Sample Chapter



Professional issues in Nursing Challenges and Opportunities 3rd Edition By Huston – Test Bank


1. A nurse is preparing a presentation for a group of nurses about the need for effective leadership to meet the demands of the current American health care system. When describing issues in the health care system, which of the following would the nurse include?
A) The doubling of costs over the past 10 years
B) Improving rates of patients receiving care
C) Rising medical errors
D) Increasing surplus of physicians but not nurses
Ans: C



2. A group of nursing students are reviewing the concept of leadership in preparation for a class discussion on the topic? Which of the following if stated by the students indicates a need for additional review?
A) Leadership involves solitary, independent action.
B) Successful leaders use effective communication skills.
C) Upcoming leaders need to be innovative.
D) Leadership is embedded in relationships
Ans: A



3. Which of the following best reflects the leadership challenges in the 21st century? Select all that apply.
A) Need to increase productivity within budgetary constraints
B) Maintaining current evidence-based practice recommendations
C) Embracing multidisciplinary health care
D) Balancing technology and interpersonal relationships
E) Encouraging teamwork
Ans: A, D, E



4. Which of the following best indicates the current status of evidence-based practice (EBP) in health care today?
A) The majority of nurse leaders are implementing EBP individually.
B) EBP is the standard of practice in most health care organizations.
C) Staff members are acting as EBP role models in institutions.
D) Institutions are fostering cultures for EBP throughout the country.
Ans: B



5. A nurse leader is working to develop an internal mechanism in the organization that will help in the promotion of nurses from within the organization. The nurse leader is involved in which of the following?
A) Mentoring
B) Coaching
C) Transactional leadership
D) Succession planning
Ans: D



6. A nurse is reviewing information from the Institute of Medicine (IOM). Which of the following would the nurse expect to find as one of the markers of safe and highly reliable care?
A) Team communication
B) Formal mentorship
C) Proactive decision making
D) Innovation
Ans: A



7. After discussing effective team communication with a group of students, the instructor determines that the discussion was effective when the students state which of the following?
A) “Team communication requires individual commitment.”
B) “Worldviews and values are similar among team members.”
C) “Team communication is a complex social process.”
D) “Effective communication is indirect and broad in scope.”
Ans: C



8. A nurse leader is working as part of a transdisciplinary health care team. Which of the following would be a key component of this team?
A) Individual disciplines working toward the same goal
B) Collaboration among all health care providers
C) Minimal trust among a variety of health care providers
D) Use of commonalities based on each discipline’s specialized knowledge
Ans: B



9. Which of the following would be most effective in promoting nursing’s influence in decision making for organizational and health policy?
A) Providing passive contributions to discussion forums on health care
B) Being proactive in ensuring representation by the best nurses
C) Engaging in limited participation in health policy venues
D) Working from the sidelines to promote health issues
Ans: B



10. Which of the following would be the first step in creating a culture of innovation and change?
A) Active participation
B) Role-modeling
C) Mentorship
D) Change in personal leadership practices
Ans: D



11. As a nurse leader, which of the following would be the primary focus?
A) Change
B) The vision
C) Patient
D) Trust
Ans: D



12. A nurse leader, working with the team, understands that trust is essential for effective team functioning. Which of the following would be inappropriate for developing this trust?
A) Transparency
B) Pride
C) Honesty
D) Integrity
Ans: B



13. A group of nursing students are reviewing information about the characteristics of a transformative leader? The students demonstrate understanding of the material when they identify which of the following as a characteristic? Select all that apply.
A) Ability to micromanage
B) Willingness to take risks
C) Focus on the team
D) Satisfaction with the present
E) Entrepreneurial spirit
Ans: B, C, E



14. A nursing instructor is describing how technology has impacted health care and leadership. Which of the following would the instructor most likely include in this discussion?
A) Information transmission, although faster, is less efficient.
B) Lag times for information have significantly increased.
C) Work and personal time boundaries have become blurred.
D) Control of communication pathways remains unchanged.
Ans: C



15. A group of nursing students are reviewing information about models of leadership and health care. The students demonstrate understanding of these models when they identify which of the following as the most common style used in health care?
A) Transactional leadership
B) Inspirational leadership
C) Transformational leadership
D) Complexity leadership
Ans: A



16. A nurse leader is considering using transformational leadership. Which of the following would the nurse leader need to keep in mind?
A) The locus of power rests with the employees.
B) Informal leadership is highly recognized.
C) Empowerment of both the leader and follower occurs.
D) Employees are expected to lead from their organizational position.
Ans: C



17. A nurse is reading a journal article on the complexity leadership model. Which of the following would the nurse most likely find as being described in the article?
A) Positional leaders carry authority focused on managing organizational dynamics.
B) Control is relatively easy to obtain and maintain.
C) Power rests solely with specific individuals.
D) System boundaries are distinct and well defined.
Ans: A



18. A nurse leader is using the trimodal model of leadership. Which of the following would the nurse be engaged in during innovation planning?
A) Providing evidence-based patient care
B) Looking for ways to improve current ineffective processes
C) Developing suitable pathways to modify roles
D) Ensuring appropriate funding for services
Ans: B



19. A nursing instructor is developing a teaching plan for a class on the characteristics of the various leadership models. Which model would the instructor include as having overlapping, informal organizational boundaries?
A) Transactional
B) Inspirational
C) Transformational
D) Complexity
Ans: D



20. The transformational leadership model involves which of the following? Select all that apply.
A) Defined boundaries
B) Leader in the central position
C) Communication in multiple directions
D) Coaching competencies
E) Planned work
Ans: A, B, E


1. When reviewing information about mandatory staffing, which of the following would best reflect the current status?
A) Many of the states in the United States have moved toward imposing mandatory licensed staffing requirements.
B) Texas has already enacted legislation requiring mandatory staffing ratios affecting hospitals and long-term care facilities.
C) Research suggests that the average number of patients assigned to RNs for care in acute-care facilities has actually decreased in the past decade, but patients are much sicker.
D) Consumers and legislators, not nurses, have urged implementation of mandatory staffing ratios because most nurses feel current staffing levels are minimum but adequate.
Ans: A



2. Benchmark research completed by Aiken and colleagues in 2002 found
A) There was no significant difference in patient outcomes when staffing at six patients per nurse rather than four.
B) There was no rise in patient morbidity until patient-to-nurse ratios exceed eight to one.
C) There is no direct, provable link between nurse-to-patient ratios and mortality rates from preventable complications.
D) In hospitals with higher patient-to-nurse ratios, the likelihood of dying within 30 days of admission and mortality complications were increased.
Ans: D



3. When evaluating the pros and cons of mandatory regulation of RN-to-patient ratios, which statement most accurately reflects the beliefs of the critics?
A) Such ratios protect the most basic elements of the public health care consumers take for granted.
B) Implementing ratios will improve the nursing shortage, at least temporarily over the short term.
C) Mandatory staffing will lead to a reduction in hospital services and increased expenses due to the need to pay overtime.
D) Mandatory staffing ratios create significant opportunity costs that encourage employers and payers to respond to market forces.
Ans: C



4. Developing draft regulations for minimum staffing ratios was challenging for the California Department of Health Services (CDHS) because
A) Although standardized patient classification system data were available, hospitals were unwilling to submit the data.
B) Hospitals had not been required to use patient classification systems prior to the passage of staffing-ratio legislation and had no data.
C) California Healthcare Association and the California Nurses Association agreed on the minimum ratios, but consumer advocate groups pressed for lower patient-to-nurse ratios.
D) Proposals received by CDHS suggested a wide range of minimum staffing ratios and even more widely differing estimates of implementation costs.
Ans: D



5. Implementing the ratio legislation in California proved to be difficult because
A) Nursing unions balked when courts ruled that both LVNs and RNs could be used to meet minimum staffing ratios.
B) The current nursing shortage made it impossible to meet the mandated ratios.
C) Legislation was introduced to delay implementation of the minimum 1:5 nurse-to-patient staffing ratio on medical-surgical units.
D) A significant number of hospitals in the state had to close their doors due to the cost of implementing staffing ratios.
Ans: C



6. When reviewing the California legislation, legal clarification became necessary due to the “at-all-times” clause, which referred to which of the following?
A) Maintaining minimum staffing ratios throughout the day including during breaks and lunches
B) Having at least one registered nurse on duty at all times
C) Ensuring no more than a 1:4 nurse-to-patient ratio on any unit in acute-care hospitals
D) Having to keep emergency departments open 24 hours a day
Ans: A



7. Which of the following best describes waivers to the mandatory staffing ratios that were part of the California legislation?
A) Were typically not allowed for any institution
B) Were sought by many of the larger hospitals because of the financial costs
C) Were routinely granted if patient safety was not being compromised
D) Were allowed but only to rural hospitals under very strict conditions
Ans: D



8. An instructor is describing compliance oversight by the California Department of Health Services in acute-care hospitals to a group of students. Which of the following would most likely occur if a hospital was found to be out of compliance with the mandatory minimum staffing ratios?
A) The hospital would be forced immediately to close its doors until it could demonstrate compliance.
B) The facility is given 48 hours to correct the deficiency after being fined substantially.
C) The hospital must discharge or transfer patients within 24 hours to reach a level of compliance.
D) There is no penalty or monetary fine for a violation unless serious injury or death occurs.
Ans: D



9. Which of the following is suggested based on the initial research findings as to the effectiveness of mandated staffing-ratio implementation in California?
A) Staffing ratios remained essentially unchanged.
B) Staffing ratios increased the number of worked nursing hours per patient day in hospitals.
C) Hospitals had less difficulty meeting ratio requirements than originally anticipated.
D) The “at-all-times” clause was not a significant hardship.
Ans: B



10. Which of the following best reflects the position taken by the Joint Commission on mandated staffing ratios?
A) Supportive, arguing that more states should follow California’s model
B) Criticism that ratios as not flexible enough due to failure to address diversity of U.S. hospitals
C) Watchful waiting by other states until California’s experience can be fully evaluated
D) Direct opposition to the implementation because of the current nursing shortage
Ans: B



11. When reviewing the various alternatives to legislated minimum staffing ratios, which of the following would a nurse expect to find as the position of the American Nurses Association?
A) A workload system that encompasses existing variables for safe staffing
B) Use of Continuous Quality Improvement to ensure adequate staffing
C) Use of market-based incentives for hospitals to maximize nurse staffing
D) Evaluation of number, competency, and skill mix of staff related to needed services
Ans: A



12. A nursing administration is using the legislation in California as a guide to implement appropriate minimum registered nurse staffing ratios for the labor and delivery area. Which of the following ratios would be most appropriate?
A) 1:1
B) 1:2
C) 1:4
D) 1:6
Ans: B



13. Various studies have examined the link between staffing mix and patient outcomes. Which of the following best describes the most common finding associated with this research?
A) Inadequate numbers of RNs has little effect on patient outcomes.
B) Mortality dropped with increased staffing numbers of nurse aides.
C) Increased numbers of RNs in staffing mix led to improved patient outcomes.
D) A decreased prevalence of infections was found with less staffing.
Ans: C



14. After describing the arguments for and against mandated minimum staffing, the instructor determines that the teaching was successful when the students identify which of the following as a major argument by critics?
A) Patient safety is unrelated to the staffing ratios.
B) Workload of nurses is difficult to translate into numbers.
C) Standardized ratios do not provide consistency in approach.
D) Overall cost of care would increase exponentially.
Ans: D



15. A nurse is reviewing the events leading up to implementing the California legislation. In addition to identifying ratios for safe staffing, the legislation also addressed which of the following?
A) Use of LPNs/LVNs as part of the staff mix
B) Possible cost incentives
C) Restrictions for procedures of unlicensed personnel
D) Patient classification systems
Ans: C



16. A nursing student is reading a journal article about mandatory staffing ratios and states that have implemented legislation related to staffing. Which state would the student be least likely to read about?
A) Ohio
B) Alabama
C) Connecticut
D) Nevada
Ans: B



17. As student is reviewing the recommendations of the ANA to maintain sufficient staffing. The student demonstrates a need for additional study when the student identifies which of the following as a recommendation?
A) Creation of staffing plans by administrative personnel
B) Legislative mandates for regulation of nurse to patient ratios
C) Staffing plans that reflect the needs of the patient population
D) Disclosure of staffing levels to a regulatory body
Ans: A



18. As part of the Hospital Patient Protection Act (2008), which nurse-to-patient ratio would be appropriate for pediatrics?
A) 1:2
B) 1:3
C) 1:4
D) 1:5
Ans: B



19. A student is reviewing research in preparation for a debate on minimum mandatory staffing relies on the study by Aiken et al. (2002) as a basis for arguing in support of this issue. Which of the following best describes the student’s use of this study?
A) It is considered the seminal work for supporting legislation of minimum staffing ratios.
B) It provided the most comprehensive study on costs, staffing, and use of unlicensed personnel.
C) It supported findings from research performed by the Agency for Healthcare Quality and Research.
D) It reinforced what was already known about the need for mandatory staffing ratios in acute-care facilities.
Ans: A



20. Which of the following would a nurse identify as the primary driving force in dictating changes in the RN skill mix in hospitals?
A) Rise in use of unlicensed assistive personnel
B) Growing nursing shortage
C) Patient outcomes
D) Economics
Ans: D


1. An instructor is describing the public image of the nursing profession to a group of new students. Which of the following would the instructor be most likely to include?
A) Nurses are typically described as being one dimensional.
B) Nursing is viewed as an honest and prestigious profession.
C) Most think of young women altruistically caring for the ill, under a doctor’s supervision.
D) The public usually see broadly educated professionals who provide care based on science.
Ans: C



2. A family of a patient calls a nurse an “angel of mercy.” The nurse understands which of the following about this stereotype?
A) Is fairly recent, originating with nurses from the Vietnam era
B) Often associated with the belief of nursing being depicted as almost a saintly vocation
C) Is the least common of all contemporary nursing stereotypes
D) Depicts a nurse with little independent thought as an adoring backdrop to the omnipotent physician
Ans: B



3. A group of nurses is working with other groups to help dispel stereotypical images of nursing. Which of the following would the group need to keep in mind about these images?
A) Are decreasing in contemporary media, particularly on television
B) Have little impact on the public’s perception of the nursing role
C) Often begin in early childhood and so are difficult to modify
D) Have little impact on recruitment into the profession
Ans: C



4. A group of students is working on a group project about nursing stereotypes. Knowledge of which of the following would be most important for the group to integrate into their project?
A) Nursing as ranked as one of the most desirable careers in the United States, ranking in the top 10 for career desirability.
B) Nurses having acted collectively and effectively to correct stereotypical and inaccurate images of nursing in the media.
C) Contemporary male nurses having overcome their stereotypes as being homosexual, nonachieving, and feminine.
D) The confusion of the public and their lack of understanding about what professional nursing is.
Ans: D



5. A nurse is preparing a presentation for “career day” at a local high school. Which of the following would the nurse need to keep in mind about young people today?
A) Are more apt to pursue nursing as a career than their mothers or fathers
B) Typically have an accurate, factual understanding of what nursing is
C) Beliefs and stereotypes being ingrained at early ages
D) No longer believe that nursing is “women’s work”
Ans: C



6. When describing the corporate initiatives launched by Johnson and Johnson in 2002, which of the following would be most appropriate?
A) Provision of over millions of dollars in scholarships for all students interested in pursuing nursing as a career
B) Initiative for recruitment and increased awareness of the value of nursing educators in the nursing profession
C) Funding for weekly hour-long television specials about the value of nurses to society throughout the ages
D) Launching of national advertising campaign titled “Campaign for Nursing’s Future” in an effort to highlight nursing practice and promote diversity.
Ans: B



7. Sociologically, conflicting stereotypes of nursing
A) Have united nurses in actively fighting for a common cause.
B) Continue to contribute to the disconnect between the reality of nursing and its public image.
C) Have resulted in nurses being viewed as dishonest or unethical by much of the public.
D) Are a significant part of the nursing profession’s history and culture needing to be encouraged.
Ans: B



8. A nursing student is reviewing information about the Center for Nursing Advocacy. Which of the following would the student identify as the Center’s goal?
A) Provide funding to increase the recruitment of nurses
B) Address the media’s negative and disrespectful portrayal of nursing
C) Foster an increase in the diversity of students entering nursing school
D) Promoting the need for nurses to dress as professionals
Ans: B



9. When reviewing the long-established, inaccurate nursing stereotypes, which of the following would most likely apply?
A) Could be changed easily if nurses banded together to write protest letters to media sources
B) Can easily be altered by presenting accurate career information to high school students
C) Are perpetuated, at least in part, by nursing’s “invisibility” as a profession
D) Have led to the erosion of the public’s trust and respect for nurses
Ans: C



10. As part of a research project, a nurse is conducting a telephone survey on the public’s perception of nursing. Which of the following terms would the nurse expect to hear? Select all that apply?
A) Hardworking
B) Caring
C) Highly educated
D) Independent thinking
E) Powerful
F) Honest
Ans: A, B, F



11. When reviewing the literature for evidence of stereotypes in nursing, the nurse would expect to find which of the following as one of the most famous portrayals of a nurse as a sex bombshell?
A) Hot Lips Houlihan in M*A*S*H*
B) Nurse Betty
C) Hana in The English Patient
D) Nurse Ratched in One Flew Over the Cuckoo’s Nest
Ans: A



12. A nurse is preparing to interact with the media. Which of the following would be most helpful for the nurse to do?
A) Focus on at least 5 to 7 key points
B) Explain answers using specific details and examples
C) Use professional language for answering
D) Remember that nothing is off the record
Ans: D



13. Which of the following would be most helpful in changing nursing’s image in the public eye?
A) Focusing on one specific strategy to foster change
B) Passively interacting with the media
C) Restricting the use of nurse to licensed RNs
D) Limiting involvement in the political process
Ans: C



14. When attempting to change nursing’s image with the media, which of the following would be most appropriate?
A) Wait for the media service to contact the nurse for information
B) Write letters to the professional organization
C) Actively initiate contact with individuals in the media
D) Contact the institution’s public relations department
Ans: C



15. After teaching a class about measures to reclaim the title of “nurse,” the instructor determines that the teaching was successful when the class identifies which of the following?
A) Having nurses return to wearing the white uniform
B) Identifying selves as nurses using surnames when introducing themselves
C) Acting as ambassadors for the profession with the public
D) Emphasizing how nursing is a combination of caring and curing
Ans: B



16. When describing who is responsible for changing the public’s image of nursing, which of the following would be most appropriate?
A) Professional nursing organizations
B) Corporate coalitions
C) Nurses
D) Media
Ans: C



17. Which of the following nursing stereotypes was typically reflected in printed novels and books?
A) Angel of mercy
B) Love interest
C) Naughty nurse
D) Handmaiden to the physician
Ans: B



18. When reviewing the literature about stereotypes and male nurses, which of the following characteristics would a nurse expect to find? Select all that apply.
A) Sex-bombshell role
B) Homosexual orientation
C) Lazy attitude
D) Sexually predatory
E) Nonachiever
Ans: B, C, D, E



19. As part of a class assignment, students were asked to watch the movie, “One Flew Over the Cuckoo’s Nest” to view an example of a nursing stereotype. Which stereotype would the students most likely have seen?
A) Angel of mercy
B) Love interest
C) Battle-axe
D) Handmaiden
Ans: C



20. When introducing oneself to a patient, which of the following would be most appropriate to promote a change in the public’s image of nursing?
A) “Hi, I’m Joe, your nurse for the day.”
B) “Hello, my name is Joe Smith, the registered nurse who will be caring for you today.”
C) “Hi, my name is Joe S. I’m a registered nurse here if you need me.”
D) “Hello, I’m Mr. Smith. I’m your nurse and I will be caring for you until 7 p.m.”
Ans: B