Professional Nursing Practice Journey.docx

Professional Nursing Practice Beginning the Journey Learning Objective 1.1 Examine changes in society that promote the nurse’s return to school for further education. 1. Which societal changes have promoted the nurse’s return to school and further education? (Select all that apply) 1. Patients have increasingly more complex and varied health needs. 2. Previously unknown diseases are being identified. 3. New technologies are being developed that require continual knowledge updates. 4. Patients are staying longer in the hospital. 5. There is a relative increase in the number of children in the population. Answer: 1, 2, 3 Explanation: Changes in society have placed new demands on nurses. The population is aging and these older patients have more complex and varied health problems. New diseases related to social and environmental problems are being identified. Scientific discoveries and new technologies require the nurse to continually update his or her knowledge base in order to provide safe and competent care. Patients are going home earlier (not staying longer in the hospital), so much more care is being provided in community and outpatient settings. The population is aging so there is not a relative increase in the number of children in the population. Learning Objective 1.2 Examine changes in the profession that promote the nurse’s return to school for further education. 1. Which statement regarding age trends of RNs is correct? 1. The average age of persons holding RN licensure has remained the same for the last 10 years. 2. The average age of male RN graduates is decreasing while the age for female RN graduates is increasing. 3. The average age of nursing school graduates has decreased, but the average age of persons holding RN licensure has increased. 4. Overall, the average age of practicing RNs has decreased. Answer: 3 Explanation: The average age of nursing school graduates has dropped from 30.5 years in 2000 to 29.6 years in 2004. The average age of RNs has increased from 45.2 years in 2000 to 46.8 years in 2004. Therefore, the average age of graduates has decreased while the average age of RNs has increased. There is no information in the text regarding age as it applies to gender. 2. According to the 2004 study cited in the textbook, what is the highest level of educational preparation for the majority of RNs? 1. Diploma 2. Associate degree 3. Baccalaureate degree 4. Master’s degree Answer: 3 Explanation: According to the U.S. Department of Health and Human Services sample survey cited in the textbook, 17.5% of nurses hold a diploma, 33.7% of nurses hold an associate degree, 34.2% of nurses hold a baccalaureate degree, and 13.0% of nurses hold a master’s or doctoral degree as their highest level of educational preparation. 3. How have the practice settings for nurses changed since 1980? 1. There has been little or no change in these settings. 2. The settings have shifted from the community to the hospital. 3. There has been a shift from the hospital to long-term care settings. 4. They have shifted from acute-care to community or primary care settings. Answer: 4 Explanation: The focus of professional nursing practice is shifting from acute hospital-based illness care to primary outpatient-based community care emphasizing health promotion and illness/injury preventions. The percentage of RNs working in hospitals decreased from 66% in 1980 to 56.2% in 2004. 4. What statement about specialty certification in nursing is true? 1. Specialty certification guarantees increase in salary for the nurse. 2. Healthcare agencies rarely recognize certifications by nursing specialty groups. 3. The nurse who works in hospital practice must hold at least one specialty certification. 4. Increasing numbers of certifications require that the nurse have a baccalaureate degree in nursing. Answer: 4 Explanation: Increasingly, specialty certifications require that the nurse hold a baccalaureate degree in nursing, have extensive experience in the field, and document continuing education in the field. Although there is no guarantee that the nurse’s salary will be increased, healthcare agencies do recognize these certifications. There is no requirement that the nurse hold a specialty certification to work in a hospital; however, work in specialty areas, such as the emergency department, critical care areas, or surgery, may require certification. Learning Objective 1.3 Apply models of transition to professional role change. 1. The nurse has been promoted from staff nurse to supervisor and is trying to make a transition to the new role. Which option reflects that this nurse is in the ending phase of Bridges’ model of transition? 1. The nurse is working to move forward in the job, avoiding the temptation of going back to familiar ways of thinking. 2. The nurse is beginning to accept the responsibilities of the new position. 3. The nurse has accepted that relationships with former peers on the unit will change. 4. The nurse questions the wisdom of accepting the new position. Answer: 4 Explanation: Bridges’ model of transition consists of three phases. The first phase, called the ending phase, consists of the individual “letting go” of the old situation. This phase consists of four components: disengagement, disidentification, disenchantment, and disorientation. The nurse who is questioning the wisdom of accepting the new position is in the letting go phase of disorientation. The second phase, neutral zone, is exemplified in this question by the nurse beginning to accept the responsibilities of the new position and accepting that relationships with former peers will change. As the nurse works to move forward in the job, resisting the temptation to go back to familiar ways of thinking and working, the nurse has moved into the final stage of transition, new beginnings. 2. The nurse who has gone back to school to earn a master’s degree is eager to talk with peers who are also considering going back to school. Which stage of Spencer and Adams’ model of transition does this desire most closely exemplify? 1. Stage 2, minimizing the impact 2. Stage 4, letting go of the past 3. Stage 6, searching for meaning 4. Stage 7, integration Answer: 3 Explanation: Spencer and Adams describe a seven-stage model. The nurse’s actions most closely exemplify stage 6, searching for meaning. In this stage, the individual desires to help others who are experiencing a similar situation. In stage 2, minimizing the impact, the person feels a need to go back to what was normal or comfortable in order to avoid the full effect of the change taking place. In stage 4, letting go of the past, the individual begins to focus on the change’s benefits and to look forward to those benefits. Stage 7, integration, is the stage of completion. In this stage, the individual experiences satisfaction and self-confidence. 3. The individual going through a transition may experience many feelings. Which feelings are common? (Select all that apply) 1. Anger 2. Anxiety 3. Optimism 4. Confusion 5. Grief Answer: 1, 2, 3, 4, 5 Explanation: A variety of emotions and feelings are common when an individual is going through a transition. These feelings include all those listed. 4. The nurse has elected to return to school to pursue a baccalaureate degree. After the first week of classes, the nurse is overwhelmed. Which stage of Spencer and Adams’ model of transition is this nurse most likely experiencing? 1. Losing focus 2. Minimizing the impact 3. The pit 4. Letting go of the past Answer: 1 Explanation: Losing focus is stage 1 of Spencer and Adams’ model of transition. In this stage, the individual has difficulty keeping things in perspective and may feel overwhelmed and panicked. Minimizing the impact is stage 2, in which the individual may resist the change or ignore the need for change. The pit is stage 3, and the individual may have feelings of depression, grief, anger, or powerlessness. Letting go of the past is stage 4, in which there is a move toward optimism. Learning Objective 1.4 Identify strategies that will assist the nursing student in the formal academic setting. 1. The nurse who is returning to school to pursue a baccalaureate degree in nursing states, “I don’t know why I am putting myself through this. I have practiced just fine for 10 years as an associate degree nurse.” Which strategy, recommended by a friend, would be helpful in overcoming this feeling? 1. “Why don’t you take a one semester break from school?” 2. “Remember that a lot of people are depending on you.” 3. “Just think how much better a nurse you will be when you finish.” 4. “Think about all the extra money you will get when you graduate.” Answer: 3 Explanation: Reframing the nurse’s comment helps to focus on the positive. “Just think how much better a nurse you will be when you finish” helps the nurse remember the reason for seeking further education. If the nurse takes a break in this frame of mind, return to school is unlikely. This nurse is already stressed, so focus on the dependence of others on him or her is unlikely to be very comforting. Although there may be some increase in salary associated with the BS degree, it is usually not substantial. Focus on a potential salary change that is not close in time will do little to assist the nurse in this period. 2. The nurse who has decided to seek a master’s degree asks the hospital’s chief nurse for support. The chief nurse followed a career ladder from associate degree nurse, to baccalaureate nurse, to master’s prepared nurse, and eventually obtained a nursing doctorate. The chief nurse would be acting in which role for the new student? 1. Colleague 2. Friend 3. Faculty 4. Mentor Answer: 4 Explanation: While the nurses in the scenario may consider themselves friends and colleagues, the description of the role of the chief nurse most closely describes that of mentor. There is no indication that the chief nurse is fulfilling the role of faculty. 3. The nurse has decided to go back to school. Which group is most likely to provide physical and financial support to this nurse? 1. Mentor 2. Family and friends 3. Career ladder organization 4. State nursing organization Answer: 2 Explanation: Although every person’s situation is different, family and friends are generally more likely to provide physical and financial support of some type. Mentors provide intellectual support along with information about the role transition. Career ladder organizations and state nursing organizations provide support related to career information and study skills, not specific physical and financial support. 4. Which individual would most likely be the best choice as a mentor to an associate degree nurse who has enrolled in a baccalaureate nursing completion program? 1. A colleague at work who holds an associate degree 2. A nurse who completed an ADN to RN program five years ago 3. The minister of the nurse’s church 4. The physician chief of staff at the hospital where the nurse works Answer: 2 Explanation: The best choice for mentor is someone who has successfully achieved the transition the nurse is seeking; therefore, a nurse who completed an ADN to RN program would be the preferred mentor. Because the colleague at work has not completed the desired transition, that nurse would not understand the pressures of the program. Although the minister and the physician might offer support, they would not fulfill the mentor position as well as someone who has lived through the transition. Learning Objective 1.5 Identify helpful approaches to academic success. 1. The nursing student identifies a personal tendency toward procrastination. Which approach would be beneficial to this student? 1. Plan the majority of study in the two days prior to scheduled exams. 2. Plan recreational activities each week. 3. Limit reading to essential content. 4. Try to complete assigned papers in one setting. Answer: 2 Explanation: Good time management requires good physical health, which requires adequate sleep, good nutrition, and recreation. The student should develop a time plan that includes keeping up with assigned readings, ongoing study throughout the course (not just before exams), and preplanning for papers and projects. Although the reading load in nursing school is heavy, the student should read everything assigned. Ideally, papers should be written, put away, and then reviewed at a later time prior to submission. 2. The nurse has received a financial aid package that has a “forgiveness” clause. What can the nurse expect as a result of this clause being part of this package? 1. If the student decides to change majors, the financial aid will be transferred to the new degree. 2. The student will not have to pay back some portion of the financial aid package if the student works is a specific location for a period of time after graduation. 3. Because the student is going to be a nurse, the amount of the financial aid package will be forgiven if the nurse continues to pursue advanced degrees in nursing. 4. The student won’t have to pay any money back unless the student’s grades fall below satisfactory. Answer: 2 Explanation: Although financial aid packages can be written in many ways, the most common meaning of “forgiveness” is that the recipient will not have to pay a portion (or sometimes all) of the money back if the recipient works in a specific location or specialty for a period of time after graduation. In most cases, financial aid packages change (and may be invalid or have to be repaid) when majors change or when grades are not satisfactory. In either case, the money owed is not forgiven. Although the student may continue to receive aid of some sort while seeking advanced degrees, there is a limit to federal aid that cannot be exceeded; and simply seeking advanced degrees does not mean that money owed does not have to be repaid. 3. The nursing student would like to talk with a faculty adviser prior to registering for next semester’s classes. What is the best strategy for this student? 1. Catch the faculty member after a lecture and ask for a few minutes to talk. 2. Stop by the faculty member’s office to see whether the faculty member has time to talk. 3. Call the faculty member and request a time to meet for advisement. 4. Talk to the faculty member in the cafeteria at school. Answer: 3 Explanation: Faculty have multiple assignments and responsibilities. The best way to assure that the faculty member is prepared to help the student is for the student to call for an appointment. Although it might be more convenient for the student to catch the faculty member after a lecture or during lunch, the faculty member is likely not to be focused on the student’s needs at those times. Dropping by the faculty member’s office is the second best option, but the faculty member may be engaged with another student or another responsibility, so the best use of time is to call for an appointment. 4. The nursing faculty has instructed students to use electronic literature databases to research for course papers. Which option is an electronic literature database? (Select all that apply) 1. Medline 2. Statistical Package for the Social Sciences (SPSS) 3. Turnitin.com 4. Cumulative Index to Nursing and Allied Health Literature (CINAHL) 5. American Psychological Association (APA) Answer: 1, 4 Explanation: Medline and CINAHL are two examples of electronic literature databases. SPSS is a statistical program used to analyze data collected in nursing research projects. Turnitin.com is a plagiarism prevention program. APA is a specific writing style. Learning Objective 1.6 Implement personal lifestyle and study strategies to promote success. 1. The nursing student is concerned because a faculty member does not follow the outline of the textbook chapters during class. What is true about this situation? 1. Many faculty use textbook reading as background for more advanced discussion. 2. The student should bring this oversight to the faculty member’s attention. 3. The only way to correct this behavior is to report the faculty to the director of the nursing program. 4. The faculty member is probably not very comfortable with the material in the textbook. Answer: 1 Explanation: Many nursing faculty use textbook reading to provide background information for more advanced discussion of the topic being covered. There is no indication that this faculty member is not comfortable with the textbook material. This educational strategy is valid and is not a reason for the student to report the faculty member or to enlighten the faculty member about what the student identifies as an oversight. 2. The nursing student has identified a discrepancy between what is written in the textbook and what the nursing faculty member said during theory class. What should the student do? 1. Wait and see whether the material is covered on the next exam. 2. Ask a clinical staff nurse for clarification of the topic. 3. Request an appointment with the faculty member who taught the material. 4. Look the topic up on the Internet for clarification. Answer: 3 Explanation: In this case, the discrepancy is between what is written in the textbook and what the student has understood from theory class. The most logical approach is to request an appointment with the faculty member who taught the material so that questions about the topic can be discussed. Reputable Internet sites and clinical staff nurses are good resources for general topics, but this question is a particular discrepancy that should be clarified with the person who taught the material. Waiting to see whether the material is covered on the next exam is a passive action that will not help the student learn the correct concepts. 3. The nursing student is planning to study all weekend for a final exam scheduled on Monday. Is this a good strategy for study? 1. Yes; this method will assure all material is fresh in the student’s mind. 2. No; the student should plan on an all-night study session on Sunday night only. 3. Yes, but the best strategy is to invite six or seven fellow students to join in the session. 4. No; study should be incremental across the semester with a general review the day before the exam. Answer: 4 Explanation: The best strategy is to study often, covering small portions of content as they are presented in the theory classroom. Marathon study sessions such as the one described in this question do not allow for consideration and processing of the material. The presence of multiple people in the marathon study session is even less productive. These large sessions tend to become social events rather than study events. All-night study sessions make the student sleep deprived on the day of the examination. 4. How much study should the student plan for each hour spent in class per week? 1. 30 minutes 2. 1 to 3 hours 3. 4 to 5 hours 4. 8 hours Answer: 2 Explanation: The minimum recommended time for study is 1 hour for each hour spent in class. Most experts recommend between 1 and 3 hours of study for each hour spent in class. Learning Objective 1.7 Use pedagogic features to enhance learning. 1. Why is self-reflection important to the student? 1. It is the only way to discover whether the student is suitable for nursing. 2. Self-reflection is required by the state nursing practice acts of all states. 3. It helps the student understand self in relation to professional role. 4. Self-reflection is part of the code of ethics for nurses. Answer: 3 Explanation: Self-reflection is important in understanding self in relation to the professional role of a nurse. Although self-reflection is very important, it is not a state nursing practice act requirement or a part of the code of ethics for nurses. There are many ways to discover the student’s suitability for nursing. 2. The nursing student is completing the Critical Thinking Exercises in the textbook. What is a strategy for getting the most benefit from these exercises? 1. Look for the single best answer to the questions asked. 2. Work independently to find answers. 3. Look for answers in an appendix in the back of the book. 4. Discuss the questions with classmates. Answer: 4 Explanation: Discussing the Critical Thinking Exercises in the book with classmates can enhance and expand the student’s understanding of text content. These exercises have multiple answer possibilities, and it is often best to work in groups on the answers. Simply looking up answers in the book is not a good way to learn. 3. The nursing student attempting to validate an Internet source wonders whether the source’s author is credible in the field. How can this student make this determination? (Select all that apply) 1. Review the author’s credentials. 2. Assume the author is credible because he or she is published on the Internet. 3. Conduct a literature search using the author’s name. 4. Look for links to information about the author. 5. Identify sites sponsored by the author individually as valid. Answer: 1, 3, 4 Explanation: In order to assess an author’s credibility, the student should review the author’s credentials, conduct a literature search using the author’s name, or look for links to information about the author. Just because an author is published on the Internet does not mean the author is credible. Authors that self-sponsor their Internet sites may not be credible. 4. What is one indicator that an Internet site may not be accurate? 1. A long bibliography is provided for additional information. 2. There are spelling errors on the site. 3. An editor is listed on the site. 4. Background information is provided by link, not on site. Answer: 2 Explanation: To assess the accuracy of an Internet site, the reader should look for a bibliography or links to background information or bibliography. Spelling errors and grammatical errors may indicate that there is no editor for the site, suggesting that the material has not been reviewed for accuracy.