Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice

Question 1

The public health nurse is presenting a health promotion class to a group of new mothers. How should the nurse best define health?

A) Health is being disease free.
B) Health is having fulfillment in all domains of life.
C) Health is having psychological and physiological harmony.
D) Health is being connected in body, mind, and spirit.

Answer 1

Ans: D
Feedback:
The World Health Organization (WHO) defines health in the preamble to its constitution as a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.

Question 2

A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What is
one characteristic the nurse would cite as necessary to possess to be an effective nurse?

A) Sensitivity to cultural differences
B) Team-focused approach to problem-solving
C) Strict adherence to routine
D) Ability to face criticism

Answer 2

Ans: A
Feedback:
To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be
culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict
adherence to routine are not characteristics needed to be an effective nurse. The ability to handle criticism is important, but to a lesser degree than cultural competence.

Question 3

With increases in longevity, people have had to become more knowledgeable about their health and the professional health care that they receive. One outcome of this phenomenon is the development of
organized self-care education programs. Which of the following do these programs prioritize?

A) Adequate prenatal care
B) Government advocacy and lobbying
C) Judicious use of online communities
D) Management of illness

Answer 3

Ans: D
Feedback:
Organized self-care education programs emphasize health promotion, disease prevention, management
of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and
Internet activities are secondary.

Question 4

The home health nurse is assisting a patient and his family in planning the patients return to work after
surgery and the development of postsurgical complications. The nurse is preparing a plan of care that addresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does the patients need for self-fulfillment relate?

A) Physiologic
B) Transcendence
C) Love and belonging
D) Self-actualization

Answer 4

Ans: D
Feedback:
Maslows highest level of human needs is self actualization, which includes self-fulfillment, desire to
know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does not relate directly to them.

Question 5

The view that health and illness are not static states but that they exist on a continuum is central to
professional health care systems. When planning care, this view aids the nurse in appreciating which of
the following?

A) Care should focus primarily on the treatment of disease.
B) A persons state of health is ever-changing.
C) A person can transition from health to illness rapidly.
D) Care should focus on the patients compliance with interventions.

Answer 5

Ans: B
Feedback:
By viewing health and illness on a continuum, it is possible to consider a person as being neither
completely healthy nor completely ill. Instead, a persons state of health is ever-changing and has the
potential to range from high-level wellness to extremely poor health and imminent death. The other
answers are incorrect because patient care should not focus just on the treatment of disease. Rapid declines in health and compliance with treatment are not key to this view of health.

Question 6

A group of nursing students are participating in a community health clinic. When providing care in this
context, what should the students teach participants about disease prevention?

A) It is best achieved through attending self-help groups.
B) It is best achieved by reducing psychological stress.
C) It is best achieved by being an active participant in the community.
D) It is best achieved by exhibiting behaviors that promote health.

Answer 6

Ans: D
Feedback:
Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen
as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach
that disease prevention is best achieved through attending self-help groups, by reducing stress, or by
being an active participant in the community, though each of these activities is consistent with a healthy
lifestyle.

Question 7

A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee. When describing quality improvement programs to nursing colleagues and members of other health
disciplines, what characteristic should the nurse cite?

A) These programs establish consequences for health care professionals actions.
B) These programs focus on the processes used to provide care.
C) These programs identify specific incidents related to quality.
D) These programs seek to justify health care costs and systems.

Answer 7

Ans: B
Feedback:
Numerous models seek to improve the quality of health care delivery. A commonality among them is a
focus on the processes that are used to provide care. Consequences, a focus on incidents, and
justification for health care costs are not universal characteristics of quality improvement efforts.

Question 8

Nurses in acute care settings must work with other health care team members to maintain quality care
while facing pressures to care for patients who are hospitalized for shorter periods of time than in the
past. To ensure positive health outcomes when patients return to their homes, what action should the
nurse prioritize?

A) Promotion of health literacy during hospitalization
B) Close communication with insurers
C) Thorough and evidence-based discharge planning
D) Participation in continuing education initiatives

Answer 8

Ans: C
Feedback:
Following discharges that occur after increasingly short hospital stays, nurses in the community care for
patients who need high-technology acute care services as well as long-term care in the home. This is
dependent on effective discharge planning to a greater degree than continuing education, communication
with insurers, or promotion of health literacy.

Question 9

You are admitting a patient to your medical unit after the patient has been transferred from the emergency department. What is your priority nursing action at this time?

A) Identifying the immediate needs of the patient
B) Checking the admitting physicians orders
C) Obtaining a baseline set of vital signs
D) Allowing the family to be with the patient

Answer 9

Ans: A
Feedback:
Among the nurses important functions in health care delivery, identifying the patients immediate needs
and working in concert with the patient to address them is most important. The other nursing functions are important, but they are not the most important functions.

Question 10

A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing
assessments and interventions with the aid of a pathway, the nurse should prioritize what goal?

A) Helping the patient to achieve specific outcomes
B) Balancing risks and benefits of interventions
C) Documenting the patients response to therapy
D) Staying accountable to the interdisciplinary team

Answer 10

Ans: A
Feedback:
Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes. Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient achieve outcomes is paramount.

Question 11

Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses of analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized
patients. How does this demonstrate a role of the APRN?

A) Involving patients in their care while hospitalized
B) Contributing to the scientific basis of nursing practice
C) Critiquing the quality of patient care
D) Explaining medical studies to patients and RNs

Answer 11

Ans: B
Feedback:
Research is within the purview of the APRN. The activity described does not exemplify explaining studies to RNs, critiquing care, or involving patients in their care.

Question 12

Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of
practice for the nurse in todays health care environment is home health care. What is the main basis for the growth in this health care setting?

A) Chronic nursing shortage
B) Western focus on treatment of disease
C) Nurses preferences for day shifts instead of evening or night shifts
D) Discharge of patients who are more critically ill

Answer 12

Ans: D
Feedback:
With shorter hospital stays and increased use of outpatient health care services, more nursing care is
provided in the home and community setting. The other answers are incorrect because they are not the basis for the growth in nursing care delivered in the home setting.

Question 13

Nurses have different educational backgrounds and function under many titles in their practice setting. If
a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by
influencing the patient, the nurse, and the health care system, what would most accurately describe this
nurses title?

A) Nursing care expert
B) Clinical nurse specialist
C) Nurse manager
D) Staff nurse

Answer 13

Ans: B
Feedback:
Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care
(e.g., cardiovascular, oncology). They define their roles as having five major components: clinical practice, education, management, consultation, and research. The other answers are incorrect because they are not the most accurate titles for this nurse.

Question 14

Nursing continues to recognize and participate in collaboration with other health care disciplines to meet
the complex needs of the patient. Which of the following is the best example of a collaborative practice model?

A) The nurse and the physician jointly making clinical decisions.
B) The nurse accompanying the physician on rounds.
C) The nurse making a referral on behalf of the patient.
D) The nurse attending an appointment with the patient.

Answer 14

Ans: A
Feedback:
The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. The other answers are incorrect because they are not examples of a collaborative practice model.

Question 15

A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy of
needs, what dimension of care should the nurse consider primary in importance when caring for a dying patient?

A) Spiritual
B) Social
C) Physiologic
D) Emotional

Answer 15

Ans: C
Feedback:
Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and
affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied to the various nursing models for assessment of a patients strengths, limitations, and need for nursing
interventions. The other answers are incorrect because they are not of primary importance when caring for a dying patient, though each should certainly be addressed.

Question 16

A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Within
this framework of understanding, what would be the nurses first priority?

A) Allowing the family to see a newly admitted patient
B) Ambulating the patient in the hallway
C) Administering pain medication
D) Teaching the patient to self-administer insulin safely

Answer 16

Ans: C
Feedback:
In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, such
as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family
addresses a higher level need related to love and belonging. Teaching the patient is also a higher level
need related to the desire to know and understand and is not appropriate at this time, as the basic physiologic need of pain control must be addressed before the patient can address these higher level needs.

Question 17

A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse
provides care. This nurses compliance with the nurse practice act demonstrates adherence to which of
the following?

A) National Council of Nursings guidelines for care
B) National League for Nursings Code of Conduct
C) American Nurses Associations Social Policy Statement
D) Department of Health and Human Services White Paper on Nursing

Answer 17

Ans: C
Feedback:
Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply
with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for
Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council
of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included
in the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLN published a specific code of conduct.

Question 18

Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and the
changing health needs of our aging population. What is one factor that has impacted the need for certified nurse practitioners (CNPs)?

A) The increased need for primary care providers
B) The need to improve patient diagnostic services
C) The push to drive institutional excellence
D) The need to decrease the number of medical errors

Answer 18

Ans: A
Feedback:
CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive additional focused training in primary care or acute care. CNPs help meet the need for primary care
providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs.

Question 19

A nurse is providing care for a patient who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality
improvement?

A) By liaising with the members of the interdisciplinary care team
B) By critically appraising the outcomes of care that is provided
C) By integrating the patients preferences into the plan of care
D) By documenting care in the electronic health record in a timely fashion

Answer 19

Ans: B
Feedback:
Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other
listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement
activities.

Question 20

Professional nursing expands and grows because of factors driven by the changing needs of health care
consumers. Which of the following is a factor that nurses should reflect in the planning and provision of
health care?

A) Decreased access to health care information by individuals
B) Gradual increases in the cultural unity of the American population
C) Increasing mean and median age of the American population
D) Decreasing consumer expectations related to health care outcomes

Answer 20

Ans: C
Feedback:
The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer
school-age children and more senior citizens, many of whom are women. The population has become more culturally diverse as increasing numbers of people from different national backgrounds enter the country. Access to information and consumer expectations continue to
increase.

Question 21

A public health nurse has been commissioned to draft a health promotion program that meets the health
care needs and expectations of the community. Which of the following focuses is most likely to influence the nurses choice of interventions?

A) Management of chronic conditions and disability
B) Increasing need for self-care among a younger population
C) A shifting focus to disease management
D) An increasing focus on acute conditions and rehabilitation

Answer 21

Ans: A
Feedback:
In response to current priorities, health care must focus more on management of chronic conditions and
disability than in previous times. The other answers are incorrect because the change in focus of health
care is not an increasing need for self-care among our aging population; our focus is shifting away from
disease management, not toward it; and we are moving away from the management of acute conditions to managing chronic conditions.

Question 22

A community health nurse has witnessed significant shifts in patterns of disease over the course of a
four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of
disease in the United States?

A) Type 1 diabetes management
B) Treatment of community-acquired pneumonia
C) Rehabilitation from traumatic brain injuries
D) Management of acute Staphylococcus aureus infections

Answer 22

Ans: A
Feedback:
Management of chronic diseases such as diabetes is a priority focus of the current health care environment. This supersedes the treatment of acute infections and rehabilitation needs.

Question 23

The ANA has identified several phenomena toward which the focus of nursing care should be directed, and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstrates these priorities?

A) Encouraging the patients dependence on caregivers
B) Fostering the patients ability to make choices
C) Teaching the patient about nurses roles in the health care system
D) Assessing the patients adherence to treatment

Answer 23

Ans: B
Feedback:
The ANA identifies several focuses for nursing care and research, including the ability to make

Question 24

The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of
health care. Which of the following activities are considered integral to the CNP role? Select all that
apply.

A) Educating patients and family members
B) Coordinating care with other disciplines
C) Using direct provision of interventions
D) Educating registered nurses and practical nurses
E) Coordinating payment plans for patients

Answer 24

Ans: A, B, C
Feedback:
This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in
home care and community nursing. Nurses help patients meet their needs by using direct intervention, by teaching patients and family members to perform care, and by coordinating and collaborating with other disciplines to provide needed services. The other answers are incorrect because NPs do not commonly perform education of nurses and they do not focus on matters related to payment.

Question 25

The ANA has identified central characteristics of nursing practice that are applicable across the wide
variety of contexts in which nurses practice. A nurse can best demonstrate these principles by
performing which of the following actions?

A) Teaching the public about the role of nursing
B) Taking action to control the costs of health care
C) Ensuring that all of his or her actions exemplify caring
D) Making sure to carry adequate liability insurance

Answer 25

Ans: C
Feedback:
The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA
does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a
central tenet of nursing practice.

Question 26

A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched
within the past decade. In this role, the nurse should prioritize which of the following activities?

A) Acting as a spokesperson for the nursing profession
B) Generating and disseminating new nursing knowledge
C) Diagnosing and treating health problems that have a predictable course
D) Helping patients to navigate the health care system

Answer 26

Ans: D
Feedback:
The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical leadership, educated to help patients navigate through the complex health care system. The other answers are incorrect because they are not what nursing has identified as the CNL role.

Question 27

Our world is connected by a sophisticated communication system that makes much health information instantly accessible, no matter where the patient is being treated. This instant access to health
information has impacted health care delivery strategies, including the delivery of nursing care. What is one way the delivery of health care has been impacted by this phenomenon?

A) Brisk changes as well as swift obsolescence
B) Rapid change that is nearly permanent
C) Limitations on the settings where care can be provided
D) Increased need for social acceptance

Answer 27

Ans: A
Feedback:
The sophisticated communication systems that connect most parts of the world, with the capability of rapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swift
obsolescence in health care delivery strategies. The other answers are incorrect because, although we
have rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health care
itself evolves. Giving nursing care has not become easier, it becomes more complex with every change;
and it does not need to be more socially acceptable; it needs to be more culturally sensitive.

Question 28

With the changing population of health care consumers, it has become necessary for nurses to work more closely with other nurses, as when acute care nurses collaborate with public health and home
health nurses. What nursing function has increased in importance because of this phenomenon?

A) Prescribing medication
B) Performing discharge planning
C) Promoting family involvement
D) Forming collegial relationships

Answer 28

Ans: B
Feedback:
The importance of effective discharge planning and quality improvement cannot be overstated. The
other answers are incorrect because giving medication and family involvement in the patients care have
not grown in importance. Making and maintaining collegial relationships has become a necessity in
working in the health care delivery system. Effective discharge planning aids in getting patients out of
the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting
possible.

Question 29

A nurse has integrated the principles of evidence-based practice into care. EBP has the potential to help
the nurse achieve what goal?

A) Increasing career satisfaction
B) Obtaining federal grant money
C) Ensuring high quality patient care
D) Enhancing the publics esteem for nursing

Answer 29

Ans: C
Feedback:
Quality improvement is the ultimate goal of EBP. Career satisfaction, public esteem, and grant money are not priorities.

Question 30

A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When defining this new role, which of the following outcomes should be prioritized by the hospitals leadership?

A) Decreased need for physician services
B) Improved patient and family education
C) Increased adherence to the principles of EBP
D) Increased coordination of health services

Answer 30

Ans: D
Feedback:
Case management is a system of coordinating health care services to ensure cost-effectiveness, accountability, and quality care. The case manager coordinates the care of a caseload of patients through
facilitating communication between nurses, other health care personnel who provide care, and insurance
companies. Reducing the need for physician services is not a central goal. Education and EBP are consistent with case management, but they are not central to this particular role.