Chapter 01: The Evolution of Nursing
Cooper: Foundations and Adult Health Nursing, 9th Edition

MULTIPLE CHOICE

	1.	What is a nursing program considered when certified by a state agency?
a.	Accredited	
b.	Approved	
c.	Provisional	
d.	Exemplified	

ANS:	B
Approved means certified by a state agency for having met minimum standards; accredited means certified by the NLN for having met more complex standards. Provisional and exemplified are not terms used in regard to nursing program certification.

DIF:	Cognitive Level: Knowledge	REF:	p. 10	OBJ:	5
TOP:	Nursing programs		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	2.	Which of the following must the nurse recognize regarding the health care delivery system?
a.	It includes all states.	
b.	It affects the illness of patients.	
c.	Insurance companies are not involved.	
d.	The major goal is to achieve optimal levels of health care.	

ANS:	D
The nurse must recognize that in the health care delivery system, the major goal is to achieve optimal levels of health care. The health care system consists of a network of agencies, facilities, and providers involved with health care in a specified geographic area. Insurance companies do have involvement in the health care system. The illness of patients is not necessarily affected by the health care system.

DIF:	Cognitive Level: Comprehension	REF:	p. 12	OBJ:	7
TOP:	Health care systems		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	3.	What is required by the health care team to identify the needs of a patient and to design care to meet those needs?
a.	The Kardex	
b.	The health care provider’s order sheet	
c.	An individualized care plan	
d.	The nurse’s notes	

ANS:	C
An individualized care plan involves all health care workers and outlines care to meet the needs of the individual patient. The Kardex, health care provider’s order sheet, and nurse’s notes do not identify the needs of the patient nor are they designed to assist all members of the health care team to meet those needs.

DIF:	Cognitive Level: Comprehension	REF:	p. 13	OBJ:	8 | 9
TOP:	Care plan	KEY:	Nursing Process Step: Planning	MSC:	NCLEX: N/A

	4.	Patient care emphasis on wellness, rather than illness, begins as a result of:
a.	increased education concerning causes of illness.	
b.	improved insurance payments.	
c.	decentralized care centers.	
d.	increased number of health care givers.	

ANS:	A
The acute awareness of preventive medicine has resulted in today’s emphasis on education about issues such as smoking, heart disease, drug and alcohol abuse, weight control, and mental health and wellness promotion activities. This preventive education has resulted in an emphasis on wellness, rather than illness. Improved insurance payments, decentralized care centers, and increased numbers of health care givers did not influence an emphasis on wellness.

DIF:	Cognitive Level: Comprehension	REF:	p. 12	OBJ:	4 | 8
TOP:	Wellness	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A

	5.	What is the most effective process to ensure that the care plan is meeting the needs of the patient?
a.	Documentation	
b.	Communication	
c.	Evaluation	
d.	Planning	

ANS:	B
Communication is the primary essential component among the health care team to evaluate and modify the care plan. Documentation, evaluation, and planning are not primary essential components to ensure the care plan is meeting the needs of the patient.

DIF:	Cognitive Level: Comprehension	REF:	p. 17	OBJ:	8
TOP:	Communication		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	6.	How does an interdisciplinary approach to patient treatment enhance care?
a.	By improving efficiency of care	
b.	By reducing the number of caregivers	
c.	By preventing the fragmentation of patient care	
d.	By shortening hospital stay	

ANS:	C
An interdisciplinary approach prevents fragmentation of care. An interdisciplinary approach does not improve the efficiency of care, reduce the number of caregivers, or shorten hospital stay.

DIF:	Cognitive Level: Comprehension	REF:	p. 16	OBJ:	8 | 9
TOP:	Interdisciplinary approach	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	7.	How may a newly licensed LPN/LVN practice?
a.	Independently in a hospital setting	
b.	With an experienced LPN/LVN	
c.	Under the supervision of a health care provider or RN	
d.	As a sole health care provider in a clinic setting	

ANS:	C
An LPN/LVN practices under the supervision of a health care provider, dentist, OD, or RN.

DIF:	Cognitive Level: Knowledge	REF:	p. 11	OBJ:	11
TOP:	Vocational nursing		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	8.	Whose influence on nursing practice in the 19th century was related to improvement of patient environment as a method of health promotion?
a.	Clara Barton	
b.	Linda Richards	
c.	Dorothea Dix	
d.	Florence Nightingale	

ANS:	D
The influence of Florence Nightingale was highly significant in the 19th century as she fought for sanitary conditions, fresh air, and general improvement in the patient environment. Clara Barton developed the American Red Cross in 1881. Linda Richards is known as the first trained nurse in America, was responsible for the development of the first nursing and hospital records, and is credited with the development of our present-day documentation system. Dorothea Dix was the pioneer crusader for elevation of standards of care for the mentally ill and superintendent of female nurses of the Union Army.

DIF:	Cognitive Level: Knowledge	REF:	p. 17	OBJ:	2 | 4
TOP:	Nursing leaders		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	9.	What document identifies the roles and responsibilities of the LPN/LVN?
a.	NLN Accreditation Standards	
b.	Nurse Practice Act	
c.	NAPNE Code	
d.	American Nurses’ Association Code	

ANS:	B
The LPN/LVN functions under the Nurse Practice Act. NLN Accreditation Standards, the NAPNE Code, and the American Nurses’ Association Code do not identify the roles and responsibilities of the LPN/LVN.

DIF:	Cognitive Level: Knowledge	REF:	p. 12 | p. 14	OBJ:	11
TOP:	Roles and responsibilities	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	10.	What is a cost-effective delivery of care used by many hospitals that allows the LPN/LVN to work with the RN to meet the needs of patients?
a.	Focused nursing	
b.	Team nursing	
c.	Case management	
d.	Primary nursing	

ANS:	C
Case management is a cost-effective method of care. Focused nursing, team nursing, and primary nursing are not cost-effective methods of delivering care that allow the LPN/LVN to work with the RN to meet patient needs.

DIF:	Cognitive Level: Comprehension	REF:	p. 15	OBJ:	7 | 9
TOP:	Patient care delivery systems	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	11.	What is the title of the American Hospital Association’s 1972 document that outlines the patient’s expectations to be treated with dignity and compassion?
a.	Code of Ethics	
b.	Patient’s Bill of Rights	
c.	OBRA	
d.	Advance directives	

ANS:	B
Patient expectations are outlined by the Patient’s Bill of Rights. Patient expectations are not outlined in the Code of Ethics, OBRA, or advance directives.

DIF:	Cognitive Level: Knowledge	REF:	p. 16	OBJ:	4 | 8
TOP:	Patient’s rights		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	12.	The relationships among nursing, patients, health, and the environment are the basis for:
a.	care plans.	
b.	nursing models.	
c.	health care provider’s orders.	
d.	evaluation of patient care.	

ANS:	B
Nursing models are theories based on the relationship between nursing, patients, health, and environment. Care plans, health care provider’s orders, and evaluation of patient care are not based on the relationships among nursing, patients, health, and environment.

DIF:	Cognitive Level: Comprehension	REF:	p. 17	OBJ:	1
TOP:	Nursing models		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	13.	What system reduces the number of employees but still provides quality care for patients?
a.	Team nursing	
b.	Cross-training	
c.	Use of critical pathways	
d.	Case management	

ANS:	B
Cross-training reduces the number of employees but does not alter the quality of patient care. Team nursing, use of critical pathways, and case management do not reduce the number of employees while continuing to provide quality care for patients.

DIF:	Cognitive Level: Comprehension	REF:	p. 15	OBJ:	8
TOP:	Patient care	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A

	14.	What is the purpose of licensing laws for LPN/LVNs?
a.	To limit the number of LPN/LVNs	
b.	Prevention of malpractice	
c.	Protection of the public from unqualified people	
d.	To increase revenue for the state board of nursing	

ANS:	C
The purpose of licensing laws for LPN/LVNs is to protect the public from unqualified health care providers. Licensing laws’ purpose is not to limit the number of LPNs/LVNs, prevent malpractice, or increase revenue for the state board of nursing.

DIF:	Cognitive Level: Comprehension	REF:	p. 11	OBJ:	4 | 9 | 10
TOP:	Licensure	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A

	15.	What premise is Maslow’s hierarchy of needs based on?
a.	All needs are equally important.	
b.	Basic needs must be met before the next level of needs can be met.	
c.	Self-actualization is a primary need.	
d.	Individuals prioritize needs the same way.	

ANS:	B
Maslow’s hierarchy of needs is based on the premise that basic needs must be met first. It is not based on all needs being equally important or that individuals prioritize needs the same way. Self-actualization is not a primary need according to Maslow.

DIF:	Cognitive Level: Comprehension	REF:	p. 12 | p. 13	OBJ:	8
TOP:	Maslow’s Hierarchy of Needs	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	16.	What must the nurse realize when assessing physical and social environmental factors affecting health and illness?
a.	They affect one another.	
b.	They cause illness.	
c.	They cause patients to react similarly.	
d.	They can be separated.	

ANS:	A
Physical and social factors affect each other, cannot be separated, and cause each patient to react in a unique manner. They do not necessarily cause illness or cause patients to react similarly, and they cannot be separated.

DIF:	Cognitive Level: Comprehension	REF:	p. 14	OBJ:	4 | 8
TOP:	Environmental factors	KEY:	Nursing Process Step: Assessment
MSC:	NCLEX: Health Promotion and Maintenance

	17.	What organization, established during World War II, provided nursing education and training?
a.	Nightingale school	
b.	Cadet Nurse Corps	
c.	Public health department	
d.	Frontier Nursing Service	

ANS:	B
The Cadet Nurse Corps was established during World War II to provide nursing education and training. The Nightingale school, public health department, and Frontier Nursing Service are not organizations established during World War II to provide nursing education and training.

DIF:	Cognitive Level: Knowledge	REF:	p. 5	OBJ:	1 | 4
TOP:	Nursing education		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	18.	What is a modern educational advancement program for the LPN/LVN to enter RN education?
a.	Repetition	
b.	Exclusion	
c.	Articulation	
d.	Coexistence	

ANS:	C
Most states have some type of articulation program in which the LPN/LVN can achieve advanced standing in an RN program without having to enroll in the entire curriculum. Repetition, exclusion, and coexistence do not refer to educational advancement.

DIF:	Cognitive Level: Knowledge	REF:	p. 10	OBJ:	1 | 9
TOP:	Nursing education		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	19.	Where did Florence Nightingale’s original nursing education take place?
a.	Saint Thomas	
b.	Kings College Hospital	
c.	Crimean Hospital	
d.	Kaiserswerth School	

ANS:	D
Florence Nightingale trained at Kaiserswerth School. Florence Nightingale’s original training was not at Saint Thomas, Kings College Hospital, or Crimean Hospital.

DIF:	Cognitive Level: Knowledge	REF:	p. 2	OBJ:	2
TOP:	Nursing programs		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	20.	What system of comprehensive patient care considers the physical, emotional, and social environment and spiritual needs of a person?
a.	Interdependent care	
b.	Holistic health care	
c.	Illness prevention care	
d.	Health promotion care	

ANS:	B
Holistic health care encompasses the physical, emotional, social, and spiritual aspects of the patient.

DIF:	Cognitive Level: Comprehension	REF:	p. 12	OBJ:	8
TOP:	Health care	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A

	21.	What official agency exists exclusively for LPN/LVN membership and promotes standards for the LPN/LVN?
a.	NFLPN	
b.	ANA	
c.	NLN	
d.	NAPNES	

ANS:	A
The NFLPN exists solely for the LPN/LVN. The other options have membership that includes RNs and the lay public.

DIF:	Cognitive Level: Knowledge	REF:	p. 10	OBJ:	5 | 6 | 9
TOP:	Nursing organizations		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	22.	What score does the graduate practical nurse require to be issued a license upon completion of the computerized examination?
a.	70% or better	
b.	This is defined and set by each state	
c.	Designated as “pass”	
d.	Within the 75th percentile	

ANS:	C
Currently graduates of an approved vocational school are eligible to take the licensing examination and be awarded a license with a score of “pass” that is recognized by all states.

DIF:	Cognitive Level: Knowledge	REF:	p. 12	OBJ:	3
TOP:	Licensure examination	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	23.	What document, published in 1965 by the ANA, clearly defined two levels of nursing practice?
a.	Licensing standards	
b.	Position paper	
c.	Smith-Hughes Act	
d.	Nurse practice act	

ANS:	B
The ANA’s position paper of 1965 defined two levels of nursing: registered nurse and technical nurse. Licensing standards, the Smith-Hughes Act, and the nurse practice act were not documents defining two levels of nursing practice published in 1965.

DIF:	Cognitive Level: Knowledge	REF:	p. 11	OBJ:	3 | 4 | 9
TOP:	Position paper			KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	24.	What is the wellness/illness continuum defined as?
a.	A concept that never changes	
b.	The range of a person’s total health	
c.	A continuum influenced only by one’s physical condition	
d.	An idea that focuses strictly on an individual’s social well-being	

ANS:	B
The wellness/illness continuum is defined as the range of a person’s total health. This continuum is ever changing, and it is influenced by the individual’s physical condition, mental condition, and social well-being.

DIF:	Cognitive Level: Comprehension	REF:	p. 12	OBJ:	8
TOP:	Wellness/illness continuum	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	25.	According to Maslow’s hierarchy of needs, what is an individual’s most basic need?
a.	Safety and security	
b.	Love/belongingness	
c.	Physiologic	
d.	Self-actualization	
e.	Esteem	

ANS:	C
Abraham Maslow believed that an individual’s behavior is formed by the individual’s attempts to meet essential human needs, which he identified as physiologic, safety and security, love and belongingness, and esteem and self-actualization.

DIF:	Cognitive Level: Comprehension	REF:	p. 12 | p. 13	OBJ:	8
TOP:	Maslow’s Hierarchy of Needs	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

MULTIPLE RESPONSE

	1.	Florence Nightingale established a nursing school at Saint Thomas Hospital in London. What was it characterized by? (Select all that apply.)
a.	Allowing all applicants who applied to be enrolled	
b.	Offering formal and practical educational experiences	
c.	Keeping records of students’ progress	
d.	Focusing on sanitation and hygiene	
e.	Retaining a registry of all graduates	

ANS:	B, C, D, E
The nursing school established by Florence Nightingale rigorously screened its applicants. The curriculum, which included both formal education and practical experiences, was focused on hygiene and sanitation. The school kept records of the students’ progress during their school years, and also kept a registry of the graduates.

DIF:	Cognitive Level: Comprehension	REF:	p. 3	OBJ:	1 | 2
TOP:	School established by Florence Nightingale		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

COMPLETION

	1.	Primitive medical interventions were based on the belief that illness was caused by the presence of _______________ spirits.

ANS:	
evil

Illness was thought to be caused by the inhabitation of the body by evil spirits. Medical interventions were designed to drive out the evil spirits by introducing good spirits.

DIF:	Cognitive Level: Comprehension	REF:	p. 1	OBJ:	1
TOP:	Primitive health care		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	2.	During early civilization _____________ men performed witchcraft and rituals to induce the bad spirits to leave the body of the ailing person.

ANS:	
medicine

Medicine men performed witchcraft and rituals to induce the bad spirits to leave the body of the ailing person during early civilization.

DIF:	Cognitive Level: Knowledge	REF:	p. 2	OBJ:	1
TOP:	Primitive health care		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	3.	The National Council of State Boards of Nursing (NCSBN) performs a job analysis every ________ years to determine the scope of practice of LPN/LVNs.

ANS:	
3
three

The National Council of State Boards of Nursing performs a job analysis every 3 years to measure the scope of practice for LPN/LVNs.

DIF:	Cognitive Level: Knowledge	REF:	p. 18	OBJ:	6 | 9
TOP:	National Council analysis	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	4.	Graduates of the first school for training the practical nurse were referred to as ___________ nurses.

ANS:	
attendant

The first school for training the practical nurse started in Brooklyn, New York, in 1892 and was conducted under the auspices of the Young Women’s Christian Association (YWCA). The Ballard School, as it was known, was approximately 3 months in duration and trained its students to care for the chronically ill, invalids, children, and the elderly. The main emphasis was on home care and included cooking, nutrition, basic science, and basic procedures. Graduates of this program were referred to as attendant nurses.

DIF:	Cognitive Level: Knowledge	REF:	p. 9	OBJ:	1
TOP:	Attendant nurses		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	5.	In 1949, the National Federation of Licensed Practical Nurses (NFLPN) was founded by Lillian _____________.

ANS:	
Kuster

In 1949, the National Federation of Licensed Practical Nurses (NFLPN) was founded by Lillian Kuster. This association is the official membership organization for licensed practical nurses/licensed vocational nurses (LPN/LVNs), and membership is limited to LPNs and LVNs.

DIF:	Cognitive Level: Knowledge	REF:	p. 10	OBJ:	2
TOP:	National Federation of Licensed Practical Nurses	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A