Chapter 14- Facing the Challenges of Todays Workplace My Nursing Test Banks

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Base Settings: Brownstone Default

Information Field: Client Needs

Information Field: Cognitive Level

Information Field: Difficulty

Information Field: Integrated Process

Information Field: Objective

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Highest Answer Letter: D

Multiple Keywords in Same Paragraph: No

Chapter: Chapter 14: Facing the Challenges of Todays Workplace

Multiple Choice

1. A nurse begins to feel comfortable on her unit and views client care in terms of long-range goals. She is able to prioritize among clients and deliberately plan her actions, which may still lack speed and flexibility. Which of Benners levels of function has this nurse achieved?

A) Novice

B) Advanced beginner

C) Competent

D) Proficient

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 505, Table 14.1

Feedback: Characteristics of the competent nurse include beginning to see the current situation in terms of long-range goals. This nurse is able to prioritize among patients and base actions on conscious deliberate planning but may still lack speed and flexibility. As such, the competent nurse is more adept than the novice and advanced beginner but less skilled than the proficient nurse.

2. A novice nurse apprehensively reflects on what she considers to be an impossible task of delivering quality care on her ward as it is assigned to her. What is the name of this phenomenon first coined by Marlene Kramer?

A) Burnout

B) Reality shock

C) Culture shock

D) Job disorientation

Ans: B

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 2

Page and Header: 506, Reality Shock

Feedback: One problem confronted by the new graduate is the seeming impossibility of delivering quality care within the constraints of the system as it exists. Kramer characterized this phenomenon as reality shock, not burnout, culture shock or job disorientation.

3. A counselor diagnoses a critical care nurse with having the syndrome known as burnout. Which of the following is a characteristic of this condition?

A) Burnout occurs when a nurse first enters the workplace and is overwhelmed by the workload.

B) All of the symptoms of burnout are psychological in nature.

C) Burnout is accompanied by a decreased ability to function on the job and at home.

D) Burnout occurs less often in high-energy areas, such as critical care or burn units.

Ans: C

Client Needs: C

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 511, Burnout

Feedback: Burnout is accompanied by a decreased ability to function both on the job and in the personal life. Burnout occurs more frequently in nurses who work in particularly stressful areas of nursing, such as critical care, oncology, or burn units. It does not typically occur early in a nurses time in a particular setting and it can result in physical manifestations.

4. A hospital manager is accused of quid pro quo sexual harassment. Which of the following is an action that might have been involved?

A) Making persistent unwanted attempts to initiate a personal relationship

B) Granting job-related benefits in return for sexual favors

C) Using suggestive or obscene language

D) Making direct sexual advances

Ans: B

Client Needs: C

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 8

Page and Header: 523, Sexual Harassment

Feedback: Quid pro quo sexual harassment involves the explicit offer of job-related benefits in return for sexual favors. It is not defined by direct advances, attempting to initiate a relationship, or suggestive language, though some or all of these activities may be present in the exchange.

5. A hospital manager evaluates the workplace to ensure that ergonomics are working. Which of the following statements describes this scientific theory?

A) Ergonomics is the study of client outcomes related to economic theories in healthcare.

B) Ergonomics empowers clients to have a voice in their own plan of care.

C) Ergonomics ensures that jobs are fitted to the physical abilities of the employees.

D) Ergonomics provides guidelines for delegating responsibilities for client care.

Ans: C

Client Needs: A-2

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 6

Page and Header: 517, Ergonomic Hazards in the Workplace

Feedback: Ergonomics is the science of fitting a task to ones physical characteristics in order to enhance safety, efficiency, and well-being. When the task does not conform to ones physical characteristics, musculoskeletal stress and injuries may occur. Ergonomics does not address client outcomes, delegation, or client autonomy.

6. Researchers have noted a high incidence of burnout among nurses. Which of the following nurses most likely faces the highest risk of burnout?

A) An experienced nurse who has long neglected her own physical health and who leads a sedentary lifestyle.

B) A nurse who provides pediatric palliative care and who is disillusioned with the overall quality of care on the unit.

C) A nurse who has recently graduated with an ADN degree and begun working in a busy, inner-city emergency department.

D) A nurse who is few months away from retirement from her current position in community health.

Ans: B

Client Needs: C

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Caring

Objective: 3

Page and Header: 512, Causes of Burnout

Feedback: Prominent among the causes of burnout is a conflict between ideals and reality. As well, practice environments with high mortality rates are associated with burnout. Poor physical health predisposes a nurse to burnout, but this is likely less salient than the combination of disillusionment and high acuity. New graduates and those approaching retirement are not particularly predisposed to burnout.

7. Melissa is a nurse who graduated earlier this year with a baccalaureate degree in nursing and immediately began working on a busy surgical unit with a high turnover of both the patients and the staff. As a result, Melissa has found the adjustment to full-time employment particularly stressful. Which of the following actions should Melissa take in order to manage the stress in her life?

A) Schedule a vacation for later in the year and focus on this upcoming trip when she is experiencing high levels of stress.

B) Reduce her workload to part-time and supplement this with casual employment on a lower-stress unit.

C) Be vigilant in personal habits that result in adequate rest, a healthy diet, and adequate physical exercise.

D) Reduce or eliminate the specific interactions in the clinical setting that cause her the most stress.

Ans: C

Client Needs: C

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 511, Personal Stress Management

Feedback: Attending to diet, rest, and activity is important in the management of job-related stress. These measures are more likely to be of benefit than trying to endure until a distant vacation. Adding another workplace has the potential to increase stress and it is not normally realistic to eliminate stressful interactions in the workplace.

8. A recent nursing graduate has become overwhelmed with reality shock in recent weeks, despite the fact that he secured a job in the setting that was his first choice. This nurses best response to his experience with reality shock is to

A) confront the manager of the unit with the details of his experience.

B) reduce the performance expectations that he places on himself.

C) prioritize physical assessments and interventions over patients psychosocial needs.

D) seek input from a trusted nurse who can act as a coach or mentor.

Ans: D

Client Needs: C

Cognitive Level: Application

Difficulty: Easy

Integrated Process: Caring

Objective: 3

Page and Header: 509, Preceptors, Coaches, and Mentors

Feedback: A coach or mentor can be of great assistance when recent nursing graduates are faced with reality shock. Such a person may be of more benefit than the manager of the unit, who may be too busy to assist the nurse with his adjustment. Reducing the quality of care or reducing expectations may place the burden of the nurses reality shock on patients themselves, which is inappropriate.

9. A nurse who provides care in a busy ambulatory clinic knows that there are numerous occupational hazards associated with the provision of nursing care. What is the employers responsibility in minimizing the nurses risk of experiencing an injury or infection?

A) The employer must provide all the necessary supplies and equipment to prevent injuries and infections.

B) The employer must ensure that staffing levels are maintained at a level specified by the state board of nursing.

C) The employer must have dedicated occupational health officers present at all times.

D) The employer must release nurses from tasks that may present a threat to their health.

Ans: A

Client Needs: A-2

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 6

Page and Header: 515, Infection as an Occupational Hazard

Feedback: Employers must be held accountable for providing the supplies and environment to make work settings safe. All risks cannot normally be eliminated and dedicated occupational health staff may or may not be available or necessary. Safe staffing levels are important, but these do not necessarily mitigate the risk of workplace injuries and infections.

10. Racial and ethnic discrimination has been identified as a reality within healthcare institutions. Which of the following goals for the nursing profession is most appropriate?

A) The nursing workforce should transcend racial and ethnic categorization and should not be appraised through this lens.

B) The nursing workforce should have fewer Caucasian members and more racial/ethnic minorities.

C) The nursing workforce should be made up of members from as many cultures as possible.

D) The nursing workforce should reflect the population for whom it provides care

Ans: D

Client Needs: C

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Caring

Objective: 7

Page and Header: 520, Racial/Ethnic Discrimination

Feedback: A workforce that reflects the population is more likely to meet the healthcare needs of that population in a culturally sensitive manner. It is simplistic to presume that the solution to discrimination lies with fewer Caucasians and more minorities. Similarly, increasing the number of cultures represented within nursing will not necessarily eliminate discrimination.

11. A nurse who works in a rural hospital has become frustrated and disillusioned at the steady increases in nurse to patient ratios at the same time that patient acuity has increased. When planning to address this issue with the hospitals leadership, the nurse should cite which of the following statements about increased nurse to patient ratios?

A) Increased nurse to patient ratios are associated with a decline in patient outcomes.

B) Reality shock is more common and severe when there are increased nurse to patient ratios.

C) An increased nurse to patient ratio increases the incidence of disruptive behavior in hospital settings.

D) Discrimination and stress increase when there is an increase in nurse to patient ratios.

Ans: A

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 5

Page and Header: 514, Nurse Staffing Levels

Feedback: Increased nurse to patient ratios have been shown to result in decreased patient outcomes. There are other deleterious effects on nurses, including reality shock and stress, but patient outcomes should be the primary consideration.

12. A nurse was helping a colleague boost a patient higher in his bed she felt sudden pain in her lumbar region. How should the nurse follow up this event?

A) Make an appointment with a physician and document the injury if there are significant results.

B) Have a trusted colleague perform a musculoskeletal assessment and monitor the nurses range of motion for the remainder of the shift.

C) Go home immediately and take enough sick time to allow her back to recover completely before returning to work.

D) Document the event as soon as possible using the hospitals designated forms.

Ans: D

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 6

Page and Header: 519, Workers Compensation

Feedback: A nurse who suspects an injury should report the event promptly using the appropriate paperwork. A common error is to delay reporting in the belief that you should report something only if you know it will be serious or require medical care. It is insufficient to leave work without documenting the event or to rely on a colleagues assessment and care.

13. Three times in the past several weeks a physician has commented on a nurses body and each comment has been more explicit and sexually suggestive than the last. How should the nurse first respond to this form of sexual harassment?

A) Avoid contact with the physician except in locations where there are colleagues or other witnesses.

B) Ignore the physician if more comments are made in the future.

C) Confront the physician directly and explain that such comments are unacceptable and unwanted.

D) Document the events in detail and inform the state medical board.

Ans: C

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 9

Page and Header: 523, Sexual Harassment

Feedback: Individuals should take steps to stop sexual harassment by giving clear, direct verbal messages indicating that the behavior in question is unwanted, unpleasant, and must stop. Sometimes this action alone stops inappropriate behavior. If clear, direct messages are not successful, the individual then should report the matter in writing to an immediate supervisor. Simply avoiding the offender or attempting to manage the behavior by reducing opportunities are not sufficient responses.

14. Despite being seen as a safe environment where victims of violence are treated, hospitals are the site of a large number of assaults. Which of the following care environments is associated with the greatest risk of physical violence?

A) Psychiatric mental health

B) Geriatrics and gerontology

C) Critical care and acute medicine

D) Labor and delivery

Ans: A

Client Needs: A-2

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 10

Page and Header: 525, Violence in the Workplace

Feedback: The majority of client assaults occur in psychiatric mental health settings.

15. A string of recent assaults perpetrated on nurses by clients has prompted the hospital administrators to address this disturbing trend. What action should the administrators prioritize in an effort to reduce the incidence of workplace violence?

A) Ensure that at least one male nurse is present at all times on each nursing unit.

B) Teach self-defense techniques to all the nurses who provide care in high-risk settings.

C) Train nurses how to effectively manage the behavior of aggressive patients and clients.

D) Withhold care from patients and clients who have a history of aggression.

Ans: C

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 10

Page and Header: 525, Violence in the Workplace

Feedback: One form of violence prevention is to train employees in the management of hostile and violent behavior. Ways of identifying hostile and assaultive clients should be developed so that staff can be warned to take extra personal safety precautions. This is different from teaching self-defense techniques, which are normally physical in nature. It is not normally possible to withhold care from an individual, even if the person has a history of violence or aggression. The presence of male nurses is not an adequate measure in the prevention of violence.

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