A novice nurse is stressed due to always being behind with her assignments. She is overheard saying, "No one here worries about checking nasogastric tube placement before they give medications and hang feedings. Skipping that step would save me an extra 30 minutes to be used for charting. If they can do it, so can I." This nurse is experiencing which stage of reality shock?

Correct Answer: D

Rationale: The correct answer is D, "native." In this scenario, the nurse is rationalizing skipping a crucial safety step by justifying it with the actions of others, indicating a lack of understanding regarding the importance of the procedure. The "native" stage of reality shock occurs when individuals start to adopt the norms and behaviors of their workplace without questioning or critically evaluating them. This nurse is displaying a mindset of conforming to unsafe practices to fit in with her colleagues, which aligns with the characteristics of the "native" stage. Incorrect choices: A: "loner" does not apply as the nurse is not isolating herself but rather seeking to emulate the actions of others. B: "rutter" does not fit as this stage involves feeling overwhelmed by the demands of the job, not justifying unsafe practices. C: "change agent" is not relevant as the nurse is not actively seeking to instigate change but rather conforming to existing practices.

Correct Answer: C

Rationale: The correct answer is C: Expert. An RN with excellent assessment and psychomotor skills derives power from their expertise in the field. They are respected and trusted for their knowledge and abilities, giving them influence over others. Rewards (A) and coercion (B) are forms of power derived from external factors like incentives or threats, not skills. Legitimate power (D) comes from one's position or title, not necessarily from skills. In this case, the RN's power comes from their expertise, making choice C the most appropriate answer.

Correct Answer: A

Rationale: The correct answer is A: utilization. Research utilization refers to the application of research findings in nursing practice to improve patient outcomes. Utilization involves integrating research evidence into clinical decision-making. Dissemination (B) refers to sharing research findings. Generalizability (C) pertains to the extent to which research findings can be applied to different populations or settings. Analysis (D) involves examining data to draw conclusions, but it does not specifically relate to using research in practice like utilization does.

Correct Answer: D

Rationale: The correct answer is D: Capitation. Capitation is a payment model where healthcare providers receive a fixed amount per patient per month to provide all necessary healthcare services. This aligns with the description of the plan in the question, offering services based on a monthly fee per participant. Capitation also emphasizes preventive care, diagnostic services, and treatment, making it the most suitable choice. A: Prospective payment system is a method where healthcare providers are paid a fixed amount per service in advance. This does not match the description of the plan in the question. B: Retrospective payment system involves reimbursing healthcare providers after services are delivered based on the actual costs incurred. This is not based on a monthly fee per participant. C: Single-payer system refers to a healthcare system where a single public or quasi-public agency organizes healthcare financing. This is not based on a monthly fee per participant.

Correct Answer: C

Rationale: The correct answer is C: Beneficence. Beneficence is the ethical principle that emphasizes the obligation to act in the best interest of the client and to do good. In this scenario, the nurse is not acting in the best interest of the client by withholding the prescribed medication for personal gain. This action goes against the principle of beneficence as it is causing harm to the client by denying them the necessary pain relief. Summary: A: Autonomy is the right of the client to make their own decisions, which is not the main issue in this scenario. B: Utilitarianism focuses on maximizing overall good for the greatest number of people, which is not directly applicable here. D: Dilemmas do not represent a specific ethical principle being violated in this situation.

Correct Answer: B

Rationale: The correct answer is B: Sunset legislation. Sunset legislation mandates that laws, including nurse practice acts, must be reviewed periodically to determine if they are still needed. If a nurse practice act is not reviewed by the specified date, it is automatically rescinded. This process ensures that laws are current and relevant. Incorrect Choices: A: Nurse review act - There is no specific law called the Nurse review act that pertains to the automatic rescinding of nurse practice acts. C: Mandatory revocation - This choice does not align with the process of automatic rescinding based on a failure to review. D: Grandfathering - Grandfathering refers to exempting individuals from new regulations based on previous circumstances, not the automatic rescinding of laws.

Correct Answer: A

Rationale: The correct answer is A because it describes a cultural belief that attributes a physical trait (cleft lip) to a specific biological event (exposure to an eclipse during pregnancy). This choice demonstrates a cultural phenomenon based on biologic variation. Choice B is incorrect because it attributes denser bones in blacks to less morbidity from osteoporosis, which is a generalization and not necessarily a cultural phenomenon. Choice C is incorrect as it describes a family dynamic related to healthcare decision-making and not a cultural belief based on biologic variation. Choice D is incorrect as it describes a family tradition related to feasting and decision-making, which does not directly involve biologic variation.

Correct Answer: D

Rationale: The correct answer is D because "safe harbor" refers to a legal provision that protects nurses when they feel unsafe accepting a staffing assignment due to lack of recent experience or competency. By invoking safe harbor, nurses can continue caring for patients while an investigation is conducted to ensure patient safety and protect the nurse's license. This process allows nurses to voice concerns without fear of reprisal. Option A is incorrect as it refers to a disaster response plan, unrelated to safe harbor. Option B is incorrect as it discusses patient care teams and infectious diseases, not safe harbor protections. Option C is incorrect because it addresses reporting violence, which is not directly related to safe harbor provisions for staffing assignments.

Correct Answer: A

Rationale: The correct answer is A because it involves a high-risk delegation. Mixing insulin is a complex task that requires precise measurements and understanding of the patient's condition. A novice RN may lack the experience and knowledge to safely perform this task, leading to potential harm for the patient. Choice B involves wound care, which is within an LPN's scope of practice and not as high-risk as insulin administration. Choice C involves basic ambulation assistance, which is appropriate for an unlicensed assistive person under supervision. Choice D involves caring for a patient with low white blood cell count, which may be challenging but not as high-risk as insulin mixing for a novice RN.