CHAPTER

1 Professional Nursing Practice

1. Using the American Nurses Association’s definition of nursing, which activities are within the domain of nursing
(select all that apply)?
a. Implementing intake and output for a patient who is vomiting
b. Establishing and implementing a stress management program for family caregivers of patients with
Alzheimer’s disease
c. Explaining the risks associated with the planned surgical procedure when a preoperative patient inquires
about risks
d. Developing and performing a study to compare the health status of older patients who live alone with the
status of older patients who live with family members
e. Identifying the effect of an investigational drug on patients’ hemoglobin levels
f. Using a biofeedback machine to teach a patient with cancer how to manage chronic pain
g. Preventing pneumonia in an immobile patient by implementing frequent turning, coughing, and deep
breathing
h. Determining and administering fluid replacement therapy needed for a patient with serious burns
i. Testifying to legislative bodies regarding the effect of health policies on culturally, socially, and
economically diverse populations

2. A nurse who has worked on an orthopedic unit for several years is encouraged by the nurse manager to become
certified in orthopedic nursing. What will certification in nursing require and/or provide (select all that apply)?
a. A certain amount of clinical experience
b. Successful completion of an examination
c. Membership in specialty nursing organizations
d. Professional recognition of expertise in a specialty area
e. An advanced practice role that requires graduate education

3. What accurately describes the health care system in which future nurses will be employed?
a. With improvements in medicine there will be fewer patients with chronic illnesses.
b. Rapidly changing technology and expanding knowledge will simplify the health care environment.
c. The Quality and Safety Education for Nurses (QSEN) project measures the ability of nursing graduates to be
prepared for the reality of practice.
d. The Joint Commission establishes National Patient Safety Goals and evidence-based solutions for nurses to
promote meeting these goals by all caring for the patient.

4. What are the six competencies from Quality and Safety Education for Nurses (QSEN) that are expected of new
nursing graduates?
a.
b.
c.
d.
e.
f.

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2 Chapter 1     Professional Nursing Practice

5. Place the steps of the evidence-based practice (EBP) process in order (0 being the first step; 6 being the last step).
Make recommendations for practice or generate data
Ask a clinical question
Critically analyze the evidence
Find and collect the evidence
Evaluate the outcomes in the clinical setting
Create a spirit of inquiry
Use evidence, clinical expertise, and patient preferences to determine care

6. The following is an example of an evidence-based practice (EBP) clinical question. “In adult seizure patients,
is restraint or medication more effective in protecting them from injury during a seizure?” Which word(s) in the
question identify(ies) the C part of the PICOT format?
a. Restraint
b. Or medication
c. During a seizure
d. Adult seizure patients
e. Protecting them from injury

7. Two nurses are establishing a smoking cessation program to assist patients with chronic lung disease to stop
smoking. To offer the most effective program with the best outcomes, the nurses should initially
a. search for an article that describes nursing interventions that are effective for smoking cessation.
b. develop a clinical question that will allow them to compare different cessation methods during the program.
c. keep comprehensive records that detail each patient’s progress and ultimate outcomes from participation in the
program.
d. use evidence-based clinical practice guidelines developed from reviews of randomized controlled trials of
smoking cessation methods.

8. Which standardized nursing terminologies specifically relate to the steps of the nursing process (select all that apply)?
a. Omaha System
b. Nursing Minimum Data Set (NMDS)
c. Perioperative Nursing Data Set (PNDS)
d. Nursing Outcomes Classification (NOC)
e. Nursing Interventions Classification (NIC)
f. NANDA International: Nursing Diagnoses

9. The nurse working in a health care facility where uniform electronic health records are used explains to the patient
that the primary purpose of such a record is to
a. reduce the cost of health care by eliminating paper records.
b. prevent medical errors associated with traditional paper records and handwritten orders and prescriptions.
c. force the use of standardized medical vocabularies and nursing terminologies so that outcomes of patient care can
be measured.
d. provide a single record in which all aspects of a patient’s medical information are readily available to any health
care provider involved in the patient’s care.

10. Which actions are done primarily by an informatics nurse (select all that apply)?
a. Designs and builds computer systems
b. Studies the validity of nursing information
c. Trains health care providers to provide nursing care
d. Communicates and accesses information for nursing staff
e. Builds systems that support the processing of nursing information

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 Chapter 1     Professional Nursing Practice 3

11. Match the phases of the nursing process with the descriptions (phases may be used more than once).
a. Analysis of data 1. Assessment
b. Priority setting 2. Diagnosis
c. Nursing interventions 3. Planning
d. Data collection 4. Implementation
e. Identifying patient strengths 5. Evaluation
f. Measuring patient achievement of goals
g. Setting goals
h. Identifying health problems
i. Modifying the plan of care
j. Documenting care provided

12. During the diagnosis phase of the nursing process, both nursing diagnoses and collaborative problems are identified.
Which are collaborative problem statements (select all that apply)?
a. Fatigue related to sleep deprivation
b. Infection related to immunosuppression
c. Excess fluid volume related to high sodium intake
d. Constipation related to irregular defecation habits
e. Hypoxia related to chronic obstructive pulmonary disease
f. Risk for cardiac dysrhythmias related to potassium deficiency

13. For the nursing diagnoses and written patient outcomes listed below, use the Nursing Interventions Classification
(NIC) to identify a specific nursing intervention to help the patient reach the outcome.
a. Nursing diagnosis: Risk for impaired skin integrity related to immobility
Patient outcome: Patient will demonstrate skin integrity free of pressure ulcers.

b. Nursing diagnosis: Constipation related to inadequate fluid and fiber intake

Patient outcome: Patient will have daily soft bowel movements in 1 week.

14. A patient with a seizure disorder is admitted to the hospital after a sustained seizure. When she tells the nurse
that she has not taken her medication regularly, the nurse makes a nursing diagnosis of ineffective self-health
management related to lack of knowledge regarding medication regimen and identifies the Nursing Outcomes
Classification (NOC) outcome of Compliance behavior, with the indicator Performs treatment regimen as
prescribed, at a target rate of 3 (sometimes demonstrated). When the nurse tries to teach the patient about the
medication regimen, the patient tells the nurse that she knows about the medication but she does not always have the
money to refill the prescription. Where was the mistake made in the nursing process with this patient?
a. Planning
b. Diagnosis
c. Evaluation
d. Assessment
e. Implementation

15. Identify the five rights of delegating nursing care (select all that apply).
a. Right time
b. Right task
c. Right patient
d. Right person
e. Right dosage
f. Right circumstance
g. Right supervision and evaluation
h. Right direction and communication

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4 Chapter 1     Professional Nursing Practice

16. Delegation is a process used by the RN to provide safe and effective care in an efficient manner. Which nursing
interventions should not be delegated to unlicensed assistive personnel (UAP) but should be performed by the RN
(select all that apply)?
a. Administering patient medications
b. Ambulating stable patients
c. Performing patient assessment
d. Evaluating the effectiveness of patient care
e. Feeding patients at mealtime
f. Performing sterile procedures
g. Providing patient teaching
h. Obtaining vital signs on a stable patient
i. Assisting with patient bathing

17. Match the following care planning tools to the description statement(s). There may be more than one statement per
tool and some statements may be used more than once.
Tools Statements
1. Nursing Care Plan A plan that directs an entire health care team
2. Concept Maps Used as guides for routine nursing care
3. Clinical Pathway Used in nursing education to teach the nursing process and care
planning
A description of patient care required at specific times during treatment
Should be personalized and specific to each patient
A visual diagram representing relationships between patient problems,
interventions, and data
Used for high-volume and highly predictable case types

18. Which nursing actions are in response to the National Patient Safety Goals (select all that apply)?
a. Use restraints to prevent patient falls.
b. Administer all medications ordered by physicians.
c. Wash hands before and after every patient contact.
d. Conduct a “time-out” when too tired to provide care.
e. Use SBAR for communicating with health professionals.
f. Evaluate the initial existence of pressure ulcers before patient dismissal.

19. Which quality of care measures influence the payment for health care services by third-party payers (select all that
apply)?
a. Clinical outcomes
b. Regulatory agencies
c. Use of evidence-based practice
d. Adoption of information technology
e. Occurrence of preventable conditions

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 ANSWERS TO WORKSHEETS

CHAPTER 1 12. b, e, f. Collaborative problems are potential or actual

complications of disease or treatment. As stated,
Answer Key
fatigue, constipation, and excess fluid volume are not
1. a, b, d, f, g, i complications of disease or treatment.
2. a, b, d. Certification usually requires an examination to 13. Many answers may be correct. Examples include the
verify a certain knowledge base and experience in the following:
specialty area to develop the expertise. Certification is a. Turn the patient every 2 hours using the following
a voluntary process that provides recognition of one’s schedule: L side → back → R side → L side → back.
expertise. Inspect and document all at-risk areas for blanching and
3. d. The Joint Commission establishes National Patient erythema at each position change.
Safety Goals (NPSG) and evidence-based solutions are b. Provide 8 oz of fluids every 2 hours (even hours) while
provided to prevent persistent safety problems. Nurses are the patient is awake (the patient prefers cold liquids).
vital to promoting this culture of safety. Rapidly expanding Assist the patient in choosing five fresh fruits or
technology and knowledge are increasing the complexity vegetables from the menu each day.
of the health care system. With the aging population there 14. d. The mistake was made during assessment when the
will be more patients with chronic illnesses. The QSEN nurse did not ask why the patient had not taken her
project identified six core competencies for nursing medication regularly and the appropriate etiology for the
education to include in the curriculum to enable graduates nursing diagnosis was not validated.
to be ready for practice. 15. b, d, f, g, h. Right task, right circumstance, right person,
4. QSEN’s six competencies are (1) Patient-centered care, (2) right direction and communication, and right supervision
Teamwork and collaboration, (3) Evidence-based practice, and evaluation.
(4) Quality improvement, (5) Safety, and (6) Informatics. 16. a, c, d, f, g. These actions or interventions require judgment
5. In order: and clinical decision making; therefore they should be
6 Make recommendations for practice or generate data performed by an RN.
1 Ask a clinical question 17. 3 A plan that directs an entire health care team
3 Critically analyze the evidence 1 Used as guides for routine nursing care
2 Find and collect the evidence 1, 2 Used in nursing education to teach the nursing
5 Evaluate the outcomes in the clinical setting process and care planning
0 Create a spirit of inquiry 3 A description of patient care required at specific times
4 Use evidence, clinical expertise, and patient preferences during treatment
to determine care 1 Should be personalized and specific to each patient
6. b. The C part of the PICOT format stands for Comparison. 2 A visual diagram representing relationships between
“Restraint” is the Intervention. “During a seizure” is patient problems, interventions, and data
the Time period. “Adult seizure patients” is the Patient/ 3 Used for high-volume and highly predictable
population. case types
“Protecting them from injury” is the Outcome. 18. c, e. Hands are to be washed with soap and water or
7. d. Evidence-based clinical practice guidelines are gel before and after each patient. SBAR is suggested
developed from summaries of research results and reflect to improve the effectiveness of communication among
the best known state of practice at the time. Use of these caregivers. Restraints are not suggested as part of
guidelines leads to more positive outcomes of care and the National Patient Safety Goals (NPSG), although
would be best to use in planning care or programs. evaluating fall risk and taking action to reduce fall risk
8. d, e, f. Only standardized terminologies describe and organize are included. All medications may not be administered
nursing practice that includes patient responses, nursing if there is interaction between them. The physician
interventions, and patient outcomes. would be notified before administering any questionable
9. d. The use of a standardized electronic health record for each medications. The “time-out” is not for the nurse’s fatigue
person is being promoted primarily to provide all health care but to ensure that the correct patient procedure and site
providers ready access to patient information to coordinate are verified before surgical procedures. To prevent health
care and to prevent duplication of information and erratic care–related pressure ulcers, NPSG suggest assessing
delivery of care. patients at risk initially on admission and on a regular basis
10. a, e. The nurse informaticist designs, builds, implements, throughout their care. To improve the accuracy of patient
evaluates, and maintains computer systems used for identification, it is suggested that two identifiers are used
health care. The studies done by nurse informaticists whenever a patient is identified, including for but not
develop ways to avoid errors. Nurses are trained by limited to medication administration.
informaticists to use computer systems but not all nursing 19. a, c, d, e. Only regulatory agencies are not quality of care
actions. All nurses use the accessing of information and measures, although they do affect patient safety, which is
communication aspects of technology. another quality of care measure that affects payment for
11. a. 2; b. 3; c. 4; d. 1; e. 2; f. 5; g. 3; h. 2; i. 5; j. 4 care.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved. 317