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TEST BANK FOR NURSING TODAY TRANSITION AND TRENDS 9TH EDITION BY ZERWEKH All chapters
Chapter 01: Role Transitions
Zerwekh: Evolve Resources for Nursing Today, 9th 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
st
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
1. Which statement indicates the nurse’s understanding of effective time management?
a. “The purpose of effective time management is to save hours, minutes, and seconds.”
b. “The purpose of effective time management is to do as much as possible in as short a time as possible.”
c. “The purpose of effective time management is to do as little as possible.”
d. “The purpose of effective time management is to achieve personal and professional
goals.”
ANS: D
Making time to meet your individual, family, professional, and career needs and goals is vital to overall success and is the primary purpose of time management. Stating that the purpose of effective time management as saving time or doing as much or as little as possible in a short time would not indicate the nurse’s understanding. Procrastinating and doing as little as possible are not characteristic of effective time management.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 24 OBJ: Identify strategies for self-care. TOP: Time management MSC: NCLEX®: Not applicable
2. A student nurse resists schedules and prefers to study when it “feels right” and in groups. Which of the following characteristics fits this student?
a. Left-brain dominant
b. Right-brain dominant
c. Equally right- and left-brain dominant
d. Neither right or left brain dominant
ANS: B
Right-brain–dominant people resist schedules and choose to do things their own way. Left-brain–dominant people process information in a linear, sequential manner, so they would probably prefer a schedule of activities. Some people are equally right- and left-brain dominant and have a mix of behaviors. There are other people who have no clear pattern.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 26
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Time management MSC: NCLEX®: Not applicable
3. In 4 weeks, a student nurse will have two tests and one paper due in the same week. What is the most effective time-management strategy for this student nurse?
a. Control time wasters to have more time for studying and writing.
b. Delegate everything possible to create more time for studying.
c. Schedule specific times on a calendar to study for the tests and to work on the paper.
d. Wait until the last minute because the student nurse “works best under pressure.”
ANS: C
The most effective approach to this problem would be to schedule specific time periods to
prepare for the tests and write the paper. Waiting until the last minute to study and write the paper creates unnecessary stress and sets the student nurse up for failure. Creating more time for studying does not solve the problem; how that time is organized and how it is used is the key. Procrastinating by putting off assignments until the last minute can lead to extreme anxiety and stressful behavior. Although delegating some tasks is realistic and can create time
for studying, it is unrealistic to delegate “everything possible” and impossible to control all time wasters.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 29
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Time management MSC: NCLEX®: Not applicable
4. How can the student nurse increase studying efficiency?
a. Maintaining a supply of simple carbohydrates for a quick energy spurt
b. Alternating mental and physical activities to increase productivity
c. Working nonstop without breaks to focus concentration
d. Delegating tasks of household chores to family members
ANS: B
Alternating tasks that are mental with tasks that are physical can increase alertness and create a natural energy spurt to keep going. Carbohydrate-induced energy spurts are short lived and ineffective for studying efficiency. Working nonstop without breaks leads to fatigue and
burnout. Although delegating tasks would be helpful to the student nurse, it does not directly increase studying efficiency.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 42
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Time management MSC: NCLEX®: Not applicable
5. The nurse has concluded that he/she is a right-brain–dominant person. Based on the nurse’s
time style, which unit governance task will the nurse implement? a. Devise a plan to restructure the nursing career ladder.
b.c. Write a procedure for central line care using new equipment.Do the unit time schedule for the next pay period.
d. Collate data obtained from a chart audit to report at the next unit staff meeting.
ANS: A
Right-brain–dominant people like to brainstorm to create new, holistic ideas and approaches to old problems, so devising a restructured nursing career ladder would be an appropriate task for this person. Writing procedures, completing time schedules, and collating data are indicative of a left-brain–dominant person.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 26
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Time management MSC: NCLEX®: Not applicable
6. What actions should a graduate nurse take in the first work experience to avoid problems with burnout?
a. Cross-train to work in different areas of the hospital.
b. Develop a social group of nurses with whom to share work experiences.
c. Plan on several sessions with a counselor regarding managing stress.
d. Maintain good nutrition and good sleep habits.
ANS: D
Taking care of oneself is a primary component to preventing burnout—for example, avoiding
alcohol, maintaining good nutrition, getting adequate amounts of sleep, and avoiding cigarette smoking. Developing social contacts outside the work environment also facilitates reduction of stress from work. Cross-training in different areas of the hospital, developing a social group with nurses to share work experiences, and meeting with a counselor would not be helpful to
the graduate nurse in avoiding problems with burnout in the first work experience because they are all related to that experience.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 37 OBJ: Discuss the importance of caring for yourself.
TOP: Burnout MSC: NCLEX®: Not applicable
7. Which action by the nurse exemplifies a sense of spiritual health?
a. Belonging to a church
b. Feeling purposeful and fulfilled
c. Feeling loved and cared for
d. Changing religious affiliations
ANS: B
A sense of spiritual health simply means that we have a daily awareness that there is something more to living than mere human existence. People who have a sense of spiritual being find their lives to be positive experiences and feel good about the future. Belonging to a church, feeling loved and cared for, and changing religious affiliations are not identified as ways that one exemplifies a sense of spiritual health.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 39 OBJ: Discuss the importance of caring for yourself.
TOP: Spiritual awareness MSC: NCLEX®: Not applicable
8. Which of the following is an example of a self-defeating belief?
a. I must always feel loved by everyone.
b. I am a caring person.
c. I will get through nursing school.
d. I am getting better.
ANS: A
Feeling as though you need to be loved by everyone is a self-defeating belief because there will always be some individuals who do not care for you. It would be unrealistic and hence self-defeating to have or express the need to be loved by everyone. There are many ways to exercise our mental potential. One of the first ways is to concentrate on removing negative thoughts or self-defeating beliefs from our minds. Affirmations or positive statements, such as being a caring person, will get through nursing school, getting better with skills or recovering from an illness, and so on are ways to avoid self-defeating comments and behaviors.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 43 OBJ: Identify strategies for self-care. TOP: Self-care
MSC: NCLEX®: Not applicable
9. Which is an example of an effective self-care strategy for a nurse?
a. Plan time for physical recuperation after working extra hours.
b. Push feelings of sadness, joy, anger, and fear out of awareness.
c. Use alcohol to reduce tension.
d. Respond to people and opportunities reactively.
ANS: A
Taking care of ourselves physically entails getting proper nutrition and adequate sleep, exercising on a regular basis, and planning for additional time to recuperate when working extra hours. Using alcohol or drugs only medicates feelings and is not considered an effective self-care strategy. Not dealing with feelings is a way to consciously suppress emotions, which can lead to a variety of anxiety disorders. Responding to people and opportunities with a reactive, or “knee-jerk,” response is not a good self-care strategy because the behavior can lead to poor decisions without adequate thought.
REF: pp. 41-42 PTS: 1 DIF: OBJ: Cognitive Level: Knowledge/Remembering Identify strategies for self-care. TOP: Self-care
MSC: NCLEX®: Not applicable
10. Nurse 1: “The manager told me that you and I have to change work schedules to accommodate Jim. That means we will both have to work days and nights in the same week. There’s nothing we can do about it.” Nurse 2: “Let’s take a minute and look at the possible alternatives.” What is the best assessment of this situation?
a. Nurse 1 is exhibiting reactive behavior, and nurse 2 is being proactive.
b. Nurse 1 is exhibiting a sense of empowerment, and nurse 2 is behaving
c. codependently.Jim and the nurse manager have formed a coalition with the goal of dominating other staff.
d. The nurse manager is evidencing good self-esteem by daring to take an unpopular action that will expose criticism.
ANS: A
Whereas nurse 1 is reacting to the situation, nurse 2 is taking time to assess the situation more thoroughly and see what choices they might have, which is a proactive response. Many of us go through life never realizing that we have many choices. You can choose to respond to people and situations rather than react. It is important to assess the situation and see what options are available and what the consequence of the options might be. Exercising our choice
potential also entails that we act responsibly toward others. Codependent behavior is a type of control or enabling behavior. Empowerment is the power to do something and acting
self-confidently to do so. The question is asking about the assessment of nurse 1 and nurse 2 responses, not the nurse manager.
PTS: 1 DIF: Cognitive Level: Application/Applying REF: Box 2.10 OBJ: Identify strategies for self-care.
TOP: Self-care—proactive response MSC: NCLEX®: Psychosocial integrity
11. A nurse has been out of school about 6 months. Which of the following would indicate that the nurse is having problems with burnout?
a. Has chronic fatigue, increased irritability, and feelings of helplessness
b. Feels angry about the type of care being delivered and scheduling of staff
c. Signs up for extra courses for an advanced degree and works double shifts
d. Is disorganized in patient care and has to stay late to finish shift work
ANS: A
Fatigue, irritability, and feelings of helplessness are all early signs of burnout. Anger about care may be very appropriate; how the anger is directed is important. Overscheduling oneself is something that may promote early burnout, as are disorganization and poor time management.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: Box 2.6 OBJ: Describe early signs of compassion fatigue and burnout.
TOP: Burnout MSC: NCLEX®: Not applicable
12. The nurse would identify which of the following strategies as a means of increasing feelings of empowerment?
a. Requesting an assignment to a different hospital unit
b. Assisting friends to cover their shifts when they need time off
c. Telling a coworker that a joke heard in private was inconsiderate and thoughtless
d. Declining to work an extra shift and going to the movies with friends
ANS: D
Taking care of oneself is critical to preventing burnout and increasing feelings of
empowerment, such as declining to work an extra shift so you can participate in activities with friends and family. Take care of yourself first; then assist others as you are able. Moving to a different hospital unit may be a type of avoidance with an issue that is unresolved. Humor and
laughter are important; however, if the joke was unethical, correcting the nurse would not increase empowerment.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 37 OBJ: Identify strategies for self-care. TOP: Empowerment
MSC: NCLEX®: Not applicable
13. What activity would most likely promote a positive feeling of well-being in a graduate nurse about 6 months after employment?
a. Have a group of staff nurses over for a party.
b. Participate in hospital-sponsored programs for community health.
c. Spend some time with an old friend who is in the middle of a divorce.
d. Get involved in a new hobby, and attend social gatherings to meet new people.
ANS: D
Planning pleasurable activities, such as a hobby or attending a social gathering, that are not associated with nursing or other people’s problems can help you to reenergize and feel better about yourself. Having nurses over for a party or participating in hospital-sponsored programs would not give the graduate nurse the time needed away from nursing. Spending time with a
friend going through a divorce would not promote a positive feeling of well-being in the graduate nurse.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 39 OBJ: Identify strategies for self-care. TOP: Empowerment
MSC: NCLEX®: Not applicable
14. A nurse is considering pursuing additional education in nursing and hopes to be promoted to a management position. What action should the nurse take to best achieve this? a. Wait until “the time is right” and inquire about program and promotion opportunities.
b. Be the best nurse possible and hope a scholarship or promotion will be awarded.
c. Set long-range, mid-range, and short-range goals with specific related activities and time frames to meet these goals.
d. Read three books on time management.
ANS: C
Setting goals so that you can prioritize your approach and identifying specific activities and time frames to work toward a management promotion are keys to success. Assess the situation to see what activities will provide the highest payoff. Waiting for the right time to achieve promotion, hoping for a scholarship or promotion, and reading books on time management are not effective; instead, the nurse must take action to achieve a goal.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 33 OBJ: Identify strategies for self-care. TOP: Time management
MSC: NCLEX®: Not applicable
15. A student nurse is feeling stressed about the combination of nursing courses and clinical experience in the semester. What actions can the student nurse take to reduce stress level based on biological rhythms?
a. Schedule difficult activities at high-energy times.
b. Shorten sleep time to accommodate increased study times.
c. Study before bedtime to increase memorization.
d. Only study when not feeling stressed.
ANS: A
Student nurses should create schedules that work with their biological rhythms, such as scheduling difficult activities at their high-energy times. Shortening sleep, studying right before bed, and only studying when they are not feeling stressed are not advised.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 24
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Managing your time MSC: NCLEX®: Not applicable
16. A nurse manager is assigning additional duties to the day shift nurses to keep the unit orderly and running smoothly. Which assignment would be the best for a right-brain–dominant nurse?
a. Clean up the break room by noon.
b. Assist with completing a unit project, based on specific rules and guidelines.
c. Create a poster board in honor of Nurse’s Week.
d. Take part in a meeting regarding unit policies.
ANS: C
Right-brain–dominant people resist rules and schedules and prefer to complete activities on their own time. Creating a poster board in honor of Nurse’s Week gives the
right-brain–dominant nurse a chance to create in a personal way without rules and restrictions. Cleaning up the break room by noon, assisting with a unit project guided by rules and specific guidelines, and taking part in a unit policy meeting would be better suited for a left-brain–dominant nurse (structure, organization, rules, time limits, and priorities are important).
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 26
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Managing your time MSC: NCLEX®: Safe and effective care environment
17. What action by student nurses indicates readiness for successful study habits?
a. Combining their study area with the space that they use to pay bills
b. Color coding their materials from each class
c. Keeping all materials and papers in one bin
d. Cleaning their study area at the end of each semester
ANS: B
To ensure success, students should first separate the area where they study from the area where they pay bills. Second, students should color code their materials from each class to ensure that they can find what they need during study sessions. Students should separate out materials and discard what is no longer needed. Frequently cleaning their study area will help
them maintain order.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 31
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Managing your time MSC: NCLEX®: Not applicable
18. What actions can a student take to manage the phone calls received throughout the day?
a. Set a specific time during the day for business- or school -related phone calls.
b. Allow phone calls at any time as long as they are short.
c. If the student needs to leave a message, state that he/she can be contacted any time.
d. Keep the phone turned off until all studying is completed for the day.
ANS: A
Students should set up a time during the day for all phone calls related to business or school. If students need to leave a message, they should state when they can be contacted. Keeping the phone turned off is not a realistic option.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 28
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Managing your time MSC: NCLEX®: Not applicable
19. A student wants to begin planning for future educational goals. Which of the following actions would NOT help the student plan?
a. Review a list of goals once a year.
b. Make a master list of goals.
c. Prioritize goals.
d. Cross out goals as they are met.
ANS: A
In planning goal-related activities, making a master list of goals and prioritizing the list are helpful strategies for completing activities and accomplishing goals. It is also helpful to cross off each goal as it is completed. Doing so provides a sense of accomplishment and immediate
gratification for completing a goal. It is important to continually review the list of goals established to determine if activities or tasks need to be moved based on how quickly they need to be attended to. Reviewing a list of goals yearly would not be sufficient in helping the student plan for completing his/her educational goals.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 35
OBJ: Identify your individual time style and personal time-management strategies.
TOP: Managing your goals MSC: NCLEX®: Not applicable
20. Which of the following actions by the nurse helps prevent burnout?
a. Picking up extra shifts each week
b. Staying late to help out at the end of each shift
c. Scheduling a massage on a day off
d. Teaching at the local community college one day a week
ANS: C
A fun, relaxing activity that is not work-related can help prevent burnout, such as scheduling a massage on a day off. Picking up extra shifts, staying late to help out at the end of the shift, and teaching part-time one day a week may lead to burnout if the nurse is not careful.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 36 OBJ: Identify strategies for self-care. TOP: Self-care strategies
MSC: NCLEX®: Health promotion and maintenance
21. Which of the following statements by the nursing student is an affirmation?
a. “I must maintain As in my school grades.”
b. “I am human and capable of making mistakes.”
c. “If I fail at something, the results will be catastrophic.”
d. “If I am not liked by everyone, I am a failure.”
ANS: B
Stating, “I am human and capable of making mistakes” is an affirmation or a positive
statement concerning the ways we would like to think, feel, or behave. The other statements are self-defeating thoughts.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: Box 2.9 OBJ: Identify strategies for self-care. TOP: Self-care activities
MSC: NCLEX®: Not applicable
MULTIPLE RESPONSE
1. When taking an online or web-enhanced course, what are effective time-management strategies? (Select all that apply.)
a. Enroll in an online or web-enhanced course that has fewer than 15 students to
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