TESTBANK FOR NURSING TODAY TRANSITIONS and TRENDS BY JoAnn
Zerwekh, EdD, RN ELEVENTH EDITION.
UNIT I: PROFESSIONAL GROWTH AND TRANSITION
Role Transitions
1. List the four major types of transitions.
Developmental, situational, health/illness, and organizational.
2. List six crucial competency areas that new graduates report as sources of stress.
Communication, leadership, organization, critical thinking, specific situations, and stress
management.
3. List the phases of reality shock described by Kramer (1974).
Honeymoon, shock and rejection, recovery.
4. List the stages of transition identified by Duchscher (2008).
Doing, being, and knowing.
5. List three critical terms related to nursing practice that are often misunderstood.
Critical thinking, decision making, and clinical judgment.
6. List five challenging skills for graduate nurses identified by Casey and colleagues (2004).
Code blues, chest tubes, intravenous skills, central lines, and blood administration.
7. Define transitions.
Transitions are passages or changes from one situation, condition, or state to another that occur
over time.
8. Define reality shock.
Reality shock describes the reaction experienced when one moves into the workforce after years
of educational preparation, encountering mismatched expectations.
9. Define critical thinking in nursing.
Critical thinking is an active, purposeful, and organized cognitive process used to carefully
examine one’s thinking and the thinking of others.
10. Define clinical judgment.
Clinical judgment is the observed outcome of critical thinking and decision-making processes,
focused on prioritizing and solving client care issues.
11. Define transition shock.
Transition shock describes the emotional and professional challenges experienced by new
graduate nurses during their first year of practice.
, 12. Differentiate between critical thinking and decision making.
Critical thinking is the process of analyzing and evaluating information, while decision making
involves generating and evaluating conclusions after recognizing a problem.
13. Differentiate between the 'honeymoon' and 'shock and rejection' phases of reality shock.
The honeymoon phase involves excitement and unrealistic perceptions, while the shock phase
involves feelings of mistrust, fatigue, and failure.
14. Differentiate between the stages 'doing' and 'being' in Duchscher’s transition process.
The 'doing' stage focuses on high stress and steep learning, while the 'being' stage involves
gaining skills, seeking familiarity, and confronting inadequacies.
15. Differentiate between novice and competent nurses.
Novice nurses rely on rules with no clinical experience, while competent nurses demonstrate
deliberate planning and the ability to manage unexpected situations.
16. Differentiate between organizational and situational transitions.
Organizational transitions involve changes in systems like leadership, while situational
transitions include events like career changes or graduations.
17. Compare and contrast developmental and health-related transitions.
Developmental transitions, like becoming a parent, focus on life stages, while health-related
transitions deal with conditions like chronic illnesses.
18. Compare and contrast the 'doing' and 'knowing' stages of transition.
The 'doing' stage focuses on stress and high learning curves, while the 'knowing' stage is about
achieving confidence and separating from the learner role.
19. Compare and contrast the expectations of graduate nurses during school and in practice.
In school, graduate nurses focus on holistic patient care; in practice, time constraints limit their
ability to meet holistic needs fully.
20. Compare and contrast reality shock and transition shock.
shock focuses on the sudden shift into the workforce, while transition shock extends this
concept to emotional and professional struggles during the first year.
21. Outline the key phases of Duchscher’s stages of transition.
Being: Developing skills, confronting inadequacies, crisis of confidence.
Knowing: Confidence in roles, prioritization, and stabilizing routine.
22. Outline the stresses faced by new graduate nurses in communication.
New graduates struggle with calling physicians, completing shift reports, addressing patient
needs, and resolving conflicts.
, 23. Outline how critical thinking progresses to clinical judgment.
Critical thinking involves analysis → Decision making involves appraisal and evaluation → Clinical
judgment is the final outcome focused on solving patient care issues.
24. Outline strategies to prepare for transition into nursing practice.
Gain realistic clinical hours, increase independence, improve nursing skills, practice critical
thinking, and request constructive feedback.
25. Outline Kramer’s phases of reality shock and their characteristics.
Honeymoon: Excitement and idealism.
Shock/Rejection: Mistrust, fatigue, hypercritical attitude.
Recovery: Humor returns, objectivity increases, tension decreases.
26. Describe the 'honeymoon' phase of reality shock.
The honeymoon phase is marked by excitement and optimism as graduates celebrate finishing
school and starting their careers. Reality conflicts soon disrupt this phase.
27. Describe the feelings experienced during the 'doing' stage of transition.
New graduates feel overwhelmed, face steep learning curves, high anxiety, and stress from
multitasking and handling critical patients.
28. Describe the characteristics of an expert nurse.
An expert nurse operates from a deep understanding of situations, focuses on problem specifics,
and demonstrates masterful performance and decision-making.
29. Explain why new graduate nurses experience reality shock.
Reality shock occurs because the expectations of practice differ from what is taught in school.
Graduates often face unclear roles, heavy workloads, and patient acuity beyond their readiness.
29. Explain the importance of flexibility during the transition process.
Flexibility helps new nurses adapt to workplace realities, policies, and procedures, ensuring they
navigate challenges without compromising core values learned in school.
Personal Management: Time and Self-Care Strategies
1. Define biological rhythms.
Answer: Biological rhythms are natural cycles in the body that regulate energy levels, sleep-wake
patterns, and behavior, such as the circadian rhythm.
2. Define circadian rhythm.
, Answer: The circadian rhythm is the body’s internal clock that regulates sleep-wake cycles over a
24-hour period.
3. Define procrastination.
Answer: Procrastination is the act of delaying or postponing tasks, often due to their unpleasant
or overwhelming nature.
4. Define left brain dominance.
Answer: Left brain dominance refers to individuals who process information in a linear,
sequential, and organized manner, relying on logic and structure.
5. Define right brain dominance.
Answer: Right brain dominance refers to individuals who are creative, holistic thinkers,
preferring flexibility and non-linear approaches to tasks.
6. Define the ‘myth of perfection’ in task management.
Answer: The myth of perfection is the mistaken belief that everything worth doing must be done
flawlessly, which can lead to procrastination.
7. Define the term ‘white noise.’
Answer: White noise refers to a consistent background sound, like a fan, used to mask disruptive
noises during sleep.
8. Define multitasking.
Answer: Multitasking is attempting to perform multiple tasks simultaneously, which can reduce
focus and efficiency.
9. Define decluttering in the context of time management.
Answer: Decluttering involves organizing and removing unnecessary items from a workspace to
improve efficiency and reduce time wasted searching for materials.
10. Define task delegation.
Answer: Task delegation is assigning specific tasks to others to save time and focus on higher-
priority activities.
11. Outline the effects of sleep deprivation.
Answer: Sleep deprivation can cause fatigue, impaired decision-making, mood disorders, weight
gain, increased susceptibility to infections, indigestion, peptic ulcers, and ischemic diseases.
12. Outline the five steps for managing paper and electronic requests.
Answer: 1) File it, 2) Forward it, 3) Respond to it, 4) Delegate it, 5) Discard it.
13. Outline strategies to prevent procrastination.
Answer: Strategies include starting tasks early, breaking tasks into smaller steps, creating
schedules, understanding consequences, and rewarding progress.
Zerwekh, EdD, RN ELEVENTH EDITION.
UNIT I: PROFESSIONAL GROWTH AND TRANSITION
Role Transitions
1. List the four major types of transitions.
Developmental, situational, health/illness, and organizational.
2. List six crucial competency areas that new graduates report as sources of stress.
Communication, leadership, organization, critical thinking, specific situations, and stress
management.
3. List the phases of reality shock described by Kramer (1974).
Honeymoon, shock and rejection, recovery.
4. List the stages of transition identified by Duchscher (2008).
Doing, being, and knowing.
5. List three critical terms related to nursing practice that are often misunderstood.
Critical thinking, decision making, and clinical judgment.
6. List five challenging skills for graduate nurses identified by Casey and colleagues (2004).
Code blues, chest tubes, intravenous skills, central lines, and blood administration.
7. Define transitions.
Transitions are passages or changes from one situation, condition, or state to another that occur
over time.
8. Define reality shock.
Reality shock describes the reaction experienced when one moves into the workforce after years
of educational preparation, encountering mismatched expectations.
9. Define critical thinking in nursing.
Critical thinking is an active, purposeful, and organized cognitive process used to carefully
examine one’s thinking and the thinking of others.
10. Define clinical judgment.
Clinical judgment is the observed outcome of critical thinking and decision-making processes,
focused on prioritizing and solving client care issues.
11. Define transition shock.
Transition shock describes the emotional and professional challenges experienced by new
graduate nurses during their first year of practice.
, 12. Differentiate between critical thinking and decision making.
Critical thinking is the process of analyzing and evaluating information, while decision making
involves generating and evaluating conclusions after recognizing a problem.
13. Differentiate between the 'honeymoon' and 'shock and rejection' phases of reality shock.
The honeymoon phase involves excitement and unrealistic perceptions, while the shock phase
involves feelings of mistrust, fatigue, and failure.
14. Differentiate between the stages 'doing' and 'being' in Duchscher’s transition process.
The 'doing' stage focuses on high stress and steep learning, while the 'being' stage involves
gaining skills, seeking familiarity, and confronting inadequacies.
15. Differentiate between novice and competent nurses.
Novice nurses rely on rules with no clinical experience, while competent nurses demonstrate
deliberate planning and the ability to manage unexpected situations.
16. Differentiate between organizational and situational transitions.
Organizational transitions involve changes in systems like leadership, while situational
transitions include events like career changes or graduations.
17. Compare and contrast developmental and health-related transitions.
Developmental transitions, like becoming a parent, focus on life stages, while health-related
transitions deal with conditions like chronic illnesses.
18. Compare and contrast the 'doing' and 'knowing' stages of transition.
The 'doing' stage focuses on stress and high learning curves, while the 'knowing' stage is about
achieving confidence and separating from the learner role.
19. Compare and contrast the expectations of graduate nurses during school and in practice.
In school, graduate nurses focus on holistic patient care; in practice, time constraints limit their
ability to meet holistic needs fully.
20. Compare and contrast reality shock and transition shock.
shock focuses on the sudden shift into the workforce, while transition shock extends this
concept to emotional and professional struggles during the first year.
21. Outline the key phases of Duchscher’s stages of transition.
Being: Developing skills, confronting inadequacies, crisis of confidence.
Knowing: Confidence in roles, prioritization, and stabilizing routine.
22. Outline the stresses faced by new graduate nurses in communication.
New graduates struggle with calling physicians, completing shift reports, addressing patient
needs, and resolving conflicts.
, 23. Outline how critical thinking progresses to clinical judgment.
Critical thinking involves analysis → Decision making involves appraisal and evaluation → Clinical
judgment is the final outcome focused on solving patient care issues.
24. Outline strategies to prepare for transition into nursing practice.
Gain realistic clinical hours, increase independence, improve nursing skills, practice critical
thinking, and request constructive feedback.
25. Outline Kramer’s phases of reality shock and their characteristics.
Honeymoon: Excitement and idealism.
Shock/Rejection: Mistrust, fatigue, hypercritical attitude.
Recovery: Humor returns, objectivity increases, tension decreases.
26. Describe the 'honeymoon' phase of reality shock.
The honeymoon phase is marked by excitement and optimism as graduates celebrate finishing
school and starting their careers. Reality conflicts soon disrupt this phase.
27. Describe the feelings experienced during the 'doing' stage of transition.
New graduates feel overwhelmed, face steep learning curves, high anxiety, and stress from
multitasking and handling critical patients.
28. Describe the characteristics of an expert nurse.
An expert nurse operates from a deep understanding of situations, focuses on problem specifics,
and demonstrates masterful performance and decision-making.
29. Explain why new graduate nurses experience reality shock.
Reality shock occurs because the expectations of practice differ from what is taught in school.
Graduates often face unclear roles, heavy workloads, and patient acuity beyond their readiness.
29. Explain the importance of flexibility during the transition process.
Flexibility helps new nurses adapt to workplace realities, policies, and procedures, ensuring they
navigate challenges without compromising core values learned in school.
Personal Management: Time and Self-Care Strategies
1. Define biological rhythms.
Answer: Biological rhythms are natural cycles in the body that regulate energy levels, sleep-wake
patterns, and behavior, such as the circadian rhythm.
2. Define circadian rhythm.
, Answer: The circadian rhythm is the body’s internal clock that regulates sleep-wake cycles over a
24-hour period.
3. Define procrastination.
Answer: Procrastination is the act of delaying or postponing tasks, often due to their unpleasant
or overwhelming nature.
4. Define left brain dominance.
Answer: Left brain dominance refers to individuals who process information in a linear,
sequential, and organized manner, relying on logic and structure.
5. Define right brain dominance.
Answer: Right brain dominance refers to individuals who are creative, holistic thinkers,
preferring flexibility and non-linear approaches to tasks.
6. Define the ‘myth of perfection’ in task management.
Answer: The myth of perfection is the mistaken belief that everything worth doing must be done
flawlessly, which can lead to procrastination.
7. Define the term ‘white noise.’
Answer: White noise refers to a consistent background sound, like a fan, used to mask disruptive
noises during sleep.
8. Define multitasking.
Answer: Multitasking is attempting to perform multiple tasks simultaneously, which can reduce
focus and efficiency.
9. Define decluttering in the context of time management.
Answer: Decluttering involves organizing and removing unnecessary items from a workspace to
improve efficiency and reduce time wasted searching for materials.
10. Define task delegation.
Answer: Task delegation is assigning specific tasks to others to save time and focus on higher-
priority activities.
11. Outline the effects of sleep deprivation.
Answer: Sleep deprivation can cause fatigue, impaired decision-making, mood disorders, weight
gain, increased susceptibility to infections, indigestion, peptic ulcers, and ischemic diseases.
12. Outline the five steps for managing paper and electronic requests.
Answer: 1) File it, 2) Forward it, 3) Respond to it, 4) Delegate it, 5) Discard it.
13. Outline strategies to prevent procrastination.
Answer: Strategies include starting tasks early, breaking tasks into smaller steps, creating
schedules, understanding consequences, and rewarding progress.
