through creative flexible scheduling. Incorrect: b. Traditional nursing programs have set schedules, often face-to-face lectures offered in a full-time format; although some programs are web-assisted, the majority require the student to be on campus for most learning experiences. c. A BSN is not an advanced practice degree. d. Although credit by examination may be a part of a nontraditional nursing program, it is only a portion and does not characterize the type of learning. DIF: Application REF: p. 35 16. A nursing student scores 95% on the written examination for the adult health course. To be successful in this course, this same student must then perform an indwelling catheter insertion and wound care in a simulated environment meeting core competencies. The student asks, “What are core competencies?” The nursing instructor replies, “Core competencies are: a. a trend used in nursing education to reduce attrition in prelicensure students.” b. those skills necessary for safe, competent nursing practice.” c. educational opportunities that provide remediation when student is unable to perform psychomotor skills correctly.” d. critical thinking exercises aimed to improve reading and math skills.” ANS: B Correct: Core competencies are those skills and elements that are fundamental and essential for safe, competent practice. Incorrect: a. The aim is not to reduce attrition but to ensure students have skills needed to provide safe care in today’s dynamic health care environment. c. Critical elements are the components of any skill required to produce safe, competent care. d. The aim is not to improve reading and math skills but rather to enhance critical thinking related to the practice of nursing. DIF: Comprehension REF: p. 35 17. A nurse realizes that a health care concern related to globalization was: a. the emergence of epidemic hepatitis A. b. the pandemic of H1N1 “swine flu.” c. reemergence of polio. d. an increase in chronic illnesses. ANS: B Correct: In 2009, there was a pandemic of H1N1 on every continent and a reemergence of Staphylococcus aureus (MRSA). Incorrect: a. Hepatitis A is not related to globalization; rather the most common cause is lack of simple hand washing. c. Polio has been almost nonexistent in the United States since the 1960s. d. Globalization does not affect chronic illness. DIF: Knowledge REF: p. 46 18. A student nurse is preparing a presentation that requires identification of outcomes for the care of heart failure patients. Which is a correctly written outcome? a. Develop a teaching program to address physical activities that improve cardiac function. b. Consider the clinical manifestations associated with Level 4 heart failure. c. List the most common pharmaceutical approaches to reduce preload in heart failure patients. d. Consider the economic impact that recidivism has on the patient and health care facility. ANS: A Correct: Outcomes use action words, actions that nurses actually do, such as develop, plan, implement, integrate, plan, or conduct. Objectives begin with words like describe, discuss, list, or recognize; they are directions for learning, not what nurses do. DIF: Application REF: p. 39 19. A member of a nursing students study group comments, “I wish our instructor would just tell us the important information that we will be tested on in our course and on NCLEX®. Instead, we spend some time early in the class discussing key facts then the most of the time working through case studies, then practicing on the simulator rather than caring for ‘real’ patients.” This teaching-learning style represents: a. memorization of basic facts presented early in the lecture. b. Objective Structured Clinical Examinations (OSCE). c. peer-to-peer learning. d. practice-based competency. ANS: D Correct: Practice-bases competency includes active engagement and application in real practice situations and interactive strategies such as case studies and simulation. Incorrect: a. Lectures and readings are passive and promote memorization. b. Objective Structured Clinical Exams are examinations or assessment measures rather than a teaching-learning style. c. Peer-to-peer learning involves peer teaching to helps students at risk. DIF: Application REF: p. 37; Table 3-1 20. The Southern Poverty Law Center would be consulted in which situation? a. An elderly patient can’t afford needed medications because his adult child uses the money for gambling. b. A group of immigrants are paid half the wages as the citizens of the country receive. c. Single mothers living below poverty level sell their government-subsidized food to purchase items such as make-up and gasoline for their cars. d. A gang of teenagers target students who participate in alternate lifestyle choices. ANS: D Correct: The Southern Poverty Law Center is a national organization that promotes tolerance in schools and monitors militant hate groups and initiates law suits against violent offenders. Incorrect: a. Social workers or agencies such as the National Center on Elder Abuse (NCEA) would be involved in representing the needs of this vulnerable population. b. The Equal Employment Opportunity Commission would be contacted when unfair wages are paid to minorities or disadvantaged groups. c. The Southern Poverty Law Center focuses on hate groups and does not intervene in poverty issues or concerns. Social workers would be involved with the needs of this vulnerable group. DIF: Comprehension REF: p. 45 21. A person interested in employment in the health care sector has less than 1 year to pursue his/her education and wants to focus on functional aspects of patient care. He/She desires to work in a long-term facility. Which type of nursing program should this person request information about? a. Bachelor’s degree in nursing (BSN) b. Licensed practical nurse (LPN) c. Associate degree in nursing d. Master’s degree in nursing ANS: B Correct: LPN programs provide basic technical bedside care and employment opportunities at hospitals, nursing homes, home care, and doctor offices. Incorrect: a. BSN programs require 2 to 4 years of study unless accelerated and focus on broad areas of care such as community, public health, home health, and acute care. c. Associate degrees are 2-year degree nursing program in community colleges, with required college courses in arts and sciences and a more integrated approach to nursing content and clinical learning. d. MSN programs usually require a BSN to enter, and practice includes education, community, and public health. DIF: Comprehension REF: p. 50; Table 3-3 | p. 51 MULTIPLE RESPONSE 1. A nurse is concerned that the policy of using povidone-iodine (Betadine) to clean foot ulcers may lead to unwarranted allergic reactions and drying of surrounding tissue. A literature review is performed to determine the “best practice” related to care of foot ulcers. This nurse: (Select all that apply.) a. is applying evidence-based practice to the clinical setting. b. is using critical thinking to change procedures performed in the care of foot ulcers. c. is minimally educated at the master’s level and participating in research to provide cost-effective care (soap is less expensive than povidone-iodine). d. lacks clinical competence in health assessment and in application of theory to the clinical setting. e. is using information to problem-solve and ensure safe, competent care. ANS: A, B, E Correct: Critical thinking is an essential part of applying evidence-based practice—that is using research findings to guide actual practice. Incorrect: c. Evidence-based research, not cost, should be used to guide actual practice. d. The nurse is demonstrating clinical competence by using assessment skills and by noting the effects of povidone-iodine and applying evidence-based practice to change procedures performed in the care of foot ulcers. DIF: Analysis REF: p. 36 COMPLETION 1. The oldest, most traditional type of program that prepares a candidate for RN licensure is the hospital-based _________ program. ANS: diploma The earliest training programs for nurses were hospital based and designed to meet the needs of the particular institution; these were referred to as diploma programs. DIF: Knowledge REF: p. 51 2. According to Lenburg, the use of practice-based assessments in nursing education is aimed toward the target of __________. ANS: competence The target that students need to meet to practice safely in today’s complex health environment is achieving critical competencies and demonstrating of practice-based skills. DIF: Comprehension REF: p. 39 Chapter 05: Theories of Nursing Practice Test Bank MULTIPLE CHOICE 1. Which nursing theory might a nurse use as a conceptual framework to determine how to meet the needs of immigrants while ensuring provision of high-quality and culturally sensitive care? a. Martha Rogers’ nursing theory b. Dorothea Orem’s nursing theory c. Hildegard Peplau’s nursing theory d. Madeleine Leininger’s nursing theory ANS: D Correct: Madeleine Leininger proposed the theory of cultural care diversity and universality. This theory of transcultural nursing comprises concepts involving caring and the components of a cultural care theory: diversity, universality, worldview, and ethnohistory. Incorrect: a. Martha Rogers’ theory is based on the nurse’s promoting synchronicity between human beings and the universe/environment. b. Dorothea Orem’s self-care deficit model facilitates client self-care by measuring the client’s deficit relative to self-care needs. c. Hildegard Peplau’s theory identifies feelings of the client as a predictor of positive outcomes related to health and wellness. DIF: Application REF: p. 82 2. When reading Peplau’s theory, a nurse was unable to determine the relationships among concepts. The nurse listed each concept and drew lines denoting relationships to be able to understand the effect of each element. The nurse created a: a. hypothesis. b. model. c. construct. d. variable. ANS: B Correct: A model is a group of concepts that are associated because of their relevance to a common theme. Incorrect: a. A hypothesis asks the question that is to be the main focus of a theory. c. A construct is similar to a concept; it is an idea or an object that can be “built” together with others into a theory. d. A variable is an object, event, or person that has an effect on a theory; a variable is usually manipulated or measured. DIF: Application REF: p. 75 | p. 77 3. The statement, “Nursing is a caring profession that focuses on helping people be as healthy as possible,” is an example of a: a. concept. b. construct. c. philosophy. d. model. ANS: C Correct: A philosophy is the values and beliefs of the discipline. Incorrect: a. A concept consists of labels given to ideas, objects, and events; it is a summary of thoughts or a way to categorize thoughts or ideas. b. A construct is a building part that combines with others to make up a theory. d. A model is a group of concepts that are associated because of their relevance to a common theme. DIF: Comprehension REF: p. 78; Table 5-1 4. Einstein’s theory of relativity laid the groundwork for theories of mathematics, and Freud and Jung provided the basis for a philosophy of man. Which nursing theory served as the foundation for nursing science? a. Rogers’ science of unitary human beings b. Nightingale’s theory of practice c. Watson’s theory of human caring d. King’s theory of goal attainment ANS: B Correct: Florence Nightingale investigated the effect of the environment on healing, and this serves as the foundation for nursing science. Incorrect: a. Rogers in 1970 proposed the science of unitary human beings. c. Watson’s theory of human caring is a holistic outlook, proposed in 1978, that addresses the effect and importance of altruism, sensitivity, trust, and interpersonal skills. d. King’s theory of goal attainment, proposed in 1971, addresses client systems and includes society, groups, and the individual. DIF: Comprehension REF: pp. 78-80 5. A community health nurse has been visiting a postpartum client who suffered domestic violence throughout the pregnancy, and now the infant may be at risk. The nurse assisted the client in finding shelter and legal protection. The nurse’s role and the conceptual framework involved are: a. change agent, according to Roy’s adaptation model. b. translator, according to Leininger’s theory of cultural care diversity and universality. c. case manager, according to Peplau’s interpersonal relations model. d. caregiver, according to Rogers’ science of unitary human beings. ANS: A Correct: In Roy’s adaptation model, when the client incurs an insult that renders him or her in need of environmental modification, the nurse will be the change agent in assisting the individual with this adaptation. Incorrect: b. The role of translator is not needed. Leininger’s theory of cultural care diversity and universality focuses on the concepts of diversity, universality, worldview, and ethnohistory, none of which is relevant in this situation. c. Peplau’s interpersonal relations model explores the interpersonal relationship between the nurse and the client and identifies the client’s feelings as a predictor of positive outcomes related to health and wellness. In this acute situation, the case manager conceptual model in not as pertinent as the change agent model. d. Rogers’ science of unitary human beings theory is one in which the nurse, as caregiver, promotes synchronicity between human beings and their environment; it is not relevant to this acute situation. DIF: Application REF: p. 84 6. What are general explanations that scholars use to explain, predict, control, and understand commonly occurring events? a. Theories b. Constructs c. Systems d. Propositions ANS: A Correct: Theories are a group of related concepts that explain existing phenomena and predict events. Theories provide us with a frame of reference, the ability to choose concepts to study, or ideas that are within one’s practice. Incorrect: b. Constructs are the events, ideas, or objects that make up a theory. c. A system is an orderly collection of logically related principles, facts, or objects. d. Propositions are statements that propose the relationships between and among concepts. DIF: Comprehension REF: p. 85 7. Which type of theory most often guides present nursing practice? a. Grand theory b. Middle range theory c. Developmental theory d. Values theory ANS: B Correct: Middle range theory is a nursing theory that refers to a specific population or to a specific situation, thereby making the theory easy to understand. An example is the theory of unpleasant symptoms (Lenz and Pugh), which examines symptoms that are influenced by physiologic, psychological, and situational factors as they relate to performance. Incorrect: a. Grand theory is broad in scope and may describe and explain large segments of human experience. c. Developmental theory is not a standard term applied to nursing theory. d. Values theory is not a standard term applied to nursing theory. DIF: Knowledge REF: p. 78 8. A client is hypertensive, and the doctor prescribes weight reduction. The client is excited about beginning the diet, but on arriving home the spouse states, “You have always been fat, and I am not going to starve because you can’t control yourself.” The client becomes anxious and is unable to participate in the diet plan, resulting in a weight gain of 5 pounds in 2 weeks. Which theorist could best be referred to for guidance regarding interventions in this situation? a. Martha E. Rogers b. Hildegard E. Peplau c. Florence Nightingale d. Myra Estrin Levine ANS: B Correct: Hildegard Peplau’s theory describes interpersonal relations as a nursing process. Nursing intervention in Peplau’s model focuses on reducing related incapacitating stressors through therapeutic interpersonal interaction. Incorrect: a. Martha Rogers’ theory is based on humans as energy fields that interact constantly with the environment. c. Florence Nightingale’s theory of practice is based on environmental adaptation. d. Myra Levine proposed the conservation model, which comprises four conservation principles of inpatient resources: energy, structural integrity, personal integrity, and social integrity. DIF: Application REF: p. 81 | p. 82; Table 5-2 9. A nurse believes that humans use creativity and critical thinking to balance their connections with their surroundings. The nurse decides to conduct a study on the basis of this belief. Which nursing theory would be best for this study? a. Peplau’s interpersonal relations as a nursing process: man as an organism that exists in an unstable equilibrium b. Roy’s adaptation model: assistance with the adaptation to stressors to facilitate the integration process of the client c. Orem’s self-care deficit model: self-care, self-care deficits, and nursing systems d. Rogers’ science of unitary human beings: humans as energy fields that interact constantly with the environment ANS: D Correct: Rogers’ science of unitary human beings, in which humans are seen as energy fields that interact constantly with the environment, is a theory in which the nurse promotes synchronicity between human beings and their universe/environment. Incorrect: a. Peplau’s theory explores the interpersonal relationship between the nurse and the client and identifies the client’s feelings as a predictor of positive outcomes related to health and wellness. b. Roy’s adaptation model identifies the client’s adaptation to conditions by using environmental stimuli to adjust perception. c. In Orem’s self-care deficit model, the nurse facilitates client self-care by measuring the client’s deficit relative to self-care needs. DIF: Application REF: p. 83 |p. 82; Table 5-2 10. A client involved in a motor vehicle accident is blinded. The nurse helps the client obtain a guide dog so the client may continue grocery shopping and visiting friends and family. This enables the client to cope with the handicap and perform activities of daily living. Which nursing theory can be applied to this scenario? a. Watson’s philosophy and science of caring and humanistic nursing b. Mishel’s uncertainty in illness c. Orem’s self-care deficit d. Rogers’ science of unitary human beings ANS: C Correct: In Orem’s self-care deficit theory, the nurse implements measures to help clients meet self-care needs by matching them with an appropriate supportive intervention. Incorrect: a. Watson’s model of human caring identifies 10 “carative” factors that are core to nursing. This holistic outlook addresses the impact and importance of altruism, sensitivity, trust, and interpersonal skills. b. Mishel’s uncertainty in illness theory holds that negative perceptions due to the perceived illness will escalate and clients will suffer. The nurse’s responsibility is to reframe the client’s perceived loss of control and help the client develop new skills of assimilation and accommodation. d. Rogers’ science of unitary human beings is one in which the nurse promotes synchronicity between human beings and their universe/environment. DIF: Application REF: p. 83 | p. 82; Table 5-2 11. A young child is having abdominal pain, and the doctor informs the parents that a computed tomography (CT or CAT) scan of the abdomen will be ordered. The doctor tells the child, “This CAT scan won’t hurt you.” The child is visibly upset because of a fear of cats. According to Mishel’s uncertainty in illness theory, which stage of the framework is represented? a. Stimuli frame b. Appraisal stage c. Initiation of coping mechanisms d. Adaptation ANS: A Correct: In the stimuli frame the client reacts to some stimulus in a negative manner. The nurse at this stage should listen carefully and then initiate, seek, and clarify concerns and questions. Incorrect: b. The appraisal stage is when the client applies a negative value to environmental conditions. c. In the initiation of coping mechanisms stage, the individual uses coping skills to deal with negative environmental stimuli. d. Adaptation occurs as the nurse intervenes in the previous stage, and ideally, fear decreases. DIF: Application REF: p. 85 12. A nurse researcher determines whether findings are substantial by calculating the level of significance. Which aspect of the scientific inquiry is being conducted? a. Hypothesis b. Method c. Data collection d. Evaluation ANS: D Correct: During evaluation, results are examined with the goal of determining the relevance of outcome data in answering the hypothesis; the significance of the data and the potential for future research are also explored. Incorrect: a. The hypothesis asks the question that is to be the main focus. b. The method decides what data will be collected to answer the question. c. Data collection is a step-by-step procedure that is undertaken with the goal of answering the question. DIF: Application REF: p. 76; Box 5-1 13. A nurse who has practiced on an orthopedic unit for 10 years unexpectedly becomes pregnant. At delivery the physician informs the mother, “Your baby has Alport syndrome, but then I don’t have to explain what that means with your medical background.” The mother is unfamiliar with this disease and withdraws as a coping mechanism. Which nursing theory would provide a framework to guide nursing care for this mother? a. Mishel’s uncertainty of illness b. Orem’s self-care deficit model c. Nightingale’s canons of nursing d. Levine’s conservation model ANS: A Correct: In Mishel’s uncertainty of illness theory, the core position is that uncertainty in illness must be addressed. When uncertainties are not addressed, clients’ negative perceptions will escalate and they will suffer. Nursing responsibility based on this theory consists of reframing the client’s perceived loss of control, or uncertainty, and helping the client develop new skills of assimilation and accommodation. Incorrect: b. In Orem’s self-care deficit model, nursing facilitates client self-care by measuring the client’s deficit relative to self-care needs. c. Nightingale’s canons of nursing is an environmental adaptation theory. d. Levine’s conservation model identifies four conservation principles of client resources (energy, structural integrity, personal integrity, and social integrity). DIF: Analysis REF: pp. 79-80; Box 5-3 | p. 85 14. If a nurse applies Nightingale’s theory to current practice, the nurse’s first step will be to evaluate the hospital room’s air quality and, second, to: a. make certain that the volume of the television is not too loud. b. consult the dietitian to check that essential nutrients are added to meet requirements noted on MyPyramid. c. ask the client’s family to bring family photographs and bright-colored throws for the bed. d. arrange for the client to go outside, weather permitting, while keeping the room’s window blinds open. ANS: D Correct: Nightingale believed the need for light was second only to the need for fresh air. Incorrect: a. Although she believed noise should be controlled, it was not the second most important consideration. b. Nightingale did believe food should do the work of healing the patient’s ailing digestive system, but this was not second most important consideration. c. Nightingale did believe in variety, which included pets and beautiful objects, but the needs for light and air were more important to her. DIF: Application REF: p. 81 15. A nurse develops a new nursing theory related to stress and viability. The nurse determines the theory accounts for historical events in which soldiers suffering from the stress of inadequate clothing to protect them from the cold and lack of correspondence from home had an increased mortality related to gunshot wounds. The theory will predict gunshot victims’ need for proper clothing and letters from significant others as they serve in Iraq. Which criterion for theory acceptance is being validated? a. Inclusiveness b. Consistency c. Accuracy d. Simplicity ANS: C Correct: The accuracy of a theory is its ability to explain past occurrences while being useful in determining future outcomes. Incorrect: a. A theory can be validated as inclusive when it is found that it includes all concepts related to its field. b. The consistency of a theory is its ability to deal with new entities and situations without altering its original assumptions. d. The simplicity of the nurse’s theory is not being examined in this example. DIF: Application REF: p. 76 16. A nurse practicing on a unit where domestic violence is common wants to learn how to apply nursing theory to practice on this unit. She considers the interrelatedness of the constructs of Watson’s Theory of Caring and designs the above: a. conceptual model of caring. b. hypothesis of the impact of caring on domestic violence. c. proposition of how caring is conceptualized. d. theory of scientific inquiry. ANS: A Correct: The above conceptual models demonstrates how the concepts of compassion, commitment, conscience, confidence, and competence form a theme of caring (Watson). Incorrect: b. A hypothesis is the first step of scientific inquiry. c. A proposition is a statement rather than a model of how constructs are related. d. Theory of scientific inquiry uses set steps in figuring out how a phenomenon happens. DIF: Application REF: p. 77 17. A nurse in a rehabilitation unit plans activities of daily living to prevent excessive fatigue, helps the patient dress before the family visits, assists with range of motion, and allows the patient to decide which clothes to wear during the visit. This nurse is best applying which theory to practice? a. Watson’s Theory of Caring b. Rogers’ Theory of Unitary Humans c. Levine’s Theory of Conservation d. Leininger’s Theory of Transcultural Nursing ANS: C Correct: Certain parts of all the theories can be applied; however all the constructs of Levine’s Model of Conservation are applied, including energy conservation, structural integrity, personal integrity, and social integrity. In this situation, the nurse conserved energy by planning ADLs, conserved structural integrity through ROMs, conserved social integrity by helping patient with appearance during family visits thus improving the milieu for social visits. Incorrect: a. Watson’s Theory of Caring meets some of the criteria, but all concepts are not applied. b. The constructs—energy fields, openness, pattern, and organization—in Rogers’ Theory of Unitary Humans are not all employed in this example. d. Leininger’s Theory is not applied because no indication of cultural diversity is noted. DIF: Application REF: p. 82; Table 5-2 18. A nurse is evaluating Levin’s Theory of Conservation to determine if it can be applied to patients in the initial phases of chemotherapy treatment. During this phase of theory acceptance, the nurse wants to determine if all the concepts of energy, structural integrity, personal integrity, and social integrity are included in the care of cancer treatment. The nurse is applying which criteria of theory acceptance? a. Inclusiveness b. Consistency c. Accuracy d. Fruitfulness ANS: A Correct: Inclusiveness asks the question, “Does the theory include all concepts related to the area of interest?” Incorrect: b. Consistency asks the question, “Can the theory address new entities without having its founding assumptions changed?” c. Accuracy asks the question, “Does the theory explain retrospective occurrences?” d. Fruitfulness asks the question, “Does the theory generate new directions for future research?” DIF: Application REF: p. 76; Box 5-2 19. A nurse is heard making this comment, “I believe human dignity is based on perceived self-worth while caring is based on perceived role in society that forms the basis of nursing practice.” This nurse is: a. demonstrating a model of human dignity. b. evaluating the relevance of Leininger’s Theory. c. applying Mishel’s Theory of Disease Uncertainty. d. making a proposition concerning the constructs of nursing practice. ANS: D Correct: A proposition is a statement that proposes the relationship between and among concepts. Incorrect: a. A model is a visual representation rather than a statement. b. Leininger’s Theory is founded on transcultural nursing. c. Nothing related to the theory of disease uncertainty occurs in this scenario. DIF: Application REF: p. 77 20. A group of nurses are interested in the how to improve teaching effectiveness for patients who have a hearing impairment and lack family involvement while hospitalized. They believe “hearing loss decreases the teaching effectiveness while hospitalized.” The group plans to evaluate teaching effectiveness using a 10-point Likert Scale pre-post teaching, perform a hearing test to determine degree of hearing loss on admission, and have social work evaluate the impact of hearing impairment on patient’s ability to safely live alone prior to discharge. The group is working in which step of the scientific process? a. Hypothesis b. Method c. Results d. Evaluation ANS: B Correct: During the method step, the group decides what data will be collected to answer the question and identifies step-by-step procedures that will be used to collect these data. Incorrect: a. Hypothesis is the formation of the question, and the group has already completed this step. c. Results (outcomes) are identified or predicted based on data’s significance. d. In the evaluation step, results are assessed to determine if they support the original hypothesis. DIF: Application REF: p. 76; Box 5-1 MULTIPLE RESPONSE 1. Which of the following are concepts related to nursing theory? (Select all that apply.) a. Environment b. Health c. Nursing d. Relevance e. Comfort ANS: A, B, C, E Correct: a. Environment is a concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual model or theory. b. Health is a concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual model or theory. c. Nursing is a concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual model or theory. e. Comfort is a concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual model or theory Incorrect: d. Relevance refers to one criterion for theory acceptance and how well the theory relates to the scientific foundation from which it was derived. DIF: Comprehension REF: p. 77 COMPLETION 1. The basic ingredients of theory are ____________. ANS: concepts A theory is defined as a group of related concepts that explain existing phenomena and predict future events. DIF: Knowledge REF: p. 77