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Essentials for Nursing Practice, 8e

All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc. Potter

Potter: Essentials for Nursing Practice, 8th Edition

Nursing Skills Online Answer Key

Safe Medication Administration Module Exam

1. (1.0 point)

How can the nurse determine a patient's history of allergies? (Select all that apply.)

a. By looking at the patient's allergy bracelet

b. By looking at the MAR

c. By asking the patient

d. By looking at the front of the chart or in the patient’s electronic medical record

(EMR)

e. By administering a dose and monitoring the patient's response

Correct selections: a, b, c, d

Rationale: Allergies are listed in at least three places: the patient's allergy bracelet, the MAR,

and conspicuously on the front of the chart or in the patient’s electronic medical record. The

nurse may also ask the patient about allergies before medication administration. Administering a

dose and monitoring the patient's response will not determine a history of allergies. Prevention of

administering medications to which the patient is allergic is an important safety measure.

2. (1.0 point)

The nurse brings the patient's medications but the patient refuses to take them, stating, "I'll take

them later. Right now my stomach feels a little upset. Could you bring me some crackers?" What

is the best action the nurse should take? (Select all that apply.)

a. Leave the medications at the patient's bedside and check on him later.

b. Document the patient is noncompliant in following the medication regimen.

c. Lock the patient's medications up temporarily and document the incident.

d. Offer the patient some crackers and see if the patient has any medications that could

help relieve the nausea.

e. Have the patient take the medications at this scheduled time with a small sip of water.

Correct selections: c, d

Rationale: The nurse should never leave the medications at the patient's bedside unless there is

an order to do so. If the medication is left unattended, the patient may forget to take it, drop it, or

intentionally avoid taking the dose without the nurse’s awareness. The nurse is responsible for

ensuring that the patient receives the ordered dose. The nurse should temporarily lock the

medications up and document the incident. If the patient is unable to take the medications later,

the health care provider should be notified within 24 hours of the refusal. The nurse may also see

if there are medications available to treat the patient's nausea, or at least provide crackers as

requested. The nurse should avoid labeling the patient as noncompliant. The patient has the right

to refuse medication.

3. (1.0 point)

Identify the 6 rights of medication administration.

a. The right health care provider

b. The right MAR

c. The right patient

d. The right medication

e. The right expiration date

f. The right dose

g. The right time

h. The right documentation

i. The right conversion factor

j. The right route

Correct selections: c, d, f, g, h, j

Rationale: The 6 rights of medication administration are the right patient, the right medication,

the right dose, the right route, the right time, and the right documentation.

4. (1.0 point)

The nurse is to administer a tablet from a stock bottle. How should the nurse get the tablet from

the bottle into the cup?

a. Pour the required number into the bottle cap and transfer them to the medication cup.

b. Pour the required number into a gloved hand and transfer them to the medication cup.

c. Pour the required number into the medication cup with the other medications.

d. Shake the tablets toward the top of the bottle and reach in and obtain the required

number. Place them in the medication cup.

Correct answer: a

Rationale: To prepare tablets or capsules from a floor stock bottle, the nurse should pour the

required number into the bottle cap and transfer the medication to the medication cup. Avoid

touching the medication with your fingers. Extra tablets or capsules may be returned to the

bottle. The nurse may accidentally pour more than needed into the medication cup and then

would have to touch the tablets to remove them from the cup of medication.

5. (1.0 point)

The patient who is to receive a medication BID will receive the medication:

a. After meals

b. Twice a day

c. Three times a day

d. Four times a day



Correct answer: b

Rationale: After meals, abbreviated pc, would be 3 doses. The abbreviation "bid" means twice a

day. Three times a day is abbreviated tid. Four times a day is abbreviated qid.

6. (1.0 point)

The health care provider has ordered allopurinol 0.05 g PO BID.

Drug available:

The nurse should give ______ tablet(s) for each dose.

Correct Answer(s): 0.5

Rationale:

Formula method:

Dimensional Analysis method:

7. (1.0 point)

The health care provider has ordered Amikin (amikacin) 500 mg, IM q8h.

Drug available:

The nurse should give ______ mL for each dose.

Correct Answer: 2

Rationale:

Formula method: 500 mg/1000mg X 4 mL = 2 mL


8. (1.0 point)

The health care provider has ordered prochlorperazine (Compazine) 2.5 mg IM q4h prm. The

medication available is Compazine 5 mg/mL.


Correct Answer: 0.5

Rationale:

Formula method

Dose ordered/dose on hand × amount on hand = amount to administer



9. (1.0 point)

The health care provider has ordered Amoxil (amoxicillin) 0.05 g, PO tid.

Drug available:


Correct Answer: 2

Rationale:

Formula method:


10. (1.0 point)

What is the best way for nurses to prevent medication errors?

a. Adhere to the 6 rights of medication administration.

b. Avoid distractions and take time to prepare medications.

c. Only give medications to patients who are alert and oriented.

d. Use an automated medication dispensing system.

Correct answer: a

Rationale: All medication errors can be linked, in some way, to an inconsistency in adhering to

the 6 rights of medication administration. Although avoiding distractions and taking sufficient

time to prepare medications may help reduce the likelihood of a medication error, following the

6 rights of medication administration will potentially prevent a variety of errors. Not all patients

requiring medication will be alert and oriented. Errors can still occur with an automated

medication dispensing system.

11. (1.0 point)

If a health care provider's handwriting is difficult to read and as a result the nurse administers a

wrong medication or incorrect dosage, who is legally responsible for the error?

a. The health care provider

b. The nurse who gave the medication

c. The pharmacist who filled the medication order

d. The hospital

Correct answer: b

Rationale: The nurse who gives the wrong medication or an incorrect dosage is legally

responsible for the error. If the health crae provider's handwriting is illegible, the nurse should

verify the order with the health care provider.

12. (1.0 point)

If the patient refuses a medication, what should the nurse do? (Select all that apply.)

a. Document the reason for refusal in the nurses’ notes.

b. Notify the prescriber within 24 hours.

c. Determine the reason for refusal.

d. Wait and administer dose at time next dose is due.

e. Hide it in their food.

Correct selections: a, b, c

Rationale: When medication is refused, determine the reason for it and take action accordingly.

Refusal of medications must be documented and the health care provider notified within 24

hours. The MAR may require a special symbol that indicates that the patient refused the

medication. The patient has the right to refuse.

13. (1.0 point)

Which of the following patients are at risk for developing drug toxicity? (Select all that apply.)

a. 65-year-old male, who has been on high doses of antibiotics for 3 weeks

b. 75-year-old female, who swallowed Caladryl lotion

c. 82-year-old male, who has renal disease

d. 16-year-old female, who has had vomiting and diarrhea

e. 43-year-old male, who has liver failure

Correct selections: a, b, c, e



Rationale: A toxic medication effect develops after prolonged intake of high doses of a

medication, after ingestion of medications intended for external application, or when a

medication accumulates in the blood because of impaired metabolism (e.g., liver disease) or

excretion (e.g., renal disease). Vomiting and diarrhea do not place a patient at risk for drug

toxicity.

14. (1.0 point)

The patient is to receive 120 mg of IV Lasix. You calculate that this will be 12 mL (10 mg/mL).

The drug book states that the usual dosage is 20 to 40 mg. What steps should the nurse take to

avoid medication errors in this situation? (Select all that apply.)

a. Question unusually large or small doses.

b. Be sure to read labels at least two times to make sure the medication is correct.

c. Double-check all calculations.

d. Use at least two patient identifiers whenever administering a medication.

e. Only administer 4 mL (40 mg).

Correct selections: a, c

Rationale: In this instance, the medication ordered is an unusually large amount. The nurse

should question the amount by verifying the order with the health care provider. The nurse

should not alter the order without talking to the healthcare provider and receiving orders to do so.

The nurse should also double-check all calculations. Reading the label and using two patient

identifiers are steps that help prevent medication errors, but in this instance, they will not prevent

administering too much medication. Labels should be checked three times before administration.

15. (1.0 point)

The health care provider has ordered Milk of Magnesia 30 mL PO now. How many ounces

would this be?

a. one ounce

b. six ounces

c. three ounces

d. half an ounce

Correct Answer: a

Rationale: There are 30 mL in one ounce.

16. The nurse administered a routine scheduled medication of Prozac (fluoxetine hydrochloride),

an antidepressant, 20 mg PO to a patient. The nurse checked the medication label against the

MAR when getting it out of the automatic dispensing system, again when placing the medication

in a cup, and once more at the patient’s bedside prior to administration. The label read 20 mg and

contained a single capsule. The nurse asked the patient to state her name and administered the

medication, offering the patient a drink of water. The nurse documented the administration of the

medication. Which of the six rights of medication administration did the nurse violate?

a. The nurse administered the medication correctly.

b. The nurse did not have a second nurse verify the dose.

c. The nurse did not make the appropriate number of checks for the right drug.

d. The nurse did not use two patient identifiers.

Correct answer: d

Rationale: The nurse failed to use two patient identifiers prior to medication administration

which could have resulted in giving medication to the wrong patient. No calculations were

involved and this was not a high-risk drug such as insulin or anticoagulants, therefore a second

nurse’s verification would be unnecessary. The nurse made three appropriate checks for the

right drug. The nurse must consistently follow the 6 rights of medication administration to avoid

medication errors.



Chapter 01: The Nursing Profession

Potter: Essentials for Nursing Practice, 8th Edition

MULTIPLE CHOICE

1. A nurse uses effective strategies to communicate and handle conflict with nurses and other health

care professionals. Which Quality and Safety Education for Nurses (QSEN) competency is the

nurse demonstrating?

a. Informatics

b. Quality improvement

c. Teamwork and collaboration

d. Evidence-based practice

ANS: C

Teamwork and collaboration uses effective strategies to communicate and handle conflict.

Informatics includes navigating electronic health records. Quality improvement uses tools such

as flow charts and diagrams to improve care. Evidence-based practice integrates best current

evidence with clinical expertise and patient/family preferences and values for delivery of optimal

health care.

PTS: 1 DIF: Cognitive Level: Applying (Application)

REF: 11

OBJ: Describe the purpose of professional standards of nursing practice.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

2. A nurse is employed by a health care agency that provides an informal training session on how to

properly use a new vital sign monitor. Which type of education did the nurse receive?

a. In-service education

b. Advanced education

c. Continuing education

d. Registered nurse education

ANS: A

In-service education programs are instruction or training provided by a health care agency or

institution designed to increase the knowledge, skills, and competencies of nurses and other

health care professionals employed by the institution. Some roles for RNs in nursing require

advanced graduate degrees, such as a clinical nurse specialist or nurse practitioner. There are

various educational routes for becoming a registered nurse (RN), such as associate, diploma, and

baccalaureate. Continuing education involves formal, organized educational programs offered by

universities, hospitals, state nurses’ associations, professional nursing organizations, and

educational and health care institutions.


REF: 6

OBJ: Discuss the importance of education in professional nursing practice.

TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care

3. A nurse listens to a patient’s lungs and determines that the patient needs to cough and deep

breath. The nurse has the patient cough and deep breath. Which concept did the nurse

demonstrate?

a. Accountability

b. Autonomy

c. Licensure

d. Certification

ANS: B

Autonomy is essential to professional nursing and involves the initiation of independent nursing

interventions without medical orders. Accountability means that you are professionally and

legally responsible for the type and quality of nursing care provided. To obtain licensure in the

United States, RN candidates must pass the NCLEX-RN® examination administered by the

individual State Boards of Nursing to obtain a nursing license. Beyond the NCLEX-RN®, some

nurses choose to work toward certification in a specific area of nursing practice.

PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)

REF: 6 OBJ: Discuss the characteristics of professionalism in nursing.


4. A registered nurse is required to participate in a simulation to learn how to triage patients who

are arriving to the hospital after exposure to an unknown gas. This is an example of a response to

what type of influence on nursing?

a. Workplace hazards

b. Nursing shortage

c. Professionalism

d. Emergency preparedness

ANS: D

Many health care agencies, schools, and communities have educational programs to prepare for

nuclear, chemical, or biological attack and other types of disasters. Nurses play an active role in

emergency preparedness. Workplace hazards include violence, harassment, and ergonomics. A

person who acts professionally is conscientious in actions, knowledgeable in the subject, and

responsible to self and others. There is an ongoing global nursing shortage, which results from

insufficient qualified registered nurses (RNs) to fill vacant positions and the loss of qualified

RNs to other professions.


REF: 4

OBJ: Discuss the influence of social, political, and economic changes on nursing practices.

TOP: Nursing Process: Evaluation MSC: NCLEX: Safety and Infection Control

5. A nurse is an advanced practice registered nurse (APRN) who cares for geriatrics. This nurse is

which type of advanced practice nurse?

a. Clinical nurse specialist

b. Nurse practitioner



c. Certified nurse-midwife

d. Certified registered nurse anesthetist

ANS: A

The clinical nurse specialist (CNS) is an APRN who is an expert clinician in a specialized area of

practice, such as geriatrics or pediatrics. The nurse practitioner (NP) is an APRN who provides

health care to a group of patients, usually in an outpatient, ambulatory care, or community-based

setting. A certified nurse-midwife (CNM) is an APRN who is educated in midwifery and is

certified by the American College of Nurse-Midwives. A certified registered nurse anesthetist

(CRNA) is an APRN with advanced education in a nurse anesthesia accredited program.


REF: 8 OBJ: Describe the roles and career opportunities for nurses.


6. A patient does not want the treatment that was prescribed. The nurse helps the patient talk to the

primary health care provider and even talks to the primary health care provider when needed.

The nurse is acting in which professional role?

a. Educator

b. Manager

c. Advocate

d. Provider of care

ANS: C

As an advocate you act on behalf of your patient, securing and standing up for your patient’s

health care rights. As an educator you explain concepts and facts about health, describe the

reason for routine care activities, demonstrate procedures such as self-care activities, reinforce

learning or patient behavior, and evaluate the patient’s progress in learning. Most nurses provide

direct patient care in an acute care setting, and this describes the role of provider of care. A

manager coordinates the activities of members of the nursing staff in delivering nursing care and

has personnel, policy, and budgetary responsibility for a specific nursing unit or agency.




7. A nurse must follow legal laws that protect public health, safety, and welfare. Which law is the

nurse following?

a. Code of Ethics

b. Nurse Practice Act

c. Standards of practice

d. Quality and safety education for nurses

ANS: B

In the United States each State Board of Nursing oversees its Nurse Practice Act (NPA), which

regulates the scope of nursing practice for the state and protects public health, safety, and

welfare. The ANA’s Code of Ethics for Nurses: Interpretation and Application (2010) provides a

guide (not a law) for carrying out nursing responsibilities to ensure high-quality nursing care and

provide for the ethical obligations of the profession. The purpose of a standard of care is to

describe the common level of professional nursing care to judge the quality of nursing practice.

The Robert Wood Johnson Foundation sponsored the Quality and Safety Education for Nurses

(QSEN) initiative to respond to reports about safety and quality patient care by the Institute of

Medicine.


REF: 7



8. A nurse is directing the care and staffing of three cardiac units. The nurse is practicing in which

nursing role?

a. Advanced practice registered nurse

b. Nurse researcher

c. Nurse educator

d. Nurse administrator

ANS: D

A nurse administrator manages patient care and the delivery of specific nursing services within a

health care agency. An advanced practice registered nurse has a master’s degree in nursing;

advanced education in pathophysiology, pharmacology, and physical assessment; and

certification and expertise in a specialized area of practice. A nurse educator works primarily in

schools of nursing, staff development departments of health care agencies, and patient education

departments. The nurse researcher investigates problems to improve nursing care and further

define and expand the scope of nursing practice.




MULTIPLE RESPONSE

1. A nurse is presenting at an interdisciplinary meeting about the multiple external forces that are

influencing nursing today. Which examples should the nurse include? (Select all that apply.)

a. Health care reform

b. Threat of bioterrorism

c. Population demographics

d. Role of nurse manager

e. Nursing shortage

ANS: A, B, C, E



Multiple external forces affect nursing today, including health care reform, demographic changes

of the population, increasing numbers of medically underserved, need for emergency

preparedness, threat of bioterrorism, workplace issues, and the nursing shortage. Role of nurse

manager is not an external force affecting nursing, but is one role of the registered nurse.


REF: 4

OBJ: Discuss the influence of social, political, and economic changes on nursing practices.


2. A nurse is teaching the staff about the characteristics of a profession. Which information should

the nurse include? (Select all that apply.)

a. Extended education

b. Theoretical body of knowledge

c. Code of ethics for practice

d. Practice developments

e. Provision of a specific service

ANS: A, B, C, E

Professions possess the following characteristics:

• An extended education of members and a basic liberal education foundation

• A theoretical body of knowledge leading to defined skills, abilities, and norms

• Provision of a specific service

• Autonomy in decision making and practice

• A code of ethics for practice

Practice developments are not a characteristic of a profession, but are essential for nurses to stay

current by gaining new knowledge about the latest research and practice developments.


REF: 5 OBJ: Discuss the characteristics of professionalism in nursing.


3. A nurse is teaching the staff about Quality and Safety Education in Nursing, which identified six

competencies for nursing. Which information should the nurse include in the teaching session?

(Select all that apply.)

a. Informatics

b. Safety

c. Health policies

d. Informatics

e. Quality improvement

ANS: A, B, D, E

The Robert Wood Johnson Foundation sponsored the Quality and Safety Education for Nurses

(QSEN) initiative to respond to reports about safety and quality patient care by the IOM. The

QSEN initiative encompasses the competencies of patient-centered care, teamwork and

collaboration, evidence-based practice, quality improvement, safety, and informatics. Health

policy is health related issues at the government level, not a competency.


REF: 10 | 11


TOP: Nursing Process: Assessment MSC: NCLEX: Safety and Infection Control

4. A nurse wants to become an advanced practice registered nurse (APRN) and have a higher

degree of independence. Which advanced roles could the nurse pursue? (Select all that apply.)

a. Clinical nurse specialist

b. Nurse manager

c. Nurse practitioner

d. Nurse midwife

e. Nurse anesthetist

ANS: A, C, D, E

The advanced practice registered nurse (APRN) is the most independently functioning nurse. An

APRN has a master’s degree in nursing; advanced education in pathophysiology, pharmacology,

and physical assessment; and certification and expertise in a specialized area of practice. There

are four core roles for the APRN: clinical nurse specialist (CNS), nurse practitioner (NP),

certified nurse midwife (CNM), and certified RN anesthetist (CRNA). Nurse managers do not

require an advanced degree.




1 Lesson Plan for

The Nursing Profession

OBJECTIVES

1. Discuss the characteristics of professionalism in nursing. 2. Discuss the importance of education in professional nursing practice. 3. Describe the purpose of professional standards of nursing practice. 4. Describe the roles and career opportunities for nurses. 5. Discuss the influence of social, political, and economic changes on nursing practices.

TEACHING FOCUS



Nursing is both a science, based on a body of knowledge that is constantly changing and evolving, and an art, based on the practice of compassion, respect, and dignity rendered to the patient and family members alike.

Even though the patient is the center of your care, the family, significant others, and community will have needs.

When rendering care, your care will be guided by a specific set of standards, a code of ethics developed by the American Nurses Association.

Nursing practice incorporates ANA standards, evidence-based practice, and critical thinking skills.

KEY TERMS

Advanced practice registered nurse (APRN), p. 8

American Nurses Association (ANA), p. 2

Caregiver, p. 7

Certified nurse-midwife (CNM), p. 8

Certified registered nurse anesthetist

(CRNA), p. 8

Clinical nurse specialist (CNS), p. 8

Code of ethics, p. 6

Continuing education, p. 5

Genomics, p. 11

In-service education, p. 6

International Council of Nurses (ICN), p. 10

Licensed practical nurse, p. 5

Licensed vocational nurse, p. 5

National League for Nursing (NLN), p. 10

Nurse administrator, p. 9

Nurse educator, p. 9

Nurse practitioner, p. 8

Nurse researcher, p. 9

Nursing, p. 2

Patient advocate, p. 7

Professional organization, p. 9

Quality and Safety Education for Nurses (QSEN), p. 10

Registered nurse (RN), p. 5

Note: Audio glossary available on Evolve.

NURSING CURRICULUM STANDARDS

QSEN

Teamwork and Collaboration o QSEN Activity: Teamwork and Collaboration, p. 12

Evidence-Based Practice o Box 1-1 Evidence-Based Practice, p. 9

Quality Improvement o Quality and Safety Education for Nurses, p. 10 o Table 1-1 Quality and Safety Education for Nurses, p. 10

CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013). Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to Potter, Perry, Stockert, and Hall: Essentials for Nursing Practice, 8th Edition. A full Concept-Based Curriculum Map covering the entire book can be found here.

16 Chapter 1 The Nursing Profession __________________________________________________



ATTRIBUTES AND ROLES OF NURSE

Professionalism o Professionalism, p. 5 o Responsibilities and Roles of the Nurse, p. 7 o Quality and Safety Education for Nurses, p. 10 o Table 1-1 Quality and Safety Education for Nurses, p.10

Ethics o Code of Ethics, p. 6

CARE COMPETENCIES

Evidence o Box 1-1 Evidence-Based Practice, p. 9

HEALTH CARE INFRASTRUCTURES

Health Care Organizations o Professional Nursing Organizations, p. 9

Health Care Law o Health Care Reform and Costs, p. 4 o Nurse Practice Acts, p. 7 o Licensure and Certification, p. 7 o Standards of Nursing Practice, p. 6 o Effect of Nursing on Politics and Health Policy, p. 11

BSN Essentials

Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Box 1-1 Evidence-Based Practice, p. 9 o QSEN Activity: Teamwork and Collaboration, p. 12 o Professional Nursing Organizations, p. 9

Essential III: Scholarship for Evidence-Based Practice o Box 1-1 Evidence-Based Practice, p. 9

Essential V: Healthcare Policy, Finance, and Regulatory Environments o Nursing Practice, p. 7 o Health Care Reform and Costs, p. 4

Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes

o Table 1-1 Quality and Safety Education for Nurses, p. 10 o QSEN Activity: Teamwork and Collaboration, p. 12

Essential VII: Clinical Prevention and Population Health o Demographic Changes, p. 4 o Medically Underserved, p. 4

Essential VIII: Professionalism and Professional Values o Professionalism, p. 5 o Standards of Nursing Practice, p. 6 o Responsibilities and Roles of the Nurse, p. 7

Essential IX: Baccalaureate Generalist Nursing Practice o History of Nursing, p. 2 o Influences on Nursing, p. 4 o Trends in Nursing, p. 10

___________________________________________________ Chapter 1The Nursing Profession 17



STUDENT CHAPTER RESOURCES

Chap. 1 READ – Textbook (pp. 1-14) REVIEW – Evolve Resources

Interactive Learning Activities

Audio Glossary

Key Points – Print ANSWER – Evolve Resources

Chapter 1, Case Study with Questions

Chapter 1, Review Questions

SG ANSWER – Study Guide

Chapter 1, The Nursing Profession, Questions 1-25

EAQ ANSWER – Elsevier’s Adaptive Quizzing

Chapter 1, The Nursing Profession

EAL REVIEW – Elsevier’s Adaptive Learning

Chapter 1, The Nursing Profession

MQR READ – Mobile Quick Reference (Chapter 1, Health Care Terminology)

INSTRUCTOR CHAPTER RESOURCES

TB Test Bank To access the ExamView format, go to the Downloads section.

PPT PowerPoint Presentations (Chapter 1, The Nursing Profession)

ETC. Chapter 1: Answer Key to QSEN Activity (below) Chapter 1: Answer Key to Clinical Decision-Making Exercises (below) Chapter 1: Answer Key to Review Questions (below)




TEACHING STRATEGIES

CONTENT FOCUS CONTENT HIGHLIGHTS LEARNING ACTIVITIES

RESOURCES INTRODUCTION Discuss the limitlessness of nursing as a

profession. Discuss: Give the ANA

and ICN definitions of nursing and ask students to comment on anything they think should be added to the definitions.

HISTORY OF NURSING Florence Nightingale

The Civil War to the Beginning of the Twentieth Century

Twentieth Century

Twenty-First Century

Discuss the historical evolution of the nursing profession.

Activity: Ask students to compare nursing during the Civil War with today’s nursing practices and priorities. What advantages do today’s nurses have? What differing demands do they face now?

Discuss: Ask students to identify how Florence Nightingale’s influences are still practiced in modern-day nursing.

INFLUENCES ON NURSING Health Care Reform and Costs

Demographic Changes

Medically Underserved

Need for Emergency Preparedness

Workplace Issues Nursing Shortage

Incorporate into the discussion the reasons why the health care delivery system is regulated. Discuss how these issues are shaping the current practice of nursing.

Discussion Topic: Discuss how the September 11, 2001, or another terrorist act has or has not changed nursing.

Discuss: Ask students to identify how they might contribute to solving the problem of rising health care costs.

PROFESSIONALISM Licensed Practical Nurse/Licensed Vocational Nurse Education

Registered Nurse Education

Advanced Education

Continuing and In-Service Education

Theory Service

Discuss the various education pathways students can take to become eligible to become a registered nurse, as well as additional opportunities available through graduate and continuing education. Discuss how roles and responsibilities influence the nurse’s scope of practice. Discuss nursing’s changing role within advanced practice arenas.

Large Group Activity: Divide the class into four groups to study what is required for each level of nursing education and what employment options are available at each level: associate’s degree, BSN, master’s degree, and doctorate degree. If a group is finished early, have them explore an area of




Autonomy and Accountability

Code of Ethics

advanced practice study. Then have each group share their findings with the class.

Online Activity: Direct students to your state board website to research your state’s Nurse Practice Act. Ask them to describe at least one item with which they agree and at least one item that they did not anticipate would be included.

Discuss: Ask students to discuss the benefits and responsibilities of the nursing profession having autonomy and accountability.

Discuss (ask the students) whether the roles and responsibilities of nurses ever conflict and how to manage those instances.

STANDARDS OF NURSING PRACTICE

Incorporate ANA standards into this discussion.

NURSING PRACTICE Nurse Practice Acts

Licensure and Certification

Incorporate Nurse Practice Act, NCLEX®, and certification into this discussion.

Online Activity: Direct students to your state board website to research your state’s Nurse Practice Act. Ask them to describe at least one item with which they agree and at least one item that they did not anticipate would be included.

Box 1-1

RESPONSIBILITIES AND ROLES OF THE NURSE Caregiver

Advocate

Educator

Communicator

Provider of Care

Manager

Discuss how roles and responsibilities influence the nurse’s scope of practice. Discuss nursing’s changing role within advanced practice arenas.

Discuss: Ask students to discuss the benefits and responsibilities of the nursing profession having autonomy and accountability.

Discuss (ask the students) whether the roles and responsibilities of nurses ever conflict and how to manage




Career Development

those instances.

PROFESSIONAL NURSING ORGANIZATIONS

Present the NLN, ANA, ICN, and NSNA/CSNA.

Online Activity: Have students locate the websites for professional nursing organizations and mark them as favorites so they can use them as resources throughout the course.

TRENDS IN NURSING Quality and Safety Education for Nurses

Genomics

Public Perception of Nursing

Effect of Nursing on Politics and Health Policy

Emphasize that nursing is constantly growing and evolving to meet the health care needs of the population. Ask students to note how much of their education is devoted to patient safety.

Discuss: Ask students to discuss the benefits and challenges of the Human Genome Project and information derived from it.

Activity: Ask students to keep track for 1 week of any public information they see about nursing and the types of images portrayed.

Table 1-1




IN-CLASS/ONLINE CASE STUDY

Tim Owens is a 66-year-old man who is in the hospital for a total knee repair. He had surgery the day before. He has an IV infusing at 125 mL/hr and a PCA pump for pain control. His wife Linda is in the room with him. Joan Black is the nursing student assigned to Mr. Owens for her clinical experience. Joan is in her second clinical nursing course. 1. In preconference, Joan’s instructor asks her if she thinks that nursing is a profession, and Joan responds that she does. What are some characteristics that identify nursing as a profession? Select all that apply. A. Nursing provides a specific service. B. Nursing requires an extended education. C. Nursing has a code of ethics for practice. D. Nursing has a theoretical body of knowledge. E. Nurses have autonomy in decision making and practice. Answer: A, B, C, D, E Rationale: All of the above are characteristics that define what constitutes a profession. 2. While Joan is in with Mr. Owens, Judy Collins, the clinical nurse specialist (CNS), enters the room to check on Mr. Owens. After Judy leaves, Mr. Owens asks Joan what the difference is between a CNS and a regular nurse. What is the best response for Joan to give to Mr. Owens? A. A CNS is an advanced practice nurse who is an expert in a specialized area of nursing. B. She has a higher degree, that’s all. C. She is considered the manager of the unit. D. A CNS does the same things as the physician. Answer: A Rationale: The CNS is one type of advanced practice nurse who works with a specialty population and functions as an expert clinician, educator, consultant, or researcher. 3. Joan gives Mr. Owens his prescribed medications, changes his dressing, and helps him with his bath. Which standard of care is Joan performing? A. Assessment B. Planning C. Diagnosis D. Implementation E. Evaluation Answer: D. Rationale: The ANA Standards of Practice describe competent levels of nursing practice. The implementation standard defines that the registered nurse implements the identified plan of care. 4. Open your charting system and enter the basic information you have been provided about Mr. Owens.




CHAPTER 1: ANSWER KEY TO QSEN ACTIVITY

As a nursing student Maria needs to recognize her role as a team member and request help as needed. She should value the input of the team members and show respect to each during the meeting. She should share information that she has about Mrs. Malone with the team to ensure that the discharge plans meet her needs. She can also seek input from the other team members so she can improve her planning and care for Mrs. Malone.




CHAPTER 1: ANSWER KEY TO TEXT CLINICAL DECISION-MAKING EXERCISES

Note: Answers to these questions can be found on the Evolve site. Click here. 1. As Maria presents information on the three career opportunities in nursing, she covers the following

similarities and differences: Similarities: All three positions require state licensure as a registered professional nurse. All roles practice according to the ANA standards of care and performance. All have the primary focus of primary delivery of quality patient-centered care. Differences: Education preparation is different. Administrator and advance practice registered nurse (APRN) both require a master’s degree or higher. The job responsibilities at each level are different: the administrator and APRN have high levels of responsibility, and the staff nurse is focused on patient-centered care. The APRN and administrator function independently in their advanced roles.

2. Maria should present the following characteristics of a professional nurse: • An extended education of members and a basic liberal education foundation • A theoretical body of knowledge leading to defined skills, abilities, and norms • Provision of a specific service • Autonomy in decision making and practice • A code of ethics for practice (ANA Code of Ethics)

3. Answer is individual for each person.




CHAPTER 1: ANSWER KEY TO REVIEW QUESTIONS

1. Answer: 2. The nurse is demonstrating the standard of evaluation. She or he evaluates the patient’s progress toward the outcome of pain relief after the pain medication is administered. Evaluation is a key practice in pain management. 2. Answer: 4. The nurse is demonstrating the standard of practice of implementation. The registered nurse implements the identified plan of regular wound care and dressing change to achieve the outcome of wound healing. 3. Answer: 1. The nurse is demonstrating the role of educator. An educator explains concepts and facts about health, describes the reason for routine care activities, demonstrates procedures such as home-care activities, reinforces learning or patient behavior, and evaluates the patient’s progress in learning through return demonstration. (p. 9) 4. Answer: 2. The nurse is in the professional role of nurse administrator. The nurse administrator needs to be skilled in business and management and understand all aspects of nursing and patient care. Functions of administrators include budgeting, staffing, strategic planning of programs and services, employee evaluation, and employee development. (p. 9) 5. Answer: 4. This is an example of the competency of evidence-based practice. The nurse integrates best current evidence about patient teaching with clinical expertise and patient/family preferences and values for delivery of optimal health care. (p. 10) 6. Answer: 3. This is an example of the competency of teamwork and collaboration. This competency focuses on the nurse functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care. (p. 10) 7. Answer: 4. The nurse is functioning in the roll of nurse researcher. The nurse researcher investigates problems such as patient falls to improve nursing care and further define and expand the scope of nursing practice. (p. 9) 8. Answer: 3. In-service education programs are instruction or training provided by a health care agency or institution designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution. Often in-service programs are focused on new technologies such as infusion pumps or are designed to fulfill required competencies of the organization. (pp. 5-6) 9. Answer: 1b, 2d, 3c, 4a. The role statements describe the activities performed and the role of the advanced practice nurse specialty. (pp. 8-9) 10. Answer: 1, 3. The purpose of a professional standard of care is to describe the common level of professional nursing care to judge the quality of nursing practice. Standards of nursing care are developed and established on the basis of strong scientific research and the work of clinical nurse experts. (p. 6)




CHAPTER 1: ANSWER KEY TO POWERPOINT SLIDE CASE STUDY

Slide 13 What are some options open to Ming? Nursing requires a significant amount of formal education. After obtaining a baccalaureate degree in nursing, you can pursue graduate education leading to a master’s or doctoral degree in any number of graduate fields, including nursing. A nurse completing a graduate program can receive a master’s degree in nursing. The graduate degree provides the advanced clinician with strong skills in nursing science and theory, with emphasis on the basic sciences and research-based clinical practice. A master’s degree in nursing is important for the roles of nurse educator and nurse administrator, and it is required for an advanced practice registered nurse (APRN). Ming’s research indicates that accelerated RN to MSN programs are available, where he may obtain a master’s degree. Reference: pp. 5-6, 8-9 Slide 17 Ming’s career options for becoming an APRN include which of the following? (Select all that apply.) A. Physician assistant (PA) B. Clinical nurse specialist (CNS) C. Certified nurse midwife (CNM) D. Certified RN anesthetist (CRNA) Answers: B, C, D. The four core roles for APRNs include clinical nurse specialist (CNS), certified nurse midwife (CNM), certified RN anesthetist (CRNA), and certified nurse practitioner (CNP). Physician assistant (PA) is not a nursing role. Reference: p. 8 Slide 20 If Ming decides to pursue a career as an APRN, which patient populations may he serve? (Select all that apply.) A. Adult-gerontology B. Prison inmates C. Neonatology D. Psychiatric mental health Answers: A, C, D. APRNs serve six patient populations: adult-gerontology, pediatrics, neonatology, women’s health/gender related, family, and psychiatric mental health. Although APRNs may care for prison inmates, this group is not a separate patient population, but rather falls into the other six categories based on age, gender, and medical condition. Reference: p. 8 Slide 22 If Ming chooses a career as a critical care CNS, his specialty will be identified by which means? A. Population B. Setting C. Disease specialty D. Type of care




E. Type of problem Answer: B. The CNS specialty may be identified by a population (e.g., geriatrics), a setting (e.g., critical care), a disease specialty (e.g., diabetes), a type of care (e.g., rehabilitation), or a type of problem (e.g., pain). Reference: p. 8

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