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: educational institution. ".edu" domain is reserved for educational institutions in the United States, indicating that the website is affiliated with an educational organization. Government agencies typically use ".gov" domain (A), commercial sites use ".com" domain (B), and Internet service providers use ".net" domain (D). Therefore, the presence of ".edu" in the domain indicates that the site is associated with an educational institution.

Correct Answer: D

Rationale: The correct answer is D because giving spur-of-the-moment recognition to an employee who has accomplished a goal is an example of positive reinforcement. This action immediately follows the desired behavior, increasing the likelihood of it being repeated. This instant feedback helps reinforce the employee's behavior positively. A: Thanking each employee every morning is a form of positive feedback, but it lacks the immediacy of reinforcement. B: Rotating a monthly recognition award does not provide immediate reinforcement for specific behaviors. C: Waiting for an annual review to recognize accomplishments does not provide timely feedback to reinforce desired behaviors.

Correct Answer: B

Rationale: The correct answer is B: patient-centered. This model focuses on meeting the individual patient's needs and preferences, involving them in decision-making, and providing care that is respectful and responsive to their values. In this scenario, the patient's decision to stop hemodialysis is respected, and palliative care is provided in alignment with his wishes. Partnerhsip (A) typically involves collaboration between healthcare providers and patients, which is not explicitly mentioned. Case management (C) focuses on coordinating services for complex cases, which is not the primary focus here. Total patient care (D) involves providing all aspects of care directly by the same nurse, which is not the main approach in this scenario.

Correct Answer: B

Rationale: The correct answer is B: those skills necessary for safe, competent nursing practice. Core competencies refer to the essential skills and knowledge required for safe and competent nursing practice. In the scenario provided, the nursing student needs to demonstrate proficiency in indwelling catheter insertion and wound care to meet these core competencies. These skills are crucial for providing quality patient care and ensuring patient safety. Choice A is incorrect because core competencies are not about reducing attrition but rather about ensuring students possess the necessary skills for nursing practice. Choice C is incorrect as core competencies focus on skills required for practice, not on educational remediation. Choice D is incorrect because core competencies are not about improving reading and math skills but about the specific nursing skills needed for practice.