Evolve 1 Flashcards

1
Q

A nursing manager has just hired several new graduates on an inpatient unit. Having heard of the “honeymoon phase” of transitioning into nursing, which action by the manager would be most helpful?

a Educate the graduates on phases of reality shock.
b Help the graduates concentrate on principles of safe care.
c Offer social events for new and seasoned nursing staff.
d Remind the graduates that they should keep their positive attitudes.

A

a

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2
Q

A nurse with 15 years’ experience has been working in the intensive care unit (ICU) for two months. The nurse’s preceptor is expressing frustration to the unit manager because the new nurse follows all the rules “to the letter” and is inflexible. Which action by the manager is most helpful?

a Encourage the preceptor to be patient and give the new nurse easier assignments.
b Explain that as a nurse new to the ICU setting, this rule-bound practice is expected.
c Discuss the situation with the new nurse and emphasize the nurse’s years of experience.
d Mediate a conversation with the nurses where performance expectations are reviewed.

A

b

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3
Q

A nurse is preparing to give a performance review to a new graduate who has worked on the unit for one year. Which action by the nurse leads the manager to conclude that a successful professional transition is occurring for the new nurse?

a Staff members relay that the nurse is easy to work with and is cooperative
b Has not called in sick or been late during the entire time of employment
c Picks up extra shifts and frequently works overtime to care for “my patients”
d Able to adjust to workload without compromising safety or quality care

A

d

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4
Q

A nurse manager is teaching a seminar for managers on reality shock experienced by new graduates. What information does the nurse manager provide? (Select all that apply.)

a Honeymoon phase: seems energetic and fascinated with nursing
b Shock and rejection phase: blames everyone else for any mistakes
c Shock and rejection phase: nurses may complain of minor illnesses
d Shock and rejection phase: uses black humor to cope with work
e Recovery phase: no longer catches contagious illnesses to which he or she is exposed

A

a c

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5
Q

A nursing manager wants to plan a program to help decrease new graduates’ stress. Which activities should the nurse manager include in this program? (Select all that apply.)

a Creating a master plan for increasing responsibilities of new staff
b Ensuring that new staff understand the unit’s formal chain of command
c Including formal skills practice and competency testing in a skills or scenario lab
d Providing an orientation to facility benefits and time-off policies \
e Reviewing proper communication techniques for calling physicians

A

a c

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6
Q

A nurse is the chairperson of the research-based practice council on her unit. Most members work well together and complete their assignments on time, but one nurse seems disorganized, can’t meet deadlines, and often strays “off topic” during meetings. Which action by the chairperson would be most helpful?

a Ask the nurse to lead a brainstorming session for new council projects.
b Enlist the help of the unit manager to reinforce council responsibilities.
c Give this nurse small, easy to complete projects with strict deadlines.
d Speak privately with the nurse and ask if council participation is desired.

A

a

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7
Q

A student nurse is reading about Pareto’s 80/20 rule and is trying to explain it to a classmate. Which explanation is best?

a Concentrating even 20% of your efforts on high-priority items leads to greater success.
b Eighty percent of your time should be spent on 20% of your daily to-do list.
c Most of your success can be accomplished by a smaller amount of effort.
d You should spend 80% of your time on important tasks and 20% on the remainder.

A

a

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8
Q

A nurse is concerned about possible burnout. Which action should the nurse perform first?

a Begin reading self-help books on maintaining a balanced lifestyle.
b Determine if the cause of burnout is internal, external, or both.
c Look for another job in a facility that has a less stressful workload.
d Volunteer to join a committee that impacts patient care practices.

A

b

The first step in analyzing possible burnout is to determine if the cause of the burnout is internal, external, or both. Internal factors leading to burnout can be mediated with self-help strategies and by living a more balanced lifestyle. External factors such as conditions in a place of employment may not be amenable to change and the nurse may have to find other employment. But prior to taking any action such as reading self-help books, looking for another job, or volunteering to be on a committee, the nurse should first determine where the stress is coming from. In fact, if the nurse is already over-extended at work, joining a committee may add to his or her distress.

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9
Q

The charge nurse on a medical unit has noticed one of the seasoned and experienced nurses acting irritable and having critical angry outbursts at work. Which action by the charge nurse would be most helpful?

a Ask what other people are doing to make him or her so angry
b Explore the nurse’s use of self-care measures and leisure activities
c Help the nurse work on better communication techniques
d Send the nurse to Employee Assistance for anger management

A

b

This nurse is displaying some early signs of burnout. The most helpful response by the charge nurse is to explore how the nurse is caring for herself or himself and whether he or she engages in any leisure activities. These are two strategies that can decrease or mitigate burnout. Better communication techniques don’t seem to be the priority, because this behavior is something the charge nurse has just recently noticed. Anger management is also probably not warranted; again, this behavior is recent, and anger management alone will not help solve the nurse’s burnout. The nurse needs to take responsibility for his or her actions, so placing blame on others is not appropriate

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10
Q

A nurse works rotating shifts and always feels fatigued, irritable, and complains of insomnia. What suggestions for good sleep can a colleague make that would be helpful? (Select all that apply.)

Cut down on the amount of carbohydrates you eat each day Correct
Exercise for 30 to 45 minutes before going to bed for the day. Incorrect
Keep the bedroom temperature warmer than other rooms Incorrect
Turn off the phone, computer, and other electronic devices Correct
Wear an eye shield and keep your bedroom dark with shades Correct
A

Suggestions for good sleep, especially when circadian rhythms are disrupted, such as seen in shift work, can be found in Box 2-1. They include using the bedroom only for sleeping and avoiding watching TV or using the computer in bed, engaging in a routine of quiet, relaxing activities prior to bedtime, keeping the bedroom cool and dark (e.g., use a ceiling fan for air movement and for some noise; use window shades or eye shields to darken the room), using other white noise generators, maintaining a quiet environment by turning off the phone and electronic devices and sleeping with earplugs, if necessary, and altering your diet to include more protein and less carbohydrates. Exercising just before bedtime or keeping the bedroom warmer are not a recommended techniques.

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11
Q

A new graduate nurse is paired with a registered nurse during work shifts. The registered nurse understands the professional role to be focused on socialization, role transition, clinical decision-making, and prioritization. What relationship does this describe?

Coaching
Mentoring
Precepting Correct
Role Modeling
A

This role is that of the preceptor. The preceptorship experience promotes role transition and socialization for the nursing student while fostering professional leadership skills in the preceptor. Although role modeling is part of all three of the other relationships, that is not a description of a formal role. Coaching consists of helping individuals attain their potential, partly by recognizing and helping develop unique qualities in the person that may not be fully appreciated. Mentoring is based on the mentor’s unique knowledge and skills. Mentoring is also associated with a trusted friend and advisor.

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12
Q

A registered nurse has been mentoring a new graduate for four weeks out of a five-week formal mentoring program. The graduate nurse is caring for a group of patients, including one with complex needs, and is having trouble organizing the required tasks. Which action by the mentor is most helpful?

Give the graduate a schedule of the activities that the graduate must complete
Have the graduate work with the complex patient only as a good learning experience.
Let the graduate work through the process unless patient care is compromised Correct
Offer advice on different methods of organizing a shift with a complex patient
A

Mentors should follow the advice of Peddy and lead, follow, or get out of the way and should know when each action is appropriate. Near the end of a formal mentoring program, it is time for the mentor to stand back and let the graduate nurse figure things out, and be ready to step in if patient care is compromised. Pushing the mentee and allowing the mentee to learn from failure are desirable traits in a mentor. The graduate is too far along to need a written schedule, should be able to manage more than one patient, and should have already gotten advice on organization

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13
Q

A nurse manager wants to create a program to decrease burnout and increase retention in new graduates. The facility already has a preceptorship program. Which component, if added, would fundamentally change the preceptorship program?

Communication guidelines
Evidence-based curriculum Correct
Long-term relationships
Personality matching
A

The best way to decrease burnout and increase retention of new graduates is to establish a nurse residency program. One major component of such programs is a curriculum that is evidence-based. Long -term relationships among the staff, personality matching, and communication guidelines might be helpful to include, but do not substantially change the nature of the existing program

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14
Q

A student nurse wishes to participate in a mentee-mentor relationship with a senior nursing student. According to the mentee checklist, the student has a score of 82. Which statement by the nursing faculty best describes the student’s mentoring ability?

"A score of 82 shows you will interact positively with a mentor." Correct
"I can help find a senior student to work with you on skills."
"This lack of flexibility will probably hinder a mentoring relationship."
"You should work on your listening skills prior to becoming a mentee."
A

The mentee checklist (Table 3-1) shows the positive traits that a successful mentee should have. A score of 80 or higher indicates that the student probably has good interaction skills that will be needed in a mentoring relationship. Helping the student find a mentor is helpful, but does not give information about the score. The score does not indicate a lack of flexibility or poor listening skills.

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15
Q

The nursing manager is looking for nurses to assign as mentors to new graduates. Which of the following nurses would the manager choose? (Select all that apply.)

Charge nurse with over 10 years' experience Incorrect
Nurse who is enthusiastic about nursing; able to laugh at self Correct
Nurse who gives meticulous care using a standard approach Incorrect
Nurse who is known for being an out of the box thinker Correct
Nurse who is planning to remain at the facility another 6 months Incorrect
A

A good mentor has many qualities shown in Box 3-1, including enthusiasm for nursing, and being able to use humor and listen to and accept differing points of view. A mentor should not be in a position of authority over the mentee, so that eliminates the charge nurse. Giving meticulous care is desirable, but using a standard approach is not as mentors have to be flexible. Because mentoring is a long-term relationship, a nurse planning to leave the facility after 6 months would not be the best choice.

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16
Q

A nurse is interviewing for a new job after working on a medical-surgical unit for 1 year. The interviewer asks why he is leaving his current job. Which is the best answer by the nurse?

"After some great experience, it's time to move to my career goal position." Correct
"I think I learned all I could working on medical-surgical unit for a year."
"It was too busy for me; I had trouble managing a large patient workload."
"The manager did not like me and there were no other men working there."
A

When giving a reason for leaving a position, the nurse should remain positive, professional, and not burn bridges. Stating that he thinks it’s time to move to a position more in line with his career goals is a good option for the nurse. Stating that he has learned all he can make him seem dismissive of the current job. The other two options (that the unit was too busy with a large patient workload and the manager didn’t like me and there were no other men working on the unit) sound too much like complaints.

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17
Q

A graduate nurse is selecting an NCLEX-RN review course. This student graduated at the top of the class, is organized, plans study time, and feels fairly confident in the ability to pass the NCLEX-RN exam. Which type of review course would be best for this graduate to select?

Face-to-face, 3-day course
None; study can be independent Correct
Online, asynchronous course
Online, real-time course
A

his student would probably be a good candidate for independent study with a review book rather than taking a review course (able to make and stick to a study schedule, top 25% of the class, experience with general medical-surgical patients, and confident about passing the exam).
An asynchronous online course would be good for independent learners who needed more guidance than self-study. A real-time on line course and face-to-face course would be good for those who don’t plan independent time well.

18
Q

A faculty member explains to a group of nursing students about the functions of the National Council of State Boards of Nursing (NCSBN). Which item does the faculty member include in this description? (Select all that apply.)

Determines application and registration process Correct
Negotiates passing scores in different states
Provides equipment and sites for testing Incorrect
Schedules, administers, and scores the exam Incorrect
Sets specific deadlines for testing in each state Correct
A

The NCSBN determines the application and registration processes, and sets deadlines related to testing in each state. The passing score is the same in all states. Pearson VUE is a vendor selected by the NCSBN to provide equipment and testing sites; and to schedule, administer, and score the exams.

19
Q

A student has test anxiety. Which action(s) should the student take to alleviate this problem? (Select all that apply.)

Find positive study buddies. Correct
Make a study plan for exams. Correct
Read only after the class time. Incorrect
Schedule study time as a priority. Correct
Take a break every 2 hours. Incorrect  .
A

est anxiety is often compounded by being rushed, so the student needs to make study time a priority to avoid cramming. This means that studying will need to be put ahead of other things, such as housework and watching TV. The student should not study with people who are negative; negative attitudes are contagious. Reading before class prepares the student for the topic of the day, which facilitates learning. The student should take a break every 50 minutes or so to avoid being overwhelmed.

20
Q

Which trend(s) will continue to be important in nursing and nursing education in the future? (Select all that apply.)

    Aging workforce Correct
    Alternative educational programs Correct
    Decreasing wages Incorrect
    Role confusion Incorrect
    Retiring faculty Correct
A

The “graying of America” will affect health care because more patients are older and have multiple health care needs. As faculty and staff become older and retire both these topics will affect the nursing shortage. Nursing programs will have to consider many more alternative methods of delivering education to attract students. Role confusion and decreasing wages are not important trends

21
Q

Which information about Florence Nightingale is correct? (Select all that apply.)

Came from a wealthy Victorian family Correct
Developed the Nightingale education method Correct
Entered nursing after a career in teaching Incorrect
Studied nursing secretly to avoid family conflict Correct
Wrote the Nightingale Pledge while bedridden Incorrect
A

There are many myths and legends about Nightingale, but some facts about her include that she came from a wealthy Victorian family, at one point studied nursing in secret, and developed schools of nursing that many other schools in Europe and America emulated. Florence Nightingale did not have an early career as a teacher, nor did she write the Nightingale pledge; Lystra Gretter did.

22
Q

The student of nursing history recognizes that which of the following is an influence on nursing from early European history?

Changing emphasis to caring for victims of disasters
Likelihood of surviving military wounds greatly increased
Nursing education beginning at early European universities
War widows finding purpose and means of living by nursing Correct
A

Because of the frequent nature of military conflicts, widows were common in the early European times. In order to survive, many widows joined the nuns and became nurses. Caring for disaster victims emerged as a 21st century concern. Soldiers became more likely to survive their wounds starting in the Crimean war, but this was also noted as a trend during the Civil War. Baccalaureate education is a fairly recent trend; in 1919, there were only nine BSN programs.

23
Q

A student nurse is participating in an interactive session on nursing history in which the students can interview any figure from nursing’s past. Which question is appropriate?

Lilian Wald: "How did you avoid becoming ill nursing soldiers in the Crimean war?"
Lystra Gretter: "What encouraged you to form the first school of nursing in America?"
Mildred Montag: "How do you feel about the BSN as the entry point to nursing now?" Correct
Sophia Palmer: "What made you realize that correspondence courses for nurses would work?"
A

Mildred Montag developed the Associate Degree program of nursing education. This question would be an appropriate one, matching person with interest. Sophia Palmer rejected the idea of correspondence courses and home study programs for nurses. Lillian Wald did not work in the Crimea. Lystra Gretter composed the Nightingale pledge.

24
Q

A student nurse complains about writing “endless” care plans. The faculty explains how this teaches one of the nursing roles in addition to preparing the student to care for patients, and that all hospitals must demonstrate the use of the nursing process. Which nursing role is the faculty referring to?

Advocate
Colleague
Manager Correct
Teacher
A

Organizing nursing care so that other nurses can continue caring for the patient in one’s absence is the essence of the earliest version of the nurse manager role. In addition to helping the student prepare to care for a particular patient, writing down directions (or entering the information into a computer) for patient care ensures consistency among the staff. The teacher provides patients with information. The advocate protects patients and, on occasion, speaks for them. The colleague works within interdisciplinary relationships for better patient care; nursing care plans are not used by other disciplines.

25
Q

A nurse caring for a patient evaluates how well the patient understood information about an upcoming diagnostic test. In which role is this nurse practicing?

Advocate
Counselor
Manager
Teacher Correct
A

The teacher provides information to patients about a multitude of things, such as diagnostic exams, conditions, medication regimens, and healthy lifestyles. Inherent in this role is evaluating the patient’s understanding and tailoring this information to the patient’s learning styles and understanding. Advocates protect the patient, often by speaking in the patient’s behalf. Counselor is not a nursing role. Managers organize patient care.

26
Q

A student wishes to enter nursing through a program that offers the best chance of being hired at the hospital where clinical is held to minimize role stress and role transition. Which nursing program should the student investigate?

Associate degree program
Baccalaureate program
Diploma program Correct
Ladder program
A

Although no program guarantees employment at a specific hospital or setting, diploma programs are usually associated with a hospital in which most clinical experiences occur. This leads to a graduate nurse already familiar with that system who is less likely to suffer from role strain on employment. Currently, there are very few diploma programs offered.

27
Q

A student is explaining a multiple-exit program to family members. What information about this program is correct?

Allows the student to transfer my courses for credit at multiple times
Gives the student a range of options for employment on graduation
Has multiple degree stops when the student can leave, but then come back Correct
Permits the student to quit at certain times during the program for a break
A

A multiple-exit program has multiple degrees, each with its own entry and exit points. For example a program might allow the student to leave after 1 year, take the practical nurse licensure examination, work for a while, and then return to the ADN program. The student can then complete the ADN, take the NCLEX-RN exam, work again for a period of time, and then return for a BSN. Some programs also contain master’s and doctoral levels. The multiple-exit program does not include specific breaks for rest, does not offer transfer credits, and is offered in only one degree—not several.

28
Q

A prospective nursing student is interviewing at a proprietary nursing school. What question might this student be most interested in when comparing all accredited schools to which he or she has applied?

Cost of tuition Correct
Ease of college transfer
Faculty credentials
Scheduling clinical experiences
A

All topics would be appropriate to discuss during an admissions interview. However, because proprietary schools are for-profit, the cost of tuition would be the topic most relevant to this particular school

29
Q

The nursing faculty member explains the meaning of nursing licensure to a class of freshman nursing students. What information about licensure is correct?

Demonstrates minimal competency Correct
Graduated from an accredited school
Proficient in nursing skills and theory
Mastered core competencies in nursing
A

Nursing licensure ensures the public that the practicing nurse has demonstrated minimal competency for safe nursing care by passing a licensure exam. It does not imply graduation from an accredited program or any level of proficiency or mastery

30
Q

Which trend(s) will continue to be important in nursing and nursing education in the future? (Select all that apply.)

    Aging workforce Correct
    Alternative educational programs Correct
    Decreasing wages Incorrect
    Role confusion Incorrect
    Retiring faculty Correct
A

The “graying of America” will affect health care because more patients are older and have multiple health care needs. As faculty and staff become older and retire both these topics will affect the nursing shortage. Nursing programs will have to consider many more alternative methods of delivering education to attract students. Role confusion and decreasing wages are not important trends

31
Q

A nurse wants to use Orem’s theory to guide nursing care. Which action by the nurse is most congruent with this theory?

Assess the patient's cultural beliefs about health care.
Determine what the patient can and cannot do. Correct
Explore the use of acceptable complementary therapies.
Negotiate with the patient on mutually acceptable goals
A

Orem’s theory of self-care includes nursing actions for patients that are wholly compensatory, partially compensatory, or educational. The nurse needs to determine what the patient can or cannot do for himself or herself and provide assistance or do the task in its entirety. Complementary and alternative therapies fit well with Martha Roger’s theory. Imogene King’s theory includes goal attainment. Assessing cultural beliefs would be most important to Leininger’s theory.

32
Q

A nurse is caring for a patient who is very upset and yells at the nurse. This nurse uses Watson’s theory to guide nursing care. Which intervention would this nurse most likely use?

Ask the patient to explain what the problem is.
Offer to return later when the patient is calmer.
Sit quietly with the patient, allowing her to vent. Correct
Tell the patient that this behavior is not acceptable.
A

jean Watson’s theory includes 10 carative factors, which have been revised as 10 caritas processes. One of these carative factors is “the promotion and acceptance of the expression of positive and negative feelings.” A nurse using Watson’s theory would most likely sit quietly with the patient and allow the patient to express his or her feelings. Telling a patient that his or her behavior is not acceptable is not specific to a carative factor and can harm the caring relationship. Asking a patient to explain a problem or offering to return later is not specific to a carative factor.

33
Q

A nurse follows Leininger’s theory of nursing. Which intervention would the nurse most likely include in a patient’s care plan?

Educating the patient on self-care measures
Helping the patient identify life stressors
Involving a folk healer in the patient's care Correct
Providing care for the patient's 14 basic needs
A

Leininger’s theory of cultural care views a person in the context of his or her culture. The nurse needs to assess the situation and decide if cultural preservation, cultural accommodation, or cultural repatterning is appropriate. If the nurse can incorporate the patient’s cultural health care beliefs, as in involving a fold healer, the health care provided is more culturally congruent. Henderson believed that patients had 14 areas of basic need, and the nurse’s job was to provide care in each area. Self-care measures are part of Orem’s theory. The stress seen in the three levels of prevention are part of Newman’s theory

34
Q

A nurse practices using Roy’s theory of nursing. Which intervention would this nurse take to decrease contextual stimuli when caring for a postoperative patient who is in great pain?

Ask the patient what was done after prior operations.
Call the provider and request more pain medication.
Let the patient sleep then assist with ambulation.
Turn the volume on the television down or off. Correct
A

Roy’s theory of nursing requires the nurse to assess how well the patient is coping or adapting to stressors. Focal stimulus is what is causing the greatest concern—in this case, pain. Contextual stimuli are other stimuli that affect how the patient copes or adapts to the focal stimuli. Noise from a TV is an example. Residual stimuli are things bothering the patient but unknown to the nurse—for example, memories of a past surgical experience. To reduce a contextual stimulus, the nurse would turn the volume down on the TV. Asking the patient about prior operations, providing the patient with pain medication, or mobilizing them for rest may be helpful and/or important, but does not address contextual stimuli.

35
Q

A nurse who admires Nightingale’s theory of nursing would most likely include which of the following activities in the patient’s care plan? (Select all that apply.)

Assist the patient to order nutritious food. Correct
Ensure that the patient signs an informed consent. Incorrect
Keep the patient's room and table uncluttered. Correct
Provide quiet time without interruption. Incorrect
Teach the patient about needed medication. Incorrect
A

Nightingale believed that the patient’s environment had a direct effect on health and recovery. She believed that nurses should support the environment to help the patient heal. She also believed that nutritious food, clean water, and good sanitation were vital. Helping the patient order nutritious food and eliminating clutter around the patient would be activities falling under her theory. Signing informed consents and providing patient quiet time and education are important concerns, but not part of Nightingale’s theory of nursing.
DIF: Apply (Application)

36
Q

A student is interested in the history of the image of nursing. What other public perceptions should the nursing student obtain information about?

Health care
Science
Teachers
Women Correct
A

The public perception of nursing has closely mirrored the public perception of women over the years as seen in media portrayals. Perceptions of health care, science, or teaching are not as closely matched to nursing (though it is important to note that historically, teaching has been a women’s profession, so some parallels could be made).

37
Q

The faculty member explains to a class of nursing students that a campaign to increase recruitment of young people into nursing was known as which of the following?

Every Patient Deserves a Nurse
Nurses for a Healthier Tomorrow
Raise the Voice campaign
The Campaign for Nursing's Future Correct
A

The Campaign for Nursing’s Future is designed to increase interest in nursing among young people and was developed by Johnson and Johnson in conjunction with several professional organizations. Every Patient Deserves a Nurse is a promotional flyer distributed by the ANA. Nurses for a Healthy Tomorrow is an alliance among 37 different nursing organizations; it focuses on promoting the positive image of nursing as patient advocates. The Raise the Voice campaign brings nurses to health care policy debates.

38
Q

A nursing instructor explains the impact of the Employee Retirement Income Security Act (ERISA) of 1974 (amendment to the Taft-Hartley Act) as which of the following?

Allowed professional organizations to be considered unions Correct
Credentialed nurses in several subspecialties of practice
Created the development of nursing licensure compacts
Permitted the drafting of registered nurses until age 45
A

An amendment to the Taft-Hartley Act allowed professional nursing organizations to be classified as unions and led to the creation of the United American Nurses, a collective bargaining organization for nurses. This act did not involve credentialing, compacts, or the military draft.

39
Q

A student nurse and computer programmer are debating about which one is a profession. Which of the following are characteristic(s) of a profession? (Select all that apply.)

    Commitment to lifelong work Correct
    Existing code of ethics Correct
    Relevance to social values Correct
    Self-governance Correct
    Specific classes in the subject Incorrect
A

Pavalko described eight dimensions of a profession in 1971. They include relevance to social values, training or education period, political action and social service, code of ethics, commitment to lifelong work, member control of their own profession, theoretical framework, and common identity and distinctive subculture. Specific classes are offered for most jobs; this is different from the educational period for nurses, which includes theory, clinical practice, and research that advances the profession.

40
Q

An experienced nurse is describing the benefits of joining professional organizations to a new graduate. Which of the following does the nurse include? (Select all that apply.)

Better pay and benefits at work Incorrect
Input into policy development Correct
Leadership opportunities Correct
Maintaining current knowledge Correct
Opportunities for networking Correct
A

There are many benefits to joining and being active in professional organizations, including the opportunity to have input into legislation and policy, continuing education, networking, leadership development, personal benefits, resources, and being part of the developing future of nursing. Membership is not related to getting better pay and benefits at work.