Chapter 01: Nursing in Today’s Evolving Health Care Environment
Black: Professional Nursing: Concepts & Challenges, 8th Edition

MULTIPLE CHOICE

	1.	Which of the following could eventually change the historical status of nursing as a female-dominated profession?
a.	More men graduating from baccalaureate and higher degree programs	
b.	The proportion of men in nursing beginning to increase	
c.	More male graduates of basic nursing programs entering the workplace	
d.	Salary compensation increasing to attract more men	

ANS:	C

	Feedback	
A	“More men graduating from baccalaureate and higher degree programs” is not the best answer because associate degree programs produce the most new graduates.	
B	The percentage of men in nursing has increased 50% since 2000.	
C	The more men who enter the workplace as nurses, the less nursing will be seen as a female-dominated profession.	
D	Salary rates do not appear to relate to the recruitment of men into nursing.	

DIF:	Cognitive Level: Comprehension	REF:	Page 2

	2.	The racial and ethnic composition of the nursing profession will change to more accurately reflect the population as a whole when
a.	the increased numbers of racial and ethnic minorities enrolled in educational programs graduate and begin to practice.	
b.	the number of Asians or Native Hawaiian-Pacific Islanders begins to increase.	
c.	the percentage of African-American and Hispanic nurses decreases more than the percentage of white nurses.	
d.	the nonwhite portion of the general population decreases.	

ANS:	A

	Feedback	
A	A larger percentage of minorities are enrolled in nursing educational programs than previously.	
B	Asians and Native Hawaiian-Pacific Islanders are over represented in nursing compared to their percentage of the general population.	
C	Not only would the percentage of African-American and Hispanic nurses need to increase, the percentage of white nurses would have to decrease in order to more accurately reflect the population as a whole.	
D	The nonwhite portion of the general population is not likely to decrease.	

DIF:	Cognitive Level: Comprehension	REF:	Page 3

	3.	Which of the following is a correct statement about the registered nurse (RN) population?
a.	The racial/ethnic composition of RNs closely resembles that of the general population.	
b.	The number of men entering nursing has decreased steadily over the last decade.	
c.	The rate of aging of RNs has slowed for the first time in the past 30 years.	
d.	The majority of employed RNs working full time must work a second position.	

ANS:	C

	Feedback	
A	The racial/ethnic composition of RNs is increasing, but does not approximate their percentage of the overall population.	
B	The number of men entering nursing is increasing.	
C	The average age of RNs in both 2004 and 2008 was 46. This is a result of the numbers of RNs under 30 in the workforce.	
D	According to 2008 data, only 12% of nurses working full time hold second positions.	

DIF:	Cognitive Level: Knowledge	REF:	Page 3

	4.	Which of the following best describes trends in nursing education?
a.	Numbers of RNs with bachelor’s and higher degrees are increasing.	
b.	Numbers of RNs with associate degrees are decreasing.	
c.	Foreign-born nurses practicing in the United States are seen as less knowledgeable because of their lesser educational preparation.	
d.	Numbers of RNs with diploma educations are increasing.	

ANS:	A

	Feedback	
A	Slightly over 50% of RNs eventually obtain their bachelor’s of science in nursing (BSN) or a higher nursing degree.	
B	The majority of nurses in this country get their initial nursing education in associate degree in nursing (ADN) programs.	
C	Foreign-born nurses practicing in the United States may be viewed as less knowledgeable by their peers because of language and cultural differences.	
D	The numbers of diploma-educated nurses are declining.	

DIF:	Cognitive Level: Knowledge	REF:	Page 4

	5.	Despite the variety of work settings available to the RN, data indicate that the primary work site for RNs is
a.	ambulatory care settings.	
b.	community health settings.	
c.	long-term care facilities.	
d.	acute care hospitals.	

ANS:	D

	Feedback	
A	Ambulatory care settings account for about 10.5% of RNs’ places of employment.	
B	Public health and community health settings account for 7.8% of employed RNs.	
C	Long-term care facilities account for 5.3% of RNs’ places of employment.	
D	Statistics show that 62.2% of RNs work in acute care hospitals.	

DIF:	Cognitive Level: Knowledge	REF:	Page 5

	6.	One important advantage of clinical ladder programs for hospital-based RNs is that they
a.	allow career advancement for nurses who choose to remain at the bedside.	
b.	encourage nurses to move into management positions in which they can influence patient care on a broader scale.	
c.	encourage RNs to become politically active and guide the profession of nursing.	
d.	provide training to staff nurses so they can move seamlessly across departments.	

ANS:	A

	Feedback	
A	Clinical ladder programs allow nurses to advance professionally while remaining at the bedside.	
B	Clinical ladder programs are designed to keep proficient nurses at the bedside.	
C	Encouraging RNs to become politically active and guide the profession of nursing is not the goal of clinical ladder programs.	
D	Clinical ladder programs are not designed to facilitate transfer between departments.	

DIF:	Cognitive Level: Comprehension	REF:	Page 6

	7.	Which of the following statements is correct about community health nursing (CHN)?
a.	Prevention and community education are the cornerstones of CHN.	
b.	Nursing care is rapidly moving from the home setting to the institutional setting.	
c.	High-tech care such as ventilators and total parenteral nutrition cannot be handled in the home.	
d.	Assessment skills are less important in CHN because patients are not acutely ill.	

ANS:	A

	Feedback	
A	The community health nurse provides educational programs in health maintenance, disease prevention, nutrition, and child care.	
B	Care is moving into the home setting.	
C	Home care is increasing in complexity.	
D	Community health nurses must have excellent assessment skills as they do not have the immediate backup that an acute care facility offers.	

DIF:	Cognitive Level: Comprehension	REF:	Page 9

	8.	Which of the following is most essential for the nurse entrepreneur to be successful?
a.	Ability to take direction well	
b.	Excellent time-management skills	
c.	Avoidance of risks	
d.	A college degree in business	

ANS:	B

	Feedback	
A	Nurse entrepreneurs must function autonomously.	
B	Nurse entrepreneurs must be well organized and efficient.	
C	Starting a business involves risk.	
D	A degree in business is not required to be a nurse entrepreneur.	

DIF:	Cognitive Level: Analysis	REF:	Page 16

	9.	The major benefit of serving as a military nurse is
a.	broader responsibilities and scope of practice than civilian nurses.	
b.	working with entirely baccalaureate-prepared peers on active duty.	
c.	serving as an officer on active duty or in the reserves.	
d.	the financial support to seek advanced degrees.	

ANS:	D

	Feedback	
A	Although military nurses do have broader responsibilities and scopes of practice than civilian nurses do, this is not the major benefit.	
B	Although military nurses do work with entirely baccalaureate-prepared peers on active duty, this is not the major benefit.	
C	Although military nurses serve as officers on active duty or in the reserves, this is not the major benefit.	
D	Advanced education is supported by the military financially and also allows for promotion in rank at an accelerated pace.	

DIF:	Cognitive Level: Comprehension	REF:	Page 11

	10.	Which of the following statements explains why the school nurse of today is truly a community health nurse?
a.	The school nurse may be called on to care for a student’s family members in underserved areas.	
b.	The school nurse’s primary responsibility is centered on the well child.	
c.	The school nurse’s primary responsibility is to maintain immunization records.	
d.	The school nurse must be certified in CHN.	

ANS:	A

	Feedback	
A	In medically underserved areas a school nurse may be called on to care for members of a child’s immediate family.	
B	Chronically ill, disabled, and physically challenged students are in regular classrooms.	
C	School nurses detect developmental problems; counsel and educate children, parents, and teachers; and maintain immunization records.	
D	Although school nurses are considered community health nurses, certification in community health is not required.	

DIF:	Cognitive Level: Comprehension	REF:	Page 12

	11.	What has been found about the outcomes of patients cared for in hospitals with a higher percentage of BSN-prepared nurses as compared to patients in hospitals with a lower percentage of BSN-prepared nurses?
a.	Patient outcomes are more dependent on nurse-patient ratios.	
b.	Outcomes were better in hospitals with more BSN-prepared nurses.	
c.	Outcomes were similar in both types of hospitals.	
d.	Medical patients had better outcomes, but surgical patients fared the same.	

ANS:	B

	Feedback	
A	Nurse-patient ratio is an important determinant of patient care outcomes but has not been shown to be more or less important that the percentage of BSN-prepared nurses providing direct patient care.	
B	Research by Aiken, et al. (2003) showed that patient outcomes were better in hospitals where higher percentages of BSN-prepared nurses were employed.	
C	Research by Aiken, et al. (2003) showed that patient outcomes were better in hospitals where higher percentages of BSN-prepared nurses were employed.	
D	Aiken, et al. (2003) studied orthopedic, general surgical, and vascular surgery patients and found the outcomes were improved for these patients in hospitals with a higher percentage of BSN-prepared nurses.	

DIF:	Cognitive Level: Knowledge	REF:	Page 7

	12.	Faith community nursing (FCN) was founded on which of the following premises?
a.	Nurses’ faith beliefs do not play a part in healing.	
b.	The spiritual aspect takes precedence over the physical body in healing.	
c.	Spiritual health is central to a person’s well-being.	
d.	Faith community nurses must receive formal training as a minister or clergy.	

ANS:	C

	Feedback	
A	The nurse’s spiritual journey is believed to be an essential aspect of this nursing role.	
B	Patients are treated holistically under FCN.	
C	FCN is based on the belief that spiritual health is central to well-being.	
D	Faith community nurses do not need to have formal training as ministers.	

DIF:	Cognitive Level: Comprehension	REF:	Page 15

	13.	One important advantage of the evolution of nursing informatics is that
a.	it allows any RN to become a certified informatics nurse.	
b.	informatics nurses are best able to design systems with the needs and skills of nurses who use them in mind.	
c.	informatics nurses will reduce the need for direct caregivers to document care.	
d.	benefits of informatics advancements include improved patient safety and increased variability of care.	

ANS:	B

	Feedback	
A	Although all nurses may use informatics, a nurse specializing in informatics should have a BSN and additional knowledge and experience in the field of informatics.	
B	Informatics nurses understand how the information needs to be used and how to make the systems work for the nurses.	
C	Direct caregivers will still need to document the care provided.	
D	Benefits do include improved patient safety, but decreased variability of care is expected with informatics systems.	

DIF:	Cognitive Level: Comprehension	REF:	Page 16

	14.	Which of the following nursing roles is not considered an advanced practice role?
a.	Certified nurse-midwife (CNM)	
b.	Community health nurse	
c.	Certified nurse practitioner (CNP)	
d.	Clinical nurse specialist (CNS)	

ANS:	B

	Feedback	
A	A CNM is an advanced practice role.	
B	The community health nurse is not an advanced practice role.	
C	CNP is an advanced practice role.	
D	CNS is an advanced practice role.	

DIF:	Cognitive Level: Comprehension	REF:	Page 18

	15.	NPs are advanced practice nurses who
a.	are required to have physician collaboration or supervision.	
b.	function under a set of universal advanced practitioner laws.	
c.	cannot receive direct reimbursement for their services.	
d.	can diagnose and treat common and chronic conditions.	

ANS:	D

	Feedback	
A	The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services.	
B	The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services.	
C	The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services.	
D	NPs are prepared to handle a wide range of basic health problems.	

DIF:	Cognitive Level: Comprehension	REF:	Page 19

	16.	The clinical nurse leader (CNL) is a recently proposed role. The responsibilities of the person in this role include which of the following?
a.	Oversee and manage care delivery in specific settings.	
b.	Manage and streamline operations in multiple nursing units.	
c.	Replace the outdated CNS role.	
d.	Provide daily care to a specific subset of patients with similar needs.	

ANS:	A

	Feedback	
A	The CNL role is intended to provide the highest quality of nursing care by having master’s-prepared nurses involved in the care of a distinct group of patients.	
B	The CNL role was not intended as a managerial or administrative role.	
C	The CNS role is not outdated, and some controversy exists because some CNSs view this new role as possibly disenfranchising them.	
D	CNLs may on occasion provide direct patient care, but not on a daily basis.	

DIF:	Cognitive Level: Knowledge	REF:	Page 18

MULTIPLE RESPONSE

	1.	Hospice and palliative care nursing is a rapidly developing specialty in nursing. Which facts have contributed to this growth? (Select all that apply.)
a.	End-of-life care is largely the responsibility of nurses.	
b.	End-of-life needs are expected to increase with the aging population.	
c.	Nursing curricula have prepared nurses to deal effectively with dying patients and their families.	
d.	Palliative care is a new focus of advanced practice nurses.	
e.	Hospice and palliative care nurses work in a variety of settings.	

ANS:	A, B, E

	Feedback	
Correct	“End-of-life care is largely the responsibility of nurses” is correct because palliative care reflects the holistic philosophy of nursing, and comfort and relief have always been nursing responsibilities. “End-of-life needs are expected to increase with the aging population” is correct because as the population ages there will be a greater demand for end-of-life care as the number of individuals needing care increases. “Hospice and palliative care nurses work in a variety of settings” is correct because palliative care takes place in hospitals, homes, hospices, skilled nursing homes, etc.	
Incorrect	“Nursing curricula have prepared nurses to deal effectively with dying patients and their families” is incorrect because nursing educational programs have not prepared nurses well as the content related to end-of-life issues and palliative care has been limited. “Palliative care is a new focus of advanced practice nurses” is incorrect because palliative care has been a focus of many nurses, not just advanced practice nurses.	

DIF:	Cognitive Level: Comprehension	REF:	Page 14

	2.	CNSs may (Select all that apply.)
a.	manage an inpatient nursing unit.	
b.	develop educational programs for nursing staff.	
c.	conduct practice outcomes research.	
d.	prescribe medications for common illnesses.	
e.	attend or assist in the delivery of low-risk newborns.	

ANS:	A, B, C

	Feedback	
Correct	CNSs are prepared with an advanced nursing degree and the skills to function in a variety of settings and functional roles.	
Incorrect	CNSs do not have prescribing authority. CNMs attend or assist at the delivery of low-risk newborns.	

DIF:	Cognitive Level: Comprehension	REF:	Page 19