,Contents
Chapter 01: Role Transitions ................................................................................................................................................. 4
Chapter 02: Personal Management: Time and Self-Care Strategies . .................................................................................. 19
Chapter 03: Mentorship, Preceptorship, and Nurse Residency Programs . ......................................................................... 32
Chapter 04: Employment Considerations: Opportunities, Resumes, and Interviewing ...................................................... 42
Chapter 05: NCLEX-RN® and the New Graduate ............................................................................................................. 54
Chapter 06: Historical Perspectives: Influences on the Present . ......................................................................................... 70
Chapter 07: Nursing Education............................................................................................................................................ 83
Chapter 08: Nursing Theory ................................................................................................................................................ 95
Chapter 09: Professional Image of Nursing ....................................................................................................................... 106
Chapter 10: Challenges of Nursing Management and Leadership. ................................................................................... 114
Chapter 11: Building Nursing Management Skills . .......................................................................................................... 128
Chapter 12: Effective Communication, Team Building, and Interprofessional Practice . ................................................. 143
Chapter 13: Conflict Management ..................................................................................................................................... 157
Chapter 14: Delegation in the Clinical Setting .................................................................................................................. 170
Chapter 15: The Health Care Organization and Patterns of Nursing Care Delivery . ................................................... 188
MULTIPLE CHOICE .................................................................................................................................................... 188
MULTIPLE RESPONSE ............................................................................................................................................... 197
Chapter 16: Economics in the Health Care Delivery System . ...................................................................................... 201
MULTIPLE CHOICE .................................................................................................................................................... 201
MULTIPLE RESPONSE .................................................................................................................................................... .
210
Chapter 17: Political Action in Nursing......................................................................................................................... 214
MULTIPLE CHOICE .................................................................................................................................................... 214
MULTIPLE RESPONSE............................................................................................................................................... 223
Chapter 18: Collective Bargaining: Traditional (Union) and Nontraditional Approaches . .......................................... 228
MULTIPLE CHOICE .................................................................................................................................................... 228
MULTIPLE RESPONSE ............................................................................................................................................... 237
Chapter 19: Ethical Issues.............................................................................................................................................. 241
MULTIPLE CHOICE .................................................................................................................................................... 241
MULTIPLE RESPONSE ............................................................................................................................................... 253
Chapter 20: Legal Issues ................................................................................................................................................ 254
MULTIPLE CHOICE .................................................................................................................................................... 254
MULTIPLE RESPONSE .................................................................................................................................................... .
269
Chapter 21: Cultural and Spiritual Awareness............................................................................................................... 271
MULTIPLE CHOICE .................................................................................................................................................... 271
MULTIPLE RESPONSE ............................................................................................................................................... 280
Chapter 22: Quality Patient Care ................................................................................................................................... 283
MULTIPLE CHOICE .................................................................................................................................................... 283
MULTIPLE RESPONSE ............................................................................................................................................... 292
Chapter 23: Nursing Informatics ................................................................................................................................... 298
MULTIPLE CHOICE .................................................................................................................................................... 298
,MULTIPLE RESPONSE .................................................................................................................................................... .
306
Chapter 24: Using Evidence-Based Practice and Nursing Research . ........................................................................... 310
MULTIPLE CHOICE .................................................................................................................................................... 310
MULTIPLE RESPONSE .................................................................................................................................................... .
317
Chapter 25: Workplace Issues ....................................................................................................................................... 322
MULTIPLE CHOICE .................................................................................................................................................... 322
MULTIPLE RESPONSE .................................................................................................................................................... .
330
Chapter 26: Emergency Preparedness ........................................................................................................................... 337
MULTIPLE CHOICE .................................................................................................................................................... 337
MULTIPLE RESPONSE .................................................................................................................................................... .
347
,Chapter 01: Role Transitions
Zerwekh: Nursing Today: Transitions and Trends, 11th Edition
MULTIPLE CHOICE
1. A graduate nurse has been hired as a nurse at a local hospital. The new nurse is in the .
honeymoon phase of role transition when making which of the following statements? a. “I
am so nervous about being on my own as a nurse.”
b. “This will be a great learning experience.” .
c. “I can’t wait to have a steady paycheck.”
d. “This job is perfect. I can finally do things my own way.”
ANS: D .
The honeymoon phase is when the student nurse sees the world of nursing as quite rosy.
Often, the new graduate is fascinated with the thrill of arriving in the profession. Reality
shock occurs when one moves into the workforce after several years of educational
preparation. Recovery and resolution occur when the graduate nurse is able to laugh at .
encountered situations. During this time, tension decreases, perception increases, and the
nurse is able to grow as a person.
.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Table 1.1 OBJ: Identify the characteristics of reality shock.
TOP: Reality shock MSC: NCLEX®: Safe and effective care environment
.
2. Which of the following actions by the graduate nurse is an inappropriate methodology to
recover from reality shock?
a. Networking .
b. Obtaining a mentor
c. Returning to school
d. Joining a support group
.
ANS: C
The transition period is successfully managed when the graduate is able to evaluate the
work situation objectively and predict effectively the actions and reactions of other staff.
Nurturing
the ability to see humor in a situation may be a first step. Returning to school is a positive
step . after the graduate has worked through role transition, has some clinical experience,
and is ready to focus on a new career objective. Networking, obtaining a mentor, and
joining a support group would give the graduate nurse an opportunity to talk to others
experiencing the .
, stress associated with reality shock. The nurse would benefit from “talking through” issues
and learning how to cope.
PTS: 1 DIF: Cognitive Level: Application/Applying .
REF: p. 9 OBJ: Describe methods to promote a successful transition.
TOP: Reality shock
MSC: NCLEX®: Safe and effective care environment Not applicable
.
3. A nurse is trying to avoid burnout. Which of the following actions is a valid way to achieve this?
a. Refusing to constantly work extra shifts .
b. Withdrawing from peer support group
c. “Going native”
d. Changing jobs every 6 to 12 months .
ANS: A
One of the quickest ways to experience burnout is to “overwork the overtime.” Set
priorities with your mental and physical health being the highest priority. Learning to say
“no” to extra shifts is a positive means of coping of avoiding burnout. “Going native” is
the term that . describes how recent graduates begin to copy and identify the reality of
their role-transition experience by rejecting the values from nursing school and
functioning more like a team member at their place of employment. Withdrawing from
peer support groups, “going native,” . and changing jobs every 6 to 12 months would
increase the chance of the nurse experiencing
burnout. The nurse should instead focus on his/her practice and seek out support from
other nurses.
.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 7 OBJ: Describe methods to promote a successful transition.
TOP: Reality shock
MSC: NCLEX®: Safe and effective care environment Not applicable .
4. Which of the following statements by the graduate nurse shows an understanding of reality
shock as it applies to nursing? .
a. “Reality shock is the period when a person moves from school into the
b. workforce.”“Reality shock is the realization that practice and education are not the same.”
c. “Reality shock is the period from graduation to becoming an experienced nurse.”.
d. “Reality shock is a transition phase that new graduates go through before changing jobs.”
ANS: A .
, “Reality shock” is a term often used to describe the reaction experienced when one moves
into the workforce after several years of educational preparation. The new graduate is
caught in the situation of moving from a familiar, comfortable educational environment
into a new role in . the workforce where the expectations are not clearly defined or may
not even be realistic. The realization that practice and nursing school are not the same is
often associated with “going native.” When nurses move from one position to another,
they have already experienced
reality shock. Becoming an experienced nurse takes time and is not part of the definition
of . reality shock.
PTS: 1 DIF: Cognitive Level: Application/Applying . REF: p. 5
OBJ: Identify the characteristics of reality shock.
TOP: Reality shock MSC: NCLEX®: Not applicable
5. A student in the last semester of nursing school has established a goal of making a
successful . role transition to graduate nurse. Which statement by the student indicates his/her
understanding of how to achieve this goal?
a. “I should care for increased numbers of patients to enhance work organization
skills.” .
b. “I will observe staff nurses as they perform nursing procedures to refine
technique.”
c. “I should seek increasingly close guidance from the nursing instructor to reduce .
errors.”
d. “I will evaluate my progress every 7 weeks or more to allow time for growth.”
ANS: A
It is important for the student to start taking care of increased numbers of patients to help
with . time management and work organization. The student should also be able to function
without close guidance from the nursing instructor. Although it is good for students to
observe staff, a
student in the final semester should be able to perform tasks with minimal observation and .
should instead focus on implementing care and time management. Waiting 7 weeks to
evaluate progress would not be helpful to the student. Although regular self-evaluation is an
important process, it is the actual experience of taking realistic patient assignments and .
working typical shift hours that assists with successful role transition.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 13 OBJ: Describe methods to promote a successful transition. .
TOP: Reality shock MSC: NCLEX®: Not applicable
, 6. A new graduate of less than 1 year describes his/her perception of a staff nurse position, stating:
“It feels great to be a nurse! In fact, it’s a snap! I can hardly believe there’s no . instructor looking
over my shoulder.” What phase of reality shock is the graduate experiencing?
a. Recovery .
b. Shock and rejection
c. Honeymoon
d. Transition .
ANS: C
In the first phase of the role transition process (the honeymoon phase), the graduate nurse is
thrilled with completing school and accepting the first job. Life is a bed of roses because
everyone knows nursing school is much harder than nursing practice. Shock and rejection .
occur as the nurse tries to understand how nursing school and the “real world” come together.
Transition occurs as the nurse begins the move from student to nurse and refers to the entire
process, not just a particular phase. The recovery phase is when the nurse can laugh at .
situations that he/she is in and is able to cope with the situations that are being faced.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 7 OBJ: Compare and contrast the phases of reality shock. .
TOP: Reality shock MSC: NCLEX®: Not applicable
7. A new graduate has worked on a busy unit for 6 months since graduating from nursing school. The
graduate tells a friend, “I’ve never been so upset in all my life! The care that some of the . staff give
our patients is outrageously bad. There’s practically no attention to the principles of asepsis the way I
learned them! The staff tell me that we have to cut corners if we’re going to get all the work done. I
can’t stand it!” What phase of reality shock is this graduate . experiencing?
a. Honeymoon
b. Shock and rejection
c. Recovery .
d. Role transformation
ANS: B
.
The honeymoon phase for the new graduate nurse is short lived when the graduate identifies
the conflicts between the way he/she was taught and the reality of what is done. Shock and
rejection cause mental and emotional withdrawal, moral outrage, and a hypercritical attitude, .
which are just some of the symptoms of the realization that the honeymoon is over. Excessive
mistrust, frequent pains and illness, a decrease in energy and fatigue, feeling like a failure and
blaming oneself for every mistake, a hypercritical attitude, and feeling morally outraged are
characteristics of the shock and rejection phase. The recovery phase is characterized by a .
, beginning sense of humor (usually the first sigh), a decrease in tension, and an increase in the
ability to cope with the situations that he/she is faced with. Role transformation is the process
of transforming from student to nurse. .
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 8 OBJ: Compare and contrast the phases of reality shock.
TOP: Reality shock MSC: NCLEX®: Not applicable.
8. A graduate nurse has been out of school for 3 months and working in a staff nurse position for the past
2 months. What type of transition is the nurse experiencing? .
a. A developmental transition
b. An organizational transition
c. A health-oriented transition
d. A situational transition .
ANS: D
A situational transition is a lifestyle change that occurs because of a new situation. Most often
the changes are by choice—for instance, graduations, marriages, and new jobs. .
Developmental transitions include becoming a parent or going through a midlife crisis. An
organizational transition involves a change in leadership. A health-oriented transition involves
dealing with an illness or health issue, such as coping with a chronic illness. .
PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 3 OBJ:
Discuss the concepts of transitions.
TOP: Types of transitions MSC: NCLEX®: Not applicable.
9. The graduate nurse understands that transitions occur throughout life. What major factor does the
nurse identify as influential in a successful transition from school to practice? a. Level of new
knowledge and skills required in the new environment.
b. Amount of classwork required to obtain a degree
c. Personal history of previous developmental transitions
d. Influence of classmates and their transitional experiences.
ANS: A
The transition from student to practice reflects a situational transition that is most often
affected by the anticipation of changes in the new work environment. Classwork no longer .
affects this transition. A personal history of previous developmental transitions and the
influence of classmates are not as prominent as the anticipated requirements to function in the
new environment of work.
.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
, REF: p. 4 OBJ: Describe methods to promote a successful transition. TOP:
Types of transitions MSC: NCLEX®: Not applicable .
10. A nurse manager is giving a presentation at a local community college. The nurse manager
understands the job expectations of a new graduate when making which of the following
statements? .
a. “A graduate nurse should be able to perform as independently as was demonstrated the last
semester of nursing.”
b. “A graduate nurse should be able to function competently as a registered nurse at the entry
level.” .
c. “A graduate nurse should be able to function in the role that was described in the
curriculum for the school of nursing.”
d. “A graduate nurse should be able to be able to function independently with ability .
to make clinical nursing judgments.”
ANS: B
The job expectations of a new graduate nurse are those of an entry-level new employee. This
. frequently includes an extended orientation to assist the new graduate to transition into the
independent role of the nurse. The new graduate nurse is not expected to function
independently with the ability to make clinical nursing judgments. School curriculum and
how . one functioned the last semester of school are usually not considered in the job
expectations of a new graduate.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding . REF: p.
12 OBJ: Discuss the concepts of transitions.
TOP: Successful transitions MSC: NCLEX®: Not applicable
11. Which action by the graduate nurse shows that a successful transition to nursing has been .
made?
a. The nurse begins to work with the nursing team and functions as others expect.
b. The nurse begins to objectively evaluate work experiences and enjoy the humor of .
clinical situations.
c. The nurse believes everything is great, patients are wonderful, and the new unit is so nice.
d. The nurse meets regularly with other new graduates to. compare and discuss
problems.
ANS: B
Objectivity and humor are two of the characteristics of a successful transition. “Going native”
. occurs when the graduate begins to provide care in the manner that the team or group wants
it done, not necessarily the correct way. The “honeymoon phase” is when everything is
going
, great. Meeting with other new graduates can be productive, but it is a part of the transition and
. not an indication of successful transition.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 8 OBJ: Compare and contrast the phases of reality shock. .
TOP: Characteristics of a successful transition MSC: NCLEX®: Not applicable
12. A student nurse is in the last semester of nursing school. Which action by the nursing student
indicates appropriate preparation for the transition experience? .
a. The nursing student requests additional experiences in performing skills and
procedures.
b. The nursing student maintains close contact with a nursing instructor. to observe
nursing procedures.
c. The nursing student practices nursing assessments and care on one or two patients to
become more competent.
d. The nursing student increases communication with a nursing instructor to maintain .
a resource person after graduation.
ANS: A
Students should get all the experience, not just observation, you can before graduation. Ask to
. perform procedures and skills and request feedback from staff nurses and instructors.
Students should also begin to build resources that will be available after graduation. It is
during the last semester that students begin to care for more complex patients (and more
patient numbers) to . gain experience in the “real world” of nursing management and to have
less reliance on the nursing instructor as a resource person.
PTS: 1 DIF: Cognitive Level: Application/Applying .
REF: p. 13 OBJ: Describe methods to promote a successful transition.
TOP: Activities to promote successful transition before graduation
MSC: NCLEX®: Not applicable
.
13. A graduate nurse has been reviewing the NCSBN’s Transition to Practice model. The graduate nurse
understands the intention of the model when making which of the following statements? .
a. “The intention of the model is to mandate that all state boards of nursing provide a
b. regulatory model for transition“The intention of the model is to provide educational
modules so that the new to practice.” graduate does not need to work with a
preceptor.” .
c. “The intention of the model is to have the new graduate take and pass the
