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Advantage Basic Nursing Thinking, Doing, and Caring
2nd
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MULTIPLE CHOICE
1. Which is the most influential factor that has shaped the nursing profession?
1) Physicians’ need for handmaidens
2) Societal need for healthcare outside the home
3) Military demand for nurses in the field
4) Germ theory influence on sanitation
ANS: 3
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Define nursing in your own words.
Chapter page reference: p. 7
Heading: Historical Context of Nursing
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Professionalism
Difficulty: Easy
Feedback
1 The physician's handmaiden was/is a nursing stereotype rather than an influence
on nursing.
2 Although there has been a need for healthcare outside the home throughout
history, this has more influence on the development of hospitals than on
nursing; this need provided one more setting for nursing work.
3 Throughout the centuries, stability of the government has been related to the
success of the military to protect or extend its domain. As the survival and
well-being of soldiers are both critical, nurses provided healthcare to the sick
and injured at the battle site.
4 Germ theory and sanitation helped to improve healthcare but did not shape
nursing.
4. Which aspect of the full-spectrum nursing role is essential for the nurse to do in order to
successfully carry out all the others?
1) Thinking and reasoning about the client’s care
2) Providing hands-on client care
3) Carrying out physician orders
4) Delegating to assistive personnel
ANS: 1
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Name and recognize the four purposes of nursing care.
Chapter page reference: p. 8
Heading: Nursing Today: Full-Spectrum Nursing
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Analysis [Analyzing]
Concept: Patient-Centered Care
Difficulty: Difficult
Feedback
1 A substantial portion of the nursing role involves using clinical judgment,
critical thinking, and problem solving, which directly affect the care the client
will actually receive.
2 Providing hands-on care is important; however, clinical judgment, critical
thinking, and problem-solving are essential to do it successfully.
3 Carrying out physician orders is a small part of a nurse’s role; it, too, requires
nursing assessment, planning, intervention, and evaluation.
4 Many simple nursing tasks are being delegated to nursing assistive personnel;
delegation requires careful analysis of patient status and the appropriateness of
support personnel to deliver care.
5. Which statement pertaining to Benner’s practice model for clinical competence is true?
1) Progression through the stages is constant, with most nurses reaching the proficient
stage.
2) Progression through the stages involves continual development of thinking and
technical skills.
3) The nurse must have experience in many areas before being considered an expert.
4) The nurse’s progress through the stages is determined by years of experience and
skills.
ANS: 2
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Discuss the transitions nursing education has undergone in the last
century.
Chapter page reference: p. 12
Heading: Benner’s Model
Integrated Processes: Caring
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 Movement through the stages is not constant.
2 Benner’s model is based on integration of knowledge, technical skill, and
intuition in the development of clinical wisdom.
3 The model does not mention experience in many areas.
4 The model does not mention years of experience.
6. Which best explains why it is difficult for the profession to develop a definition of nursing?
1) There are too many different and conflicting images of nurses.
2) There are constant changes in healthcare and the activities of nurses.
3) There is disagreement among the different nursing organizations.
4) There are different education pathways and levels of practice.
ANS: 2
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Discuss the transitions that nursing education has undergone in the
last century.
Chapter page reference: p. 8
Heading: How Is Nursing Defined?
Integrated Processes: Caring
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Analysis [Analyzing]
Concept: Professionalism
Difficulty: Difficult
Feedback
1 The conflicting images of nursing make it more important to develop a
definition; they may also make it more difficult but not to the extent that
constant change does.
2 Healthcare is constantly changing and with it come changes in where, how, and
what nursing care is delivered. Constant changes make it difficult to develop a
definition.
3 Although different nursing organizations have different definitions, they are
similar in most ways.
4 The different education pathways affect entry into practice, not the definition of
nursing.
7. Nurses have the potential to be very influential in shaping healthcare policy. Which factor
contributes most to nurses’ influence?
1) Nurses are the largest health professional group.
2) Nurses have a long history of serving the public.
3) Nurses have achieved some independence from physicians in recent years.
4) Political involvement has helped refute negative images portrayed in the media.
ANS: 1
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Discuss issues related to healthcare reform.
Chapter page reference: p. 24
Heading: Influence of Nurses on Health Policy
Integrated Processes: Caring
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Health Care System
Difficulty: Easy
Feedback
1 Nurses are trusted professionals and the largest health professional group. As
such, they have political power to effect changes. If nursing were a small group,
there would be little potential for power in shaping policies, even if all the other
answers were true.
2 Serving the public, although positive, does not necessarily help nurses to be
influential in establishing health policy.
3 Independence from physicians, although positive, does not necessarily make
nurses influential in establishing healthcare policy.
4 Refuting negative media, although positive, does not necessarily make nurses
influential in establishing healthcare policy.
8. Nursing was described as a distinct occupation in the sacred books of which faith?
1) Buddhism
2) Christianity
3) Hinduism
4) Judaism
ANS: 3
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Discuss the transitions that nursing education has undergone in the
last century.
Chapter page reference: p. 6
Heading: Historical Context of Nursing
Integrated Processes: Caring
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Knowledge [Remembering]
Concept: Professionalism
Difficulty: Easy
Feedback
1 Nursing was not described as a distinct occupation in the sacred books of
Buddhism.
2 Nursing was not described as a distinct occupation in the sacred books of
Christianity.
3 The Vedas, the sacred books of the Hindu faith, described Indian healthcare
practices and were the earliest writings of a distinct nursing occupation.
4 Nursing was not described as a distinct occupation in the sacred books of
Judaism.
11. Which provides evidence-based support for the contribution that advanced practice nurses
(APNs. make within healthcare?
1) Reduced usage of diagnostics using advanced technology
2) Decreased number of unnecessary visits to the emergency department
3) Improved patient compliance with prescribed treatments
4) Increased usage of complementary alternative therapies
ANS: 3
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Name nine expanded roles for nursing.
Chapter page reference: p. 22
Heading: Expanded Career Roles for Nurses
Integrated Processes: Nursing Process – Planning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 No well-known scientific studies support APNs’ effect on the use of advanced
technology.
2 No well-known scientific studies support APNs’ effect on the frequency of
emergency department visits.
3 Studies demonstrate that APNs have improved patient outcomes over those of
physicians, including increased patient understanding and cooperation with
treatments and decreased need for hospitalizations.
4 No well-known scientific studies support APNs’ effect on the use of alternative
therapies.
12. Which is an example of what traditional medicine and complementary and alternative
medicine therapies have in common?
1) Both can produce adverse effects in some patients.
2) Both use prescription medications.
3) Both are usually reimbursed by insurance programs.
4) Both are regulated by the FDA.
ANS: 1
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Delineate the forces and trends affecting contemporary nursing
practice.
Chapter page reference: p. 22
Heading: What Are Some Trends in Nursing and Healthcare?
Integrated Processes: Caring
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 Both traditional and complementary therapies can produce adverse effects in
some patients.
2 Many medications are derived from herbs, but the alternative treatments usually
use the herbs, not prescription medication.
3 Insurance programs do not necessarily reimburse alternative treatments, because
many are not supported by sound scientific research methodology.
4 Alternative medications are not regulated by the FDA.
13. Which is the biggest disadvantage of having nursing assistive personnel (NAP) assist nurses
in practice?
1) Nurses must know what aspects of care can legally and safely be delegated to the
NAP.
2) Nurses may rely too heavily on information gathered by the NAP when making
patient care decisions.
3) Nurses are removed from many components of direct patient care that have been
delegated to the NAP.
4) Nurses still maintain responsibility for the patient care given by the NAP.
ANS: 2
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Delineate the forces and trends affecting contemporary nursing
practice.
Chapter page reference: p. 24
Heading: Increased Use of Nursing Assistive Personnel
Integrated Processes: Nursing Process – Implementation
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Collaboration
Difficulty: Easy
Feedback
1 All of the options may be disadvantages to using NAPs, but making decisions
based on another’s information is the greatest drawback because of the potential
for negatively affecting patient care. Treatment decisions based on incorrect
information may cause harm to the patient.
2 All of the options may be disadvantages to using NAPs, but making decisions
based on another’s information is the greatest drawback because of the potential
for negatively affecting patient care. Treatment decisions based on incorrect
information may cause harm to the patient.
3 All of the options may be disadvantages to using NAPs, but making decisions
based on another’s information is the greatest drawback because of the potential
for negatively affecting patient care. Treatment decisions based on incorrect
information may cause harm to the patient.
4 All of the options may be disadvantages to using NAPs, but making decisions
based on another’s information is the greatest drawback because of the potential
for negatively affecting patient care. Treatment decisions based on incorrect
information may cause harm to the patient.
14. An older adult patient is diagnosed with type 1 diabetes mellitus (DM). The patient can
perform self-care activities but needs help with shopping and meal preparation as well as with
blood glucose monitoring and insulin administration. Which type of healthcare facility would
be most appropriate for this patient?
1) Acute care facility
2) Ambulatory care facility
3) Extended care facility
4) Assisted living facility
ANS: 4
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Describe the healthcare delivery system in the United States,
including sites for care, types of workers, regulation, and financing of healthcare.
Chapter page reference: p. 16
Heading: Extended Care Facilities
Integrated Processes: Nursing Process – Planning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Acute care facilities focus on preventing illnesses and treating acute problems.
These facilities include physicians’ offices, clinics, and diagnostic centers.
2 Ambulatory care facilities provide outpatient care. Clients live at home or in
nonhospital settings and come to the site for care. Ambulatory care facilities
include private health and medical offices, clinics, surgery centers, and
outpatient therapy centers.
3 Extended care facilities typically provide long-term care, rehabilitation, wound
care, and ongoing monitoring of patient conditions.
4 Assisted living facilities are intended for those who are able to perform self-care
activities but who require assistance with meals, housekeeping, or medications.
16. Which healthcare worker should the nurse consult to counsel a patient about financial and
family stressors affecting healthcare?
1) Social worker
2) Occupational therapist
3) Physician’s assistant
4) Technologist
ANS: 1
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Describe the healthcare delivery system in the United States,
including sites for care, types of workers, regulation, and financing of healthcare.
Chapter page reference: p. 17
Heading: Who Are the Members of the Interprofessional Healthcare Team?
Integrated Processes: Nursing Process – Planning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Collaboration
Difficulty: Moderate
Feedback
1 The social worker coordinates services and counsels patients about financial,
housing, marital, and family issues affecting healthcare.
2 The occupational therapist helps patients regain function and independence in
activities of daily living.
3 Physician’s assistants work under the physician’s direction to diagnose certain
diseases and injuries.
4 Technologists provide a variety of specific functions in hospitals, diagnostic
centers, and emergency care. For example, laboratory technologists aid in the
diagnosis and treatment of patients by examining blood, urine, tissue, and body
fluids. Radiology technologists perform x-rays and other diagnostic testing.
17. Which type of managed care allows patients the greatest choice of providers, medications, and
medical devices?
1) Health maintenance organization
2) Integrated delivery network
3) Preferred provider organization
4) Employment-based private insurance
ANS: 3
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Describe the healthcare delivery system in the United States,
including sites for care, types of workers, regulation, and financing of healthcare.
Chapter page reference: p. 19
Heading: Managed Care
Integrated Processes: Nursing Process – Planning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Health maintenance organizations allow patients to choose a primary care
provider within the organization to coordinate their care. This type of program
will only reimburse medical care when patients have first obtained a referral
from their primary providers.
2 Integrated delivery networks combine providers, healthcare facilities,
pharmaceuticals, and services into one system, and patients must remain within
the system to receive care.
3 Preferred provider organizations are a form of managed care that allows patients
greater choice of providers, medications, and medical devices within the
designated list.
4 Employment-based private insurance is not a managed care organization.
PTS: 1 CON: Patient-Centered Care
18. A patient who underwent a total abdominal hysterectomy is assisted out of bed as soon as her
vital signs are stable. Which item is directing this intervention?
1) Critical pathway
2) Nursing care plan
3) Case manager
4) Traditional care model
ANS: 1
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Delineate the forces and trends affecting contemporary nursing
practice.
Chapter page reference: p. 20
Heading: Work Redesign
Integrated Processes: Nursing Process – Implementation
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Health Care System
Difficulty: Easy
Feedback
1 This patient’s care is most likely being directed by a critical pathway. A critical
pathway is a multidisciplinary approach to care that sequences interventions
over a length of stay for a given case type such as total abdominal hysterectomy.
Using this model, the patient can be assisted out of bed as soon as her vital signs
are stable.
2 The nursing care plan guides nursing care but cannot specify when the patient
can get out of bed postoperatively without a physician’s order.
3 When case management is used, care is coordinated by the case manager across
the healthcare setting, but the case manager does not direct each care
intervention.
4 Using the traditional model, the nurse would have to obtain a physician’s order
to assist the patient out of bed after surgery.
19. Which member of the healthcare team typically serves as the case manager?
1) Occupational therapist
2) Physician
3) Physician’s assistant
4) Registered nurse
ANS: 4
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Name nine expanded roles for nursing.
Chapter page reference: p. 9
Heading: Table 1-1 Roles and Functions of the Nurse
Integrated Processes: Caring
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Collaboration
Difficulty: Easy
Feedback
1 The occupational therapist, physician, and physician’s assistant all serve on the
healthcare team and take direction from the case manager.
2 The occupational therapist, physician, and physician’s assistant all serve on the
healthcare team and take direction from the case manager.
3 The occupational therapist, physician, and physician’s assistant all serve on the
healthcare team and take direction from the case manager.
4 Typically, registered nurses serve as case managers for patients with specific
diagnoses. Their role is coordinator of care across the healthcare system.
21. Which nursing activities represent direct care? Choose all that apply
1) Administering a medication
2) Documenting an assessment
3) Participating in a care conference
4) Making work assignments for the shift
ANS: 1
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Name nine expanded roles for nursing.
Chapter page reference: p. 15
Heading: Who Are the Recipients of Nursing Care?
Integrated Processes: Nursing Process – Implementation
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Comprehension [Understanding]
Concept: Professionalism
Difficulty: Easy
Feedback
1 Direct care involves personal interaction between the nurse and clients (e.g.,
giving medications, dressing a wound, or teaching a client about medicines or
care).
2 Nurses deliver indirect care when they work on behalf of an individual, group,
family, or community to improve their health status (e.g., restocking the code
blue cart [an emergency cart], ordering unit supplies, or arranging unit staffing).
3 Nurses deliver indirect care when they work on behalf of an individual, group,
family, or community to improve their health status (e.g., restocking the code
blue cart [an emergency cart], ordering unit supplies, or arranging unit staffing).
4 Nurses deliver indirect care when they work on behalf of an individual, group,
family, or community to improve their health status (e.g., restocking the code
blue cart [an emergency cart], ordering unit supplies, or arranging unit staffing).
22. An 80-year-old patient fell and fractured her hip and is in the hospital. Before the fall, the
patient lived at home with her spouse and managed their activities of daily living (ADLs) very
well. The hospital is ready to discharge the patient because the recommended length of stay in
a hospital has been exceeded. However, she cannot walk or perform ADLs independently. She
requires lengthy physical therapy and further monitoring of medications and both physical and
mental status. To which type of facility should the patient be transferred?
1) Nursing home
2) Rehabilitation center
3) Outpatient therapy center
4) None of these; she should receive home healthcare
ANS: 2
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Describe the healthcare delivery system in the United States,
including sites for care, types of workers, regulation, and financing of healthcare.
Chapter page reference: p. 16
Heading: Extended Care Facilities
Integrated Processes: Nursing Process – Planning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 A nursing home provides custodial care for those people who cannot live on
their own but who are not sick enough to require hospitalization. It provides a
room, custodial care, and opportunity for recreation.
2 A skilled nursing facility primarily provides skilled nursing care for patients
who can be expected to improve with treatment. For example, a patient who no
longer needs hospitalization may transfer to a skilled nursing facility, such as a
rehabilitation center, to get skilled care until able to return home.
3 This patient cannot ambulate or perform ADLs, so outpatient therapy and home
care would not be appropriate.
4 This patient cannot ambulate or perform ADLs, so outpatient therapy and home
care would not be appropriate.
23. A high school graduate desires to become a registered nurse in order to work in a community
setting. In which type of program should this student enroll?
1) RN-BSN
2) Associate degree
3) Diploma program
4) Baccalaureate degree
ANS: 4
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Differentiate between the various forms of nursing education.
Chapter page reference: p. 11
Heading: How Do Nurses’ Educational Paths Differ?
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Professionalism
Difficulty: Easy
Feedback
1 Nurses who have already received basic nursing education, passed the
NCLEX-RN® examination, and now desire to earn a baccalaureate degree
would enter an RN-BSN program.
2 Associate program nurses are prepared to provide direct patient care.
3 Diploma program nurses are prepared to provide direct patient care.
4 Baccalaureate degree nurses are prepared to address complex clinical situations,
provide direct patient care, work in community care, apply research findings,
and enter graduate education.
24. A practicing registered nurse wants to become a staff development educator. Which type of
education should this nurse investigate?
1) Master’s degree
2) Doctoral degree
3) Baccalaureate degree
4) Continuing education
ANS: 1
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Differentiate between the various forms of nursing education.
Chapter page reference: p. 11
Heading: How Do Nurses’ Educational Paths Differ?
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Professionalism
Difficulty: Easy
Feedback
1 Master’s degree programs prepare RNs to function in a more independent and
autonomous role, such as nurse educator.
2 Baccalaureate and master’s degrees are required before entrance to a doctoral
program. Courses of study in doctoral programs include practice or research.
3 Baccalaureate degree nurses are prepared to address complex clinical situations,
provide direct patient care, work in community care, apply research findings,
and enter graduate education.
4 Continuing education courses do not prepare nurses for a particular role.
25. In preparation for relocating to another state the nurse contacts the state board of nursing to
obtain the necessary transfer of nursing license. Where will the nurse learn about continuing
education requirements for the new state of practice?
1) State board of nursing
2) The Joint Commission
3) School of original nursing education
4) Human resource department at new place of employment
ANS: 1
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Differentiate between the various forms of nursing education.
Chapter page reference: p. 11
Heading: How Do Nurses’ Educational Paths Differ?
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Professionalism
Difficulty: Easy
Feedback
1 The state board of nursing notifies nurses about continuing education
requirements and will notify nurses of any changes in the requirements.
2 The Joint Commission is a regulatory body that does not license nurses.
3 The school of original nursing education will not notify registered nurses about
continuing education requirements for licensure.
4 The Human Resources department at the new place of employment will not
notify or track continuing education requirements for the nursing staff.
MULTIPLE RESPONSE
26. Which are examples of a health-promotion activity? Select all that apply.
1) Helping a client develop a plan for a low-fat, low-cholesterol diet
2) Disinfecting an abraded knee after a child falls off a bicycle
3) Administering a tetanus vaccination after an injury from a car accident
4) Distributing educational brochures about the benefits of exercise
5) Administering a measles, mumps, rubella (MMR) immunization to a toddler at 15
months of age
ANS: 1, 4, 5
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Discuss issues related to healthcare reform.
Chapter page reference: p. 18
Heading: Nursing and Health Promotion
Integrated Processes: Nursing Process – Implementation
Client Need: Health Promotion and Maintenance
Cognitive level: Comprehension [Understanding]
Concept: Health Promotion
Difficulty: Moderate
Feedback
1. This is correct. Health promotion includes strategies that promote positive lifestyle
changes, such a developing a healthy diet.
2. This is incorrect. Disinfecting an abraded knee is a treatment/intervention for an
injury.
3. This is incorrect. Administering a vaccination is a disease-prevention and treatment
activity.
4. This is correct. Health promotion includes strategies that promote positive lifestyle
changes.
5. This is correct. Primary care focuses on health promotion and disease prevention.
Activities include health education and immunizations for infectious diseases.
27. The nurse registers to attend an in-service education program. What should the nurse expect
this program to provide? Select all that apply.
1) Review of new policies
2) Introduction to new equipment
3) Credit toward a professional nursing degree
4) Continuing education hours for license renewal
5) Enhancement of competency in knowledge, skills, and attitudes
ANS: 1, 2, 5
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Differentiate between the various forms of nursing education.
Chapter page reference: p.11
Heading: How Do Nurses’ Educational Paths Differ?
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Professionalism
Difficulty: Moderate
Feedback
1. In-service education is institution specific and provides information about policy
changes.
2. In-service education is institution specific and provides information about the use of
new equipment.
3. In-service education does not provide credit toward a professional nursing degree.
4. In-service education does not count toward meeting the continuing education
requirement for licensure or renewal.
5. In-service education is designed to enhance continuing competence in knowledge,
skills, and attitudes.
28. The nurse manager prepares information on the regulations of nursing practice for a group of
new nursing employees. Which information should the manager include in this presentation?
Select all that apply.
1) Laws
2) Standards of practice
3) Facility policies and procedures
4) The Joint Commission regulations
5) Professional organization guidelines
ANS: 1, 2, 5
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Explain how nursing practice is regulated.
Chapter page reference: p. 13
Heading: How Is Nursing Practice Regulated?
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Professionalism
Difficulty: Easy
Feedback
1. Laws regulate the practice of nursing
2. Standards of practice regulate the practice of nursing
3. Facility policies and procedures do not regulate the practice of nursing.
4. The Joint Commission regulations are not used to regulate the practice of nursing.
5. Guidelines from professional organizations regulate the practice of nursing
29. The nursing instructor provides a program on the state board of nursing for students preparing
to graduate from a school of nursing. What should the instructor emphasize about the role of
the state boards of nursing? Select all that apply.
1) Approve nursing education programs
2) Define the scope of practice for nursing
3) Develop rules and regulations for nursing practice
4) Provide guidance on knowledge, skills, and attitudes
5) Publish statements of duties for competent performance
ANS: 1, 2, 3
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Explain how nursing practice is regulated.
Chapter page reference: p. 13
Heading: How Is Nursing Practice Regulated?
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Professionalism
Difficulty: Easy
Feedback
1. Each state board of nursing is responsible for approving nursing education
programs.
2. Each state board of nursing is responsible for defining the scope of practice for
nursing.
3. Each state board of nursing is responsible for developing rules and regulations for
guidance to nurses.
4. Standards provide a guide to the knowledge, skills, and attitudes (KSAs) that nurses
must incorporate into their practice to provide safe, quality care.
5. Standards are authoritative statements of the duties that all registered nurses,
regardless of role, population, or specialty, are expected to perform competently.
30. The nurse reviews standards of professional practice every 3 to 4 months. Why does the nurse
complete this review? Select all that apply.
1) Judge own performance
2) Develop an improvement plan
3) Incorporate into evaluation tools
4) Educate the public about nursing
5) Understand employer expectations
ANS: 1, 2, 5
Chapter number and title: 1, Nursing Past & Present
Chapter learning objective: Explain how nursing practice is regulated.
Chapter page reference: p. 13
Heading: How Is Nursing Practice Regulated?
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive level: Application [Applying]
Concept: Professionalism
Difficulty: Moderate
Feedback
1. Practicing nurses use the standards to judge their own performance.
2. Practicing nurses use the standards to develop an improvement plan.
3. Employers may incorporate the standards into annual employee evaluation tools.
4. Professional organizations use the standards to educate the public about nursing.
5. Practicing nurses use the standards to understand employers’ expectations.
I went to bed early. I hadn’t had much sleep for three days, so at ten
o’clock in the morning I was still pounding my ear commodiously. I
was awakened by long, lean, drawling Tex MacDowell.
“Take a peek at the paper and then arise and shine,” he told me.
“We start for the Gulf of Mexico in exactly one hour.”
One peer at the headlines, that took up half the front page,
awakened me as thoroughly as a pail of ice water would have.
“Laguna In Ruins!” the paper screamed in letters big enough to
put on a signboard.
Within a moment I had the details. One of those tidal waves,
estimated as at least a hundred feet high and two miles in width, had
swept in from the Gulf. Doubtless the result of a volcanic eruption on
the sea floor. According to the meager reports available, every
house, structure and living thing existing in the portion of Laguna,
within a half mile of the beach, had been doomed by that vast crush
of water. The remainder of the town, back farther from the beach,
had been inundated; but houses were standing, and many of the
people had escaped alive. The low country—marshy ground, a lot of
it, anyway—was under three feet of water, and Laguna, as well as
small settlements along the beach, which had likewise been
demolished, was a marooned and ruined little city. Telegraph lines
down, railroads washed out, telephones useless, and at least one
thousand people dead or washed out to sea.
“We go over to patrol the Gulf for survivors,” Tex said tersely.
“Donovan Field ships will ferry food and water and medical supplies
down. We leave in an hour. Get a move on!”
All I could think of, as I made passes at my whiskers and leaped
into my clothes and gulped some food was this—how must it feel to
look up and see millions of tons of water about to fall on you? A ten
foot wave in a storm makes me feel like an ant bucking a steam
roller.
Four men were to be left at the field for patrol. Six ships were
warming up, as I ran out on the field. The roar of the half-dozen four
hundred and fifty horsepower Libertys fairly shook the earth, and
their propellers send clouds of dust swirling upward. As I approached
the line, a car tore into the airdrome. There was Shirley, her hair
blowing in the wind, as she streaked down the road toward the ships.
As I got closer, I saw her fling herself out of the roadster and
make a beeline for none other than Kennedy. Penoch O’Reilly was
standing near by, his face a study.
“Kennedy going down?” I asked him, noting meanwhile that
Shirley and Kennedy were holding hands.
“Begged to,” boomed O’Reilly. “He’s got guts, all right, and a
craving for excitement.”
“How’s he acting—toward you, I mean?”
“Doesn’t speak. Hardly speaks to anybody. I think he’s afraid
some of the rest are wise to him.”
Just then I saw Shirley lean forward, as if to kiss him good-by. He
looked around almost furtively and held her off. Mr. Ralph Kennedy,
for the moment, was very unsure of his ground. As Penoch and I
passed him on our way to our ships, his eyes rested on us for just a
moment. They were passionless, but when his face was serious the
meanness in it seemed to be intensified. Funny what an effect eyes
too close together can give. Add that mouth—and my imagination—
and perhaps you can see what I mean. Somehow, I shivered.
A moment later I was in my ship, giving her the last look-over, as
she strained against the wheel-blocks. Oil pressure, air pressure,
rotations per minute, battery-charging rate, temperature—all were O.
K. Captain Kennard was already swinging out on the field; I being
Number Two followed him, and the others took up the parade in their
proper positions. One by one we took off, circling the field for altitude
in single file. At a thousand feet the C. O. zoomed, and I slid in,
twenty-five feet behind him, twenty-five feet to one side, and ten feet
higher than he. Tex MacDowell came in on the left, and the others
followed, until a V of ships, three on one side and four on the other,
turned eastward and thundered their way toward the Gulf.
Much happened during our days at Laguna; but that has nothing to
do with Penoch O’Reilly and Ralph Kennedy. Anyway, twenty
minutes later we were all back in the air, carrying packages of food
and water, put up to float. Each of us had a sector assigned. We
went roaring out over the open Gulf, spotting survivors who were
floating on improvised rafts or clinging to planks. Kennard’s ship,
with Jack Beaman at the radio key, was flashing information to San
Antonio. Soon the Donovan ships would be coming in, carrying
supplies.
As we got out over the water, I turned to look at George Hickman,
pointing downward. He’s big and blond and nerveless; but his face
was strained, and there was the closest thing to fear, that I’ve ever
seen in his eyes.
As for me, I was one jump ahead of a fit. Down below, flashing
along between carcasses of human beings and animals, were what
seemed like untold hundreds of fins, cutting the water and feeding on
their prey. Six times we swooped low to drop food and water to those
poor wretches down below us. We could almost look into sharks’
eyes, and time after time the flash of a white belly announced
another mouthful.
Remember this, too. If we came down in the water, we could float
two hours. There was not a single serviceable boat to rescue a soul.
I flew six solid hours that day, as did every one of the others. It
was just before the last patrol, and getting dusk, when I ran into
Kennedy for the first time. Our landings hadn’t synchronized before.
“God!” I heard him mumble in an unutterably tired voice. “This’ll
drive me nuts! I can’t even swim, if I come down.”
“No difference, my boy,” Jimmy Jennings told him with an attempt
at jauntiness. “None of us could swim over a mile. Who thinks he
could make five hundred feet through that forest of fins?”
And he was right. It seemed as if every shark in the Atlantic
ocean had come to the picnic. But there were still unexplored
sections, little towns along the shore which needed help, and on we
went. Twenty Donovan ships were ferrying supplies; one came in
almost every ten minutes. God knows we were willing to fly until we
dropped. Those poor devils down in the water will haunt me to my
dying day, I guess.
The sun was setting, when I turned around from a spot ten miles out
in the Gulf, my last package dropped and my patrol over. My twelve-
cylinder Liberty had never missed a lick, and I remembered saying
over and over to the rhythm of the motors:
“If you’ll only keep it up—if you’ll only keep it up—”
My ears were ringing from a day’s bombardment; my face was so
sun-burnt with sun and wind that it was sore as a boil, and I was
more tired than I’ve ever been in my life. Two other D.H.’s, one a
mile to my right and the other on beyond, were coming home across
the vile, befouled water.
I was two thousand feet high, and land was six or seven miles
ahead, when Hickman grabbed me with a grip like a vise. My heart
did a backflip, and I turned as if I’d been shot. He was pointing to the
right. In a second I had swung my ship and was flying wide-open
toward that middle D.H.
It was coming down in a shallow dive. The propeller was turning
as slowly as a water-wheel. One look was enough to tell me that the
motor was dead, and that only the air-stream was moving the stick.
Two of the boys were going to the sharks.
I was diving now, motor full on. I don’t know why. I guess I had
some wild idea that I could help them out. The other ship was
heading for the falling D.H., too. We ranged alongside it almost
together. The pilot in the crippled plane was Ralph Kennedy. The
man in the third ship was Penoch O’Reilly.
Everyone was flying alone, except me, for two reasons. One was
to leave more room for supplies to drop; the other was to conserve
manpower as much as possible. I had George along to work the
radio. We’d reconnoitered some outlying towns on the trip.
It seemed a year before the ship hit, and I was thinking at top
speed, searching for some possible method of saving Kennedy. He
could float for two hours; then he’d be sunk—
Just before the ship hit the water I let out a wild yell, which I
myself couldn’t hear. Right ahead of Kennedy was a huge, partially
submerged thing floating. It looked like a bunch of logs tied together.
I guess he never saw it.
The ship crashed into it with its undercarriage. Just what
happened I don’t know, because the water rose in a geyser, and I
couldn’t see for a moment. But what I saw, when the water subsided,
was plenty.
It seemed that the ship had been crumpled completely. It had
turned on its back. Kennedy was invisible. The fuselage had broken
in half, the wings crumpled back, and the motor, of course, was
under water. That little heap of wreckage would become water-
soaked in a few minutes. It would sink in a quarter of an hour,
instead of in two hours.
I guess I was shaking a little. I remember Penoch, circling and
circling. Kennedy had not come to the surface.
“Knocked out and drowning—maybe a mercy,” I was thinking, and
four fins, circling, sent cold chills up and down my back.
Then he came to the surface. He struggled weakly to climb up out
of the water, but it took him a full two minutes. Even then he was
partly submerged. Suddenly the sight of those fins set me crazy, I
guess.
“I’ll give him a chance to drown, at least!” I fairly shouted at them;
and the next second I was pouring machine-gun bullets into the
shadowy green monsters, and they were floating, dead, on the
surface of the water.
There was not one single, solitary thing that could be done to
save him. Two minutes more, and his frail life-raft would be sunk.
There was no time to fly back and get something to which he could
cling and drop it to him. He couldn’t swim.
I fairly froze in my seat, as a great mass of water rose from the
sea. As it cleared, I saw the tail of Penoch’s DeHaviland, high in the
air, less than ten feet from Kennedy. The next second Penoch was
clambering up on the wreckage of his own ship. A few seconds later
he was stripped to his underwear, and swimming toward the crippled
Kennedy.
As the little devil was towing his enemy I came to myself. I circled
watchfully above the water, and machine-gunned an approaching
shark. As I did that my stunned brain got working. I don’t think I’m
either better or worse than the average. I’m franker, that’s all. If I had
been sitting in my ship, while my deadly enemy was dying a sure
death, I would have been conscious of a sense of relief.
Penoch O’Reilly had landed to give him two hours more of life; it
seemed a certainty that at the end of two hours, Penoch, too, would
go down to the sharks, with the man who had almost ruined his life.
Then and there that squat, little figure, ho-ho-ho-ing at life, grew
into a giant, towering above ordinary mortals, as far as I was
concerned.
“There must be some way,” I kept telling myself over and over as
I circled them. Maybe I hypnotized myself into an idea. I gave a war-
whoop of relief. Anything was better than one hundred per cent.
hopelessness.
Kennedy was hurt. That was apparent. Penoch had to drag him
up on the fuselage, and then the reserve man lay there as if he were
completely out.
I made wild motions to Penoch; he nodded. He was standing up,
a small white figure, his feet far apart to brace himself against what
fate had in store. As I sped for land, I almost thought I could hear him
laughing that deep-toned, Rabelaisian laugh, flinging his challenge to
the gods, a small white speck in the dusk.
A moment after I had landed, I’d told my story. Tex MacDowell
and Sleepy Spears were in their ships in two seconds less than
nothing, and we were off. When we arrived, Penoch had the upper
left wing detached, and Kennedy was on it.
From there O’Reilly started his heartbreaking journey, a full mile,
pushing that wing slowly through the water, his legs kicking tirelessly.
Kennedy, partially recovered, was using the vertical fin as a paddle
to help. Three airplanes cruised round and round over the ugly
water, and not a shark got within our lines. Every second was a
strain, for the sharks could come up from below and get Penoch, but
they did not. With so much dead meat in the sea, I guess our outfit
was entirely too suspicious for them to bother with.
It was ten minutes after dark when Penoch and Kennedy
staggered up on the beach. Kennedy collapsed. When I got out of
my plane, I was swaying like a rubber lamp-post, and before Penoch
had been taken care of and got back, I had eaten and fallen on a cot,
fully dressed, but dead to the world.
Strange as it may seem, I didn’t see either of them next day. Our
flyings came at different hours, and when one was on the ground the
others were in the air. And at three in the afternoon, when I landed, I
found that Penoch and Kennedy and Pete Miller had started back for
McMullen. Kennard, Sleepy and Tex and I started home at five
o’clock. There were Donovan ships available, and there’d been
another bandit raid in our territory. The patrol was needed on the
river.
I saw Penoch in the mess-hall, at dinner, and sat next to him. We
were all ready to drop, and hadn’t even washed. Kennard went to
sleep over his soup. Sleepy Spears gave up after the meat course,
and stumbled out to bed.
“Where’s Kennedy?” I asked Penoch.
“In at Shirley’s—for dinner,” he said tersely and, as our eyes met,
I guess our thoughts were the same.
“Then what you did for him had no effect, eh?” I finally asked him.
“How’d he act?”
“Avoids me.”
“I see. Come clean, Penoch. It must have been a temptation to
leave him down there, even if you figured you’d have a good chance
of saving him.”
Penoch buttered some bread thoughtfully.
“I just couldn’t; and I’d never thought of that wing gag. Just had
an idea that there ought to be some way out—”
“So you tossed a few sharks right out of your mind, eh?” I
interrupted.
“Oh, hell, I didn’t think of anything, except how nice it would be if
he was dead. Well, old-timer, he’s sure slapped me in the face
tonight by going back there. Shows what he is. Hell, I’ve been doing
things for him all my life, and he’s willing to blackmail me. Guess I
was a damn’ fool back over the Gulf, eh? Well, there’ll be excitement
about in a few days, I guess. Better get some sleep tonight. Ho-ho-
ho!”
I knew then that he had fully made up his mind, that he’d
considered everything, and was ready to go. And when that crisis
was passed with Penoch O’Reilly, he feared not man, devil or
circumstances. Right at that moment he figured that the Army was a
thing of the past and that the world was waiting to be bucked by a
man in disgrace. The tougher it was, the louder he’d laugh.
The next day we both saw Kennedy at breakfast. He greeted us
with a straight stare, said, “Hello,” in his customary breezy manner,
ate with relish, and was absolutely himself. His eyes were as cold a
green as ever, except for that surface shine that came when he
laughed. He told a good story about Noah and the Johnstown flood,
indulged in his reminiscences of the Columbus raid and likewise the
Galveston flood, in all of which he had participated with considerable
gusto.
I just sat there and watched him. That clear-cut, hard face and
those fishy eyes made as impenetrable a mask as I’ve ever seen.
“The hell it’s a mask!” I finally told myself. “He just hasn’t any
feelings that can’t be expressed in a grin or a laugh or a snarl. He
couldn’t hate anybody real hard any more than he could like anybody
very much. Except himself.”
At lunch he came breezing in with:
“Well, well, the good old feedbag’ll be fastened round my snoot
pronto. The meal ain’t been cooked that I can’t clean up by myself.”
He shook out his napkin, grasped his fork firmly and started in at
the salad. His eating was not a pronouncedly delicate proceeding. It
was audible for miles around when he wasn’t trying to act unnaturally
elegant; and I believe that in a straight contest Kennedy’s eating
anything could drown out my snoring.
“By the way, Peewee, my lad, how about a bit of poker at
Shirley’s Old Man’s house tonight? I was given instructions to ask
you and Slim to come out. Sheriff Trowbridge’ll be there, too. Come,
and bring your checkbook, because it’s my night to howl!”
Penoch just looked at him. Kennedy stared back with a mirthless
smile.
“Risk a few nickels!” he gibed. “I ain’t seen your game for years.
How about it? Shirley’ll be glad to see you both, she said. She ain’t
had much time—”
“Yes, I’ll go.”
Simple, those words. But I knew as surely as I knew that I was at
the table that Penoch’s deliberate interruption was a threat. He
stared straight at Kennedy, and the implication in his statement was
plain for me to see. That poker game that night was to include some
unscheduled fireworks. Shirley and her father were to hear some
hitherto unknown episodes in the lives of Ralph Kennedy and
Percival Enoch O’Reilly.
“Fine! A good time’ll be had by all,” Kennedy came back. “You act
as though you’d been invited to risk your life, or attend your own
funeral. Heh-heh-heh! Didja hear him say that, boys? Peewee don’t
think any more of a nickel lost at cards than he does his left eye.”
There he sat, gibing at the man who had saved his life. It was
apparent to any one that there was a deadly undercurrent in the
conversation between the two. I saw Kennard and Tex and the
others looking at them speculatively.
Directly after the meal I put it up to Penoch.
“You’re going to lay your information on the line tonight, eh?” I
asked him.
“Right. And my resignation’ll be written. He doesn’t intend to back
away from Shirley. I can see that. Maybe what I say won’t change a
thing; but she’ll go into it with her eyes open.”
“Damn’ funny, at that,” I said in considerable bewilderment. “I
don’t see why a girl—any girl—could mean so much to Kennedy that
he’s willing to run the risk of exposure as a criminal. I—”
“He doesn’t think I’ll go through with it,” rasped Penoch. “Well, I’m
going to take a nap.”
He strode away, his short legs twinkling through the dust, toward
his tent. He didn’t sleep, though, because I peeked in a few times.
He wrote reams of letters, setting his house in order, as it were,
before he moved out. And he didn’t seem so downcast. In fact, the
devil-may-careness of his face had increased, and there was hard
recklessness there. He had taken his hundredth knockout blow from
fate; and he was still standing erect, unbeaten.
It was a long and tough afternoon for me. Kennedy flew a patrol,
and then took a long time dressing for dinner. At the meal he was in
excellent form, holding the floor continuously with ribald tales, which
were good. And Penoch O’Reilly, his eyes bright, seemed strung to a
high nervous pitch. His roaring “Hoho-ho!” rolled forth continuously,
and he and his enemy fought a silent battle of eyes beneath the
laughter. I was depressed and silent, but possessed with such
infinite hatred and repulsion when I thought of Kennedy that I could
have stuck the bread-knife in his throat and enjoyed it.