Chapter 1: Nursing and the health care system

1. Florence Nightingales contributions to nursing practice and education:

a. are historically important but have no validity for nursing today.
b. were neither recognized nor appreciated in her own time.
c. were a major factor in reducing the death rate in the Crimean War.
d. were limited only to the care of severe traumatic wounds. 


ANS:C
By improving sanitation, nutrition ventilation, and handwashing techniques, Florence Nightingales nurses
dramatically reduced the death rate from injuries in the Crimean War.


2. Early nursing education and care in the United States:
a. were directed at community health.
b. provided independence for women through education and employment.
c. were an educational model based in institutions of higher learning.
d. have continued to be entirely focused on hospital nursing. 


ANS:B
Because of the influence of early nursing leaders, nursing education became more formalized through
apprenticeships in Nightingale schools that offered independence to women through education and
employment.

3. In order to fulfill the common goals defined by nursing theorists (promote wellness, prevent illness,
facilitate coping, and restore health), the LPN must take on the roles of:
a. caregiver, educator, and collaborator.
b. nursing assistant, delegator, and environmental specialist.
c. medication dispenser, collaborator, and transporter.
d. dietitian, manager, and housekeeper. 


ANS:A
In order for the LPN to apply the common goals of nursing, he or she must assume the roles of caregiver,
educator, collaborator, manager, and advocate.


4. Although nursing theories differ in their attempts to define nursing, all of them base their beliefs on
common concepts concerning:
a. self-actualization, fundamental needs, and belonging.
b. stress reduction, self-care, and a systems model.
c. curative care, restorative care, and terminal care.
d. human relationships, the environment, and health. 


ANS:D

Although nursing theories differ, they all base their beliefs on human relationships, the environment, and
health.


5. Standards of care for the nursing practice of the LPN are established by the:
a. Boards of Nursing Examiners in each state.
b. National Council of States Boards of Nursing (NCSBN).
c. American Nurses Association (ANA).
d. National Federation of Licensed Practical Nurses. 


ANS:D

The National Federation of Licensed Practical Nurses modified the standards published by the ANA in 2004
to better fit the role of the LPN.


6. The LPN demonstrates an evidence-based practice by:
 a. using a drug manual to check compatibility of drugs.
b. using scientific information to guide decision making.
c. using medical history of a patient to direct nursing interventions.
d. basing nursing care on advice from an experienced nurse. 


ANS:B

The use of scientific information from high-quality research to guide nursing decisions is reflective of
the application of evidence-based practice.


7. Lillian Wald and Mary Brewster established the Henry Street Settlement Service in New York in 1893 in
order to:
a. offer a shelter to injured war veterans.
b. found a nursing apprenticeship.
c. provide health care to poor persons living in tenements.
d. offer better housing to low-income families. 


ANS:C

Henry Street Settlement Service brought the provision of community health care to the poor people living
in tenements.


8. An educational pathway for an LPN refers to an LPN:
a. learning on the job and being promoted to a higher level of responsibility.
b. moving from a maternity unit to a more complicated surgical unit.
c. obtaining additional education to move from one level of nursing to another.
d. learning that advancement requires consistent work and commitment. 


ANS:C

By broadening the educational base, an LPN may advance and build a nursing career.



9. When diagnosis-related groups (DRGs) were established by Medicare in 1983, the purpose was to:
a. put patients with the same diagnosis on the same unit.
b. attempt to contain the costs of health care.
c. increase availability of medical care to the elderly.
d. identify a patients condition more quickly. 


ANS:B

The purpose of instituting DRGs was to contain skyrocketing costs of health care.



10. The advent of diagnosis-related groups (DRGs) required that nurses working in health care agencies:
a. record supportive documentation to confirm a patients need for care in order to qualify for
reimbursement.
b. use the DRG rather than their own observations for patient assessment.
c. be aware of the specific drugs related to the diagnosis.
d. acquire cross-training to make staffing more flexible. 


ANS:A
DRGs required that nurses provide more supportive documentation of their assessments and identified
patient needs to qualify the facility for Medicare reimbursement. Observant assessment might also indicate
another DRG classification and consequently more reimbursement for the facility.

11. If a member of a health maintenance organization (HMO) is having respiratory problems such as fever,
cough, and fatigue for several days and wants to see a specialist, the person is required to go:
a. directly to an emergency room for treatment.
b. to any general practitioner of choice.
c. directly to a respiratory specialist.

d. to a primary care physician for a referral.
ANS:D

Participants in an HMO must see their primary physician to receive a referral for a specialist in order
for the HMO to pay for the care.


12. An advantage of preferred provider organizations (PPOs) is that:

a. they make insurance coverage of employees less expensive to employers.
b. there are fewer physicians to choose from than in an HMO.
c. long-term relationships with physicians are more likely.
d. patients may go directly to a specialist for care. 


ANS:A
The use of PPOs allows insurance companies to keep their premiums low and in turn makes insurance coverage
less expensive for the employers. There are usually more physicians from which to choose than from a HMO,
but long-term relationships between physician and patient cannot be established easily. Patients still
must see their primary physician before being referred to other specialties.

13. After passing the National Council Licensure Examination for Practical Nurses (NCLEX-PN), the nurse is
qualified to take an additional certification in the field of:
a. pharmacology.
b. care of infants and children.
c. operating room technology.
d. community health. 


ANS:A

After becoming an LPN, the nurse may apply for additional certification in pharmacology or long-term care.


14. Nursing interventions are best defined as activities that:

a. are taken to improve the patients health.
b. involve researching methods to maintain asepsis.
c. include the family in nursing care.
d. review guidelines for handling infectious wastes. 


ANS:A

Interventions are actions taken to improve, maintain, or restore health.


15. Nurse Practice Acts define the legal scope of an LPNs practice, which are written and enforced by:
a. the American Nurses Association.

b. the National Council Licensure Examiners.
c. each state.

d. each health care agency.

ANS:C

Each state writes and enforces the Nurse Practice Act, which defines the legal scope of nursing practice.


16. Women volunteers were organized to give nursing care to the wounded soldiers during the Civil War by:
a. Florence Nightingale.
b. Dorothea Dix.
c. Clara Barton.
d. Lillian Wald.

ANS:B
The Union government appointed Dorothea Dix, a social worker, to organize women volunteers to provide
nursing care for the soldiers during the Civil War.


17. The nursing theory presented by Sister Calista Roy is based on:
a. reduction of stress.

b. achievement of maximum level of wellness.
c. relief of self-care deficit.

d. adaptation modes.

ANS:D

Adaptation modes (physiologic, psychological, sociologic, and independence) are the basis of the nursing
theory of Sister Calista Roy.


18. The founding of the Red Cross is attributed to:
a.Lillian Wald.
b.Dorothea Dix.
c. Florence Nightingale.
d. Clara Barton.

ANS:D

Clara Barton founded the Red Cross.



19. The nursing theorist whose practice framework is based on 14 fundamental needs is:
a. Dorothy Johnson.
b. Jean Watson.
c. Virginia Henderson.
d. Martha Rogers.

ANS:C

Virginia Hendersons nursing theory framework is based on 14 fundamental needs.


20. The nursing theory that uses seven behavioral subsystems in an adaptation model is:
a. Betty Neumann.
b. Sister Calista Roy.
c. Dorothy Johnson.
d. Patricia Benner.
ANS:C

Dorothy Johnsons practice framework is based on seven behavioral subsystems in an adaptation model.


21. The Standards of Clinical Nursing Practice are designed to direct LPNs to:
a. advance their nursing career.

b. seek a scientific basis for their interventions.
c. deliver safe, knowledgeable care.

d. a leadership role.

ANS:C

The Standards of Clinical Nursing Practice are designed to guide the LPN to deliver safe, knowledgeable
care.

22. A states Nurse Practice Act is designed to protect the:

a. physician.
b. nurse.

c. public.

d. hospital.

ANS:C

Nurse Practice Acts are designed to protect the public.



23. It is appropriate for practical nurses to provide direct patient care to persons in a hospital under
the supervision of a:
a. physicians assistant.

b. registered nurse on the unit.

c. supervising nurse who is responsible for care on several units.
d. more experienced LPN on the unit.
ANS:B

Practical nurses provide direct patient care under the direct supervision of a registered nurse,
physician, or dentist.


24. An example of tertiary health care is _____ care.
a. hospice

b. restorative
c. emergency
d. home health
ANS:A

Tertiary health care includes extended care, chronic disease management, medical homes, in-home personal
care, and hospice care.


25. Preferred provider organizations (PPOs) use __________ to finance their services and pay the physical
cost of the service.
ANS: capitated cost

The capitated cost is the set fee that is paid to the network for each patient enrolled to finance its
services.


26. In the United States, the Young Womens Christian Association (YMCA) in New York opened The __________
School, the first practical nursing school.
ANS: Ballard

In 1892, the YMCA opened The Ballard School, a 3-month course in practical nursing that was the first
school of practical nursing.


27. Such health services as surgical procedures, restorative care, and home health care would be
classified as __________ care.
ANS: secondary

Surgical procedures, restorative care, and home health are part of the many services classified as
secondary care.


28. Characteristics of primary nursing include which of the following? ( Select all that apply. )
a. Elimination of fragmentation of care between shifts
b. Evolved in the mid-1950s
c. Planning and direction performed by one nurse
d. Ancillary workers used to increase productivity
e. The care plan covering the entire day
f. Associate nurses taking over care and planning when the primary nurse is off duty 


ANS:A,C,D,E,F
Primary care reduces fragmentation of care between shifts. Care is planned by one nurse to cover a 24-hour
period using ancillary workers to increase productivity. An associate nurse may take on direction of care
in the absence of the primary nurse.

29. In 1991, the American Nurses Association (ANA) published the Standards of Clinical Nursing Practice.
These standards are designed to: ( Select all that apply. )
a. set standards for safe nursing care delivery.
b. define the legal scope of practice.
c. establish state legal requirements for clinical practice.
d. protect the nurse, patient, and health care agency.
e. regulate the nursing profession.
f. define activities in which nurses may engage. 


ANS:A,D,F

The Standards of Clinical Nursing Practice generally define activities in which nurses may engage, set
standards for nursing care and delivery,
and thereby protect the nurse, patient, and health care agency.

30. An example of the role of an LPN as a delegator is: ( Select all that apply. )
 a. changing a patients wound dressing.
b. assisting a patient to complete his or her bath.
c. assigning patient care tasks to certified nursing assistants.
d. requesting the housecleaning staff to mop the floor of a patients room.
e. instructing the unit secretary to page a physician to the floor. 


ANS:C,D,E
Delegation under the scope of the practice of an LPN is the assignment of a certified nursing assistant to
certain nursing care or other non-medical staff to aspects of patient care.

31. During the Civil War, nursing schools offered education to women both in England and in the United
States. The schools in the United States differed from those in Europe because in U.S. schools: ( Select
all that apply. )
a. students worked without pay.
b. the core curriculum was the same.
c. instruction was presented by physicians at the bedside.
d. the educational focus was on nursing care.
e. classes were held separately from the clinical experience. 


ANS:A,C
In the United States, the students staffed the hospital and worked without pay. There were no formal
classes; education was achieved through work. There was no set curriculum, and content varied depending on
the type of cases present in the hospital. Instruction was done at the bedside by the physician and
therefore came from a medical viewpoint.