Republic of the Philippines

PROFESSIONAL REGULATION COMMISSION

Manila

BOARD OF NURSING

Philippine Nurse Licensure Examination

NURSING PRACTICE I – COMMUNITY HEALTH NURSING

INSTRUCTION: Select the correct answer for each of the following

questions. Mark only one answer for each item by shading the box
corresponding to the letter of your choice on the answer sheet provided.
STRICTLY NO ERASURES ALLOWED.

Situation: PHN Ricky is developing a plan for identifying local needs and
resources can help changemakers understand how to improve their
communities in the most logical and efficient ways possible.

1. Which of the following would be the best definition of a community?

a. People with open boundaries living in a particular area
b. People gathered together to solve a particular problem
c. People with a sense of belonging or common identity
d. People with at least one common demographic characteristic

2. Which of the following would be the best way to determine the health of
a community?
a. Ask a firefighter which neighborhoods have the fewest fires.
b. Ask a realtor which neighborhoods have the most expensive houses.
c. Ask people living in the neighborhood if they are happy with where they
live.
d. Ask the police department which neighborhoods have the lowest crime
rates.

3. Which of the following characteristics would be most indicative of a

healthy community?
a. Excellent private schools and superb fire and police systems
b. A United Way that receives large donations each year
c. An extensive array of services offered by private physicians
d. Clean air and water and a sense of community cohesion

4. When a community is assessed from a developmental framework, which data

must be determined?
a. The demographics (such as age) of the persons living in the community
b. The emotional maturity of the community’s residents
c. The history of the community
d. The number and quality of daycare centers and schools

5. A nurse was assessing the neighborhood near the health agency. The
nurse drove around observing the condition of the buildings, sidewalks,

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and the people in the community. Which of the following best describes the
actions of the nurse?
a. A drive-through
b. A neighborhood observation
c. A quick overview
d. A windshield survey

6. The community/public health nurse wanted to most effectively and

efficiently determine the health and well-being of the community. Which of
the following is the easiest way to determine a community’s health?
a. Ask the members of the media who report on the community
b. Examine epidemiologic statistics of morbidity and mortality
c. Review the discharge diagnoses of clients from the community hospital
d. Visit the local grocery stores and exercise programs

7. The community/public health nurse was excited about creating a program

for prenatal education and care for single teenage mothers. Before writing
an application for a grant to fund the program, what should the nurse
determine?
a. Agency’s policies about writing grants for such a program
b. Number of single teenage mothers in the local high schools
c. Whether local teenagers are interested in receiving such a service
d. Whether anyone else in the area is offering such a service

8. Which of the following factors can consumers easily evaluate?

a. Appropriateness of the selected intervention
b. Interpersonal skill of caregivers
c. Quality of the care provided
d. Effectiveness of the program

9. The community/public health nurse was enthusiastic about giving care to

the community’s residents. Which of the following actions should the nurse
take when asked to attend a city council meeting?
a. Appreciating the opportunity to meet the policy makers in the community
b. Clarifying which agenda item was relevant to the agency and its purpose
c. Insisting on dedicating the nurse’s time toward giving care, not
observing politics
d. Pointing out that the nurse’s caseload was too heavy to waste time in
such a way

10. Which of the following factors has a direct correlation with the
health and well-being of the community?
a. The number of hospitals and other health agencies in the community
b. The number of physicians who practice in the community
c. The government funding level of the community
d. The poverty level of the community

Situation: The PHN is conducting community diagnosis. The PHN is aware

that it is the foundation for improving and promoting the health of
community members.

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11. Which of the following facts is a drawback of the community
empowerment model?
a. Bankers and other money people are very busy and often uninterested.
b. Grants, although beautifully written, may not get funded.
c. It is hard to persuade experts to volunteer their time.
d. It is the slowest approach and takes the longest to obtain results.

12. How might the social planning model best be defined?

a. A process of experts engaging in rational, deliberate problem solving
b. A process of group meetings that take place until everyone reaches
consensus
c. A process of collaboration to write grants to fund health care programs
d. A process of using democratic decision making through a grassroots
approach

13. How might the social action approach be summarized?

a. A process of experts engaging in rational, deliberate problem solving
b. A process of group meetings that take place until everyone reaches
consensus
c. A process in which groups seek redistribution of power or basic change
in organizational policies
d. A process in which groups work together to write several grants to get
money for health care programs

14. A community/public health nurse is using the social action model to

facilitate change in the community. Which of the following aspects of this
model may make the nurse feel uncomfortable?
a. Admitting that the nurse may not know the best approach
b. Cooperating with a large number of community agencies
c. Confronting power brokers directly
d. Sharing decision making with other people

15. Lewin’s change theory is being applied as the community is addressing

improvements in public safety. Which of the following would be one of the
first steps in creating change?
a. Determining whether anyone else agrees
b. Having a careful plan as to what change is desirable
c. Making community members aware of the need for change
d. Assessing community needs to determine whether change is possible

Situation: Health promotion and risk reduction services are becoming a

vital part of comprehensive health care for persons of all ages.

16. Which of the following is one of the goals of Healthy People 2020?
a. Decreasing institutionalization and increasing community-based care
services
b. Achieving health equity, eliminating disparities, and improving the
health of all groups

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c. Creating environments to improve the eating and exercise habits of all
people
d. Expanding the technology, resources, and medications used to treat
chronic illness

17. How was the concept of health defined originally?

a. Balance and harmony
b. Maximum self-actualization
c. Absence of disease
d. Total well-being

18. Which of the following definitions of health is most typically used in

nursing today?
a. Ability to interact and adapt to the environment
b. Ability to perform required social roles
c. Ability to stay free from disease
d. Ability to maximize human potential

19. What is the primary goal of health promotion?

a. Discovering people who are at risk and helping them obtain appropriate
health care
b. Enabling people to exercise control over their own well-being
c. Preventing further physiologic damage by early intervention and
education
d. Reducing specific risks by early diagnosis and treatment

20. A public health agency had enough funds to provide one more health-
promotion program during the calendar year. In relation to nutrition and
exercise, which of the following would be the best choice?
a. Elementary school program for children to which parents are invited
b. High school program for those who are involved in athletics
c. Young adult programs provided at the YMCA
d. Senior citizen programs offered during a free meal

21. The intervention that a nurse and a planning group proposed was not
accepted, primarily because of poor timing and lack of funds. Which of the
following is helpful for the nurse to remember?
a. At least an effort was made to intervene.
b. The situation will probably not get worse.
c. The communities can function without the proposed program.
d. There are always other options that might meet the same goals.

22. What is the primary reason why every step of an intervention is

planned before the intervention is implemented?
a. It is required by the nursing process procedure.
b. It is the way in which agencies expect to see performance by the nurse.
c. It saves time, and the implementation process goes more smoothly.
d. It allows the nurse to remember what was going to be done.

23. What is the primary usefulness of a Gantt chart?

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a. It creates a deadline for each step.
b. It describes potential program problems.
c. It identifies the process needed to achieve a certain result.
d. It outlines the steps of the assessment process.

24. What is the primary usefulness of a Program Evaluation and Review

Technique (PERT) chart?
a. It creates a flowchart of activities in sequence with time estimates.
b. It identifies potential program problems and possible solutions.
c. It identifies the process needed to achieve a certain result.
d. It outlines the steps of the assessment process.

25. The nurse is planning to present an educational program. Which of the

following is important for the nurse to remember?
a. Having many handouts so that the audience can remember what was said
b. Ordering a microphone so that everyone in the room can hear easily
c. Using pictures and posters of professionals demonstrating the needed
behaviors
d. Using many different methods of presentation with multimedia art

Situation: Evaluation is crucial to determine whether, after application

of the nursing process, the client's condition or well-being improves.

26. A community/public health nurse is planning the evaluation of a

community education program about smoking cessation. Why is it important
to complete this evaluation?
a. It facilitates additional decision making.
b. It clarifies the actual care involved in the service.
c. It is required by accrediting agencies.
d. It demonstrates that outcomes of the program were met.

27. Which of the following is a necessary assumption for evaluation to

occur?
a. Accrediting agencies focus on careful documentation.
b. Actions have both intended and unintended results.
c. Nursing care is dependent on the reimbursement available.
d. People expect professionals to document their care.

28. What is the purpose of outcome attainment?

a. Answering the question Were goals achieved?
b. Clarifying whether agency funds were appropriately expended
c. Determining quantity of care given
d. Measurement of community living outcomes

29. A nurse is determining the quality of care that is provided. Which of

the following factors would the nurse examine?
a. Adequacy and appropriateness
b. Agency mission statements
c. Cost-benefit ratios
d. Personal feelings about the care

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30. How does summative evaluation help the community/public health nurse?
a. Analyzing the data and recognizing gaps
b. Determining long-term effect on health
c. Improving care as it is being delivered
d. Enhancing future offerings of the program

Situation: Implementing a successful Community Risk Reduction program

brings additional resources to the effort through partnerships within the
fire department as well as the community served. This community-based
approach increases public safety because of the collective work with the
community to understand, assess, and provide inclusive solutions to
community safety issues.

31. A nurse is planning a community-wide program about reducing the risk

of developing cardiovascular disease. Which of the following actions
should the nurse take first?
a. Developing a public education campaign by using public service
announcements
b. Assessing the extent of the problem in the local community
c. Forming partnerships and establishing support with community agencies
d. Gathering resource materials and identifying funding sources

32. A public health nurse was asked by a towns community college to offer
health education programs for its employees. How would the nurse most
effectively determine which programs to offer?
a. Asking the administrators which programs they would like
b. Performing a complete physical examination on each employee during work
time
c. Having employees complete a health-risk appraisal form
d. Planning a program on the basis of the broader community’s demographic
data

33. The nurse gave each participant a health-risk appraisal tool to

determine the health needs of the group as a whole. What other purpose may
the tool serve?
a. To assess the needs of the broader community
b. To demonstrate the necessity of having health education programs
c. To motivate participants to consider changing high-risk behaviors
d. To provide data for future planning by the nurse’s employer

34. When a nurse plans educational programs appropriate for a population

being served, which of the following actions should the nurse take?
a. Bill the employer for the actual cost of the health program.
b. Provide feedback and follow-up information to attendees.
c. Make handouts available to the audience.
d. Incorporate the latest technology into the presentation.

35. A nurse used a lifestyle assessment to measure health-promoting

lifestyle behaviors of participants at a meeting. Which of the following

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actions should the nurse take when reviewing the results with each
individual?
a. Arrange for the client to meet with a lifestyle coach.
b. Collaborate with the client in choosing what changes to make.
c. Explain ways that the client can engage in new behaviors.
d. Tell the client what to do to improve his or her health.

Situation: Community Health Nurse have been using family perspective to

address the individuals client’s health needs or problems and to enhance
family functioning for growth & development.

36. When a home health nurse visits a family for the first time, what is
the nurse’s primary goal?
a. Complete physical examinations on as many family members as time
allows.
b. Have the family complete as many assessment tools as time allows.
c. Make sure all records, including third-party payer information, are
accurate.
d. Observe and interview the family to identify family strengths and
needs.

37. After completing an assessment, the nurse discusses with the family
some actions that needed to be taken and refers to the wife in the family
as an incredible organizer. Which of the following goals is the nurse
trying to achieve by making this statement?
a. Making the husband proud that he had married his wife
b. Making the wife feel very complimented and positive
c. Encouraging the wife to volunteer to follow through on all the needed
actions
d. Reinforcing for the family some of the strengths of one of their family
members

38. Upon what variable are Duvall’s developmental stages based?

a. Age of the oldest child
b. Age of the parent or parents
c. Family function
d. Family structure

39. Why would a family strenuously resist the nurse’s efforts to be

helpful?
a. People have the tendency to want to stay the same.
b. The family as a system operates on the principle of equifinality.
c. The nurse crossed the family’s coping boundary.
d. The family system is trying to achieve entropy.

40. After completing an assessment and discussing the plan of care with
the family, upon which member would the nurse focus effort?
a. The adult patient with the acute flare-up of chronic illness
b. The child who, being young, was energetic and enthusiastic
c. The extended family, who had to learn to become a resource

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d. The spouse, who was flexible and able to cope

41. A nurse in a particular community decided that the priority was to

decrease the number of teenagers who smoke. Which of the following should
the nurse measure first?
a. Percentage who currently smoke
b. Attitudes toward smoking
c. Prior experience with smoking cessation
d. Knowledge about the dangers of smoking

42. One of the responsibilities of the community/public health nurse was

to teach parenting classes to teenage mothers at high risk for committing
child abuse. Which of the following would be an effective approach to
helping mothers deal with their infant’s behavior without resorting to
physical discipline?
a. Asking the mothers to listen carefully to the nurse’s suggestions
b. Asking the mothers to develop a contract to use the techniques
discussed
c. Asking the mothers to come to a consensus about how to deal with
specific problems
d. Asking the mothers to self-report abuse of their infants

43. A community/public health nurse was told to focus on teenage smoking.

Which of the following actions should be the priority of the nurse?
a. Ensuring that smoking is not allowed on school property
b. Establishing community-wide programs on the dangers of smoking
c. Lobbying to pass laws against teenagers purchase of cigarettes
d. Establishing programs to help adults, especially parents, give up
smoking

44. The nurse wanted to determine the community’s level of self-esteem and
well-being. Which of the following would be the most effective way to
systematically and accurately determine the satisfaction level?
a. Asking every community member, “What is your level of self-esteem?
b. Asking the employing agency’s director, who lives in the community,
about satisfaction level
c. Distributing self-esteem scales to a random sample of community members
d. Observing the clients currently using certain community-based services

45. Which of the following personal beliefs best demonstrates the meaning
of self-efficacy?
a. You are capable of continued growth and development.
b. You are responsible for your own health and well-being.
c. You can improve your own health and well-being by using imagery.
d. You can influence your environment and circumstances.

Situation: Health education is any combination of learning experiences

designed to facilitate voluntary actions conducive to health and one of
the strategies for implementing health promotion and disease prevention
programs.

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46. Which of the following factors most influences a client’s ability to
learn from a health education program?
a. Client’s belief that the information will be useful or enjoyable
b. Handouts given to the client
c. Nurse’s ability to teach
d. Setting in which the educational program is given

47. A nurse is teaching a client how to perform her own insulin

injections. Which of the following should the nurse assess first to
determine the client’s experiential readiness to learn?
a. Culture and ethnic background
b. Educational ability
c. Family structure
d. Home environment

48. Behavioral objectives should be

a. Comprehensive and complete.
b. Observable, measurable, and clearly communicated.
c. Specific and detailed.
d. Written on the teaching plan.

49. The nurse distributed written materials with culturally appropriate

pictures to the small groups in the audience and began to lecture on the
important content before the planned discussion period. However, no one
was listening. What should the nurse have done differently?
a. Created a more interesting and entertaining lecture
b. Withheld the written materials until after the lecture
c. Let the audience discuss the material as a whole, not in small groups
d. Skipped the lecture and went directly to the discussion period

50. Which of the following statements best demonstrates an appropriately

written behavioral objective?
a. The learner will be able to verbally explain the need for political
action.
b. The panel of experts will have discussed knowledge, assumptions, and
cultural values.
c. The participant will understand the material presented.
d. The teacher will distribute and collect evaluation forms.

Situation: Community health nursing can play an important role in

conducting community needs assessments that provide critical data upon
which programming, planning, and evaluation should be based. The community
health services developed for any given community should be planned with
the specific needs of the community residents in mind.

51. A nurse is completing a community assessment by using a systems

framework. Which of the following is the key to the success of the
assessment?
a. Demanding a reasonable budget for assessment expenses

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b. Telling everyone what he or she is doing so that the listener may have
input
c. Using a tool to systematically identify, collect, and organize
appropriate data
d. Allowing at least 2 weeks to collect data to ensure thoroughness

52. What is the first step in beginning a community assessment?

a. Choosing persons who live in the community and may share their insights
b. Creating a budget of both time and money to devote to assessment
c. Defining the community and determining its boundaries or parameters
d. Outlining the data needed and determining where they might be found

53. Why would a nurse be concerned when a community has relatively closed,
rigid boundaries?
a. The community does not have an identity.
b. The community is probably resistant to change.
c. The nurse will not be able to share community resources.
d. The nurse may have limited access to the community.

54. Which of the following events illustrates how the suprasystem affects
a community as a system?
a. A group of concerned citizens points out the rising number of homeless
persons in the community.
b. A subgroup of the community demands that housing for homeless persons
be built.
c. Homeless persons decide to picket in front of the city government
building.
d. The state legislature passes a law that all communities must build some
housing for homeless persons.

55. How might the goals of communities best be summarized?

a. Ensuring that the community’s history is remembered
b. Encouraging socialization with persons outside the community
c. Maximizing availability of financial and other resources
d. Promoting survival and maximizing the well-being of members

56. A community/public health nurse employed by the local health

department is told by the director to engage in health planning. Which of
the following actions will the nurse perform?
a. Collecting and analyzing data
b. Serving vulnerable populations
c. Planning for health care needs of individuals
d. Applying the nursing process to community-based care

57. The director of a public health agency suggested that the

community/public health nurse select the target population for a new
program. Of the following populations, which would be considered the
target population?
a. Persons for whom the nurse is most comfortable caring

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b. Persons for whom some change in health or lifestyle behaviors is
desired
c. Persons eligible for care according to federal guidelines
d. Persons that can afford to pay for their care

58. Whether a nurse’s plan of care for a community is acceptable is

probably determined by which aspect of the plan?
a. It was created in coordination with community members.
b. It was financially feasible.
c. It was politically correct and feasible.
d. It was something in which the nurse really believes.

59. Which of the following aspects of a solution to a problem allows the

nurse to identify it as the best choice?
a. It must be financially reimbursable.
b. It must have the support of the clinical agency.
c. It must represent the values, beliefs, and perceptions of the involved
aggregate.
d. It must have the most advantages and the fewest disadvantages.

60. Which of the following situations will cause difficulties when a nurse
tries to persuade a community to accept a particular intervention?
a. The solution is oriented to the future, not the present.
b. Powerful groups in the community may not be committed to this
intervention.
c. The intervention is inconsistent with cultural, ethnic, or religious
beliefs.
d. The intervention may need more tax dollars than have currently been
funded.

Situation: Nurses are well placed to evaluate their services and practice,
and to develop an evidence base for effective care delivery.

61. How does formative evaluation help the community/public health nurse?
a. Analyzing the data and recognizing gaps
b. Determining what to do differently next time
c. Improving care as it is being delivered
d. Enhancing future offerings of the program

62. A nurse is planning to involve the community in the evaluation

process. Why is this a critical part of evaluation?
a. The nurse has completed her ethical, legal, and political
responsibilities.
b. The agency retains state approval and national accreditation.
c. The community does not feel ignored by the agency.
d. The interventions helped community members make appropriate lifestyle
changes.

63. Stakeholders are defined as persons who:

a. Have expectations about care to be delivered.

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b. Have loaned money to the agency.
c. Helped write the legislation for health care agency funding.
d. Own stock in the agency.

64. A nurse is planning to examine program outcomes. Which of the

following would be the most important question to ask?
a. Was the agency adequately funded?
b. What organizational process was used?
c. What techniques were used?
d. What were the end effects on clients?

65. A community/public health nurse plans a program to improve the

community’s ability to prevent accidents. Which of the following
measurements would be the best way to evaluate the outcomes of the nurse’s
intervention?
a. Number of accidents in the subsequent year in comparison with the
previous year
b. Number of people who attended the educational program
c. Number of requests for information received after the program
d. Satisfaction level of those who attended the program

Situation: Families who experience psychosocial issues connected to acute

or chronic illness rely on nurses to assist them in managing situational
crisis, and nurses have a long history of studying psychosocial issues
related to family functioning, family strengths, resilience, and coping
with health conditions.

66. What are the two phases that families experience after a major life
event?
a. Asking for help and accepting assistance
b. Seeking assistance and relying on the family’s own resources
c. Temporary adjustment and long-term adaptation
d. Reduction of stressors and adapting to reduce tensions

67. Which of the following variables makes some families more vulnerable
to dysfunction than others in facing a particular crisis?
a. A family members moving away
b. Addition of a new family member
c. Additional stressful events
d. Previous experience with stressful events

68. Which of the following actions should a community/public health nurse

perform when providing care with the use of a family perspective?
a. Assessing all individuals for necessary services and interventions
b. Engaging in therapy on the basis of theories of communication and
symbolic interaction
c. Maximizing the health and well-being of all individuals within a family
d. Suggesting appropriate roles for various family members during a crisis

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69. What are some reasons why community/public health nurses may choose to
focus on the family as a unit of care? (Select all that apply.)
1. A family perspective allows for a broader view than an individual
perspective.
2. A family perspective results in a better understanding of an individual
who needs care.
3. An individual’s health depends on his or her family.
4. An individual’s ill health will affect the family.
5. The family has always been the unit of focus of nursing care.
6. The family perspective allows for higher reimbursement of nursing care.

A. 1, 2, 3, 4
B. 2, 3, 4, 5, 6
C. 1, 2, 3, 5, 6
D. 3, 4, 5, 6
E. 1, 2, 3, 4, 5

70. Which of the following information will a nurse need to assist a

family trying to cope with developmental changes? (Select all that apply.)
1. A list of credentialed family therapists available as resources
2. Ages of the extended family members
3. Examples of apparent success of the family’s previous coping strategies
4. Current family strategies to meet demands
5. The family’s knowledge of current developmental demands
6. The family’s pattern of using professional health care

a. 1, 2, 3, 6
b. 2, 3, 4, 5
c. 3, 4, 5
d. 1, 3, 4, 5

Situation: Health promotion requires policy makers across all government

departments to make health a central line of government policy

71. A community/public health nurse was responsible for setting up a

health fair in a very heavily attended inner-city church, with several
screenings being given simultaneously. Within the public health agency,
what would the nurse call the health fair?
a. Case finding
b. Community service
c. Multiphasic screening
d. Unreimbursed care

72. A local community hospital offers weekly hypertension screenings at

the community center. A community/public health nurse was asked by a
community member about when the health department would be offering a
hypertension screening at the center. Which of the following would be the
best response from the community/public health nurse?
a. When the public health department receives additional grant funding.
b. When the residents of the neighborhood request free screenings.

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c. When the community/public health nurse has extra time.
d. When the community hospital stops offering screenings.

73. As nursing students were setting up a health screening at a local

community center, they reviewed the need to screen for heart disease and
cancer. One student asked, but colon cancer is prevalent; why aren’t we
setting up for sigmoidoscopy? How would the instructor reply?
a. A sigmoidoscopy is expensive to perform and invasive.
b. Can you find adequate privacy for a sigmoidoscopy?
c. What a great idea. Would you like to help arrange it?
d. Would you like to administer that test for the screening?

74. The ability of a screening test to distinguish correctly between

persons with and without a disease is known as
a. Sensitivity.
b. Validity
c. Reliability.
d. Specificity.

75. Sensitivity is the ability of a screening test to accurately identify

what aspect of the screening?
a. Persons who do not have the disease
b. Persons who have the disease
c. Persons with symptoms of the disease
d. Persons who now have a diagnosis of the disease

Situation: Patient education is a significant part of

a nurse's job. Education empowers patients to improve their health status.
When patients are involved in their care, they are more likely to engage
in interventions that may increase their chances for positive outcomes.

76. For whom are patient education programs very helpful?

a. Adults and families who can learn to avoid health problems
b. Adults and families, who will all be clients in the future
c. People who wish to learn how best to use the health care system
d. People with an identified health problem

77. Toward which individuals and their families are health education
programs primarily aimed?
a. Those who are acutely ill and need information to help them recover and
avoid further problems
b. Those who are healthy and can support each other in maintaining healthy
lifestyles
c. Those who must cope with an ongoing chronic disease
d. Those who have defined health problems and who can support each other
in maintaining healthy lifestyles

78. Which of the following factors most influences a client’s ability to

learn from a health education program?
a. Clients belief that the information will be useful or enjoyable

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b. Handouts given to the client
c. Nurse’s ability to teach
d. Setting in which the educational program is given

79. A nurse is teaching a client how to perform her own insulin

injections. Which of the following should the nurse assess first to
determine the client’s experiential readiness to learn?
a. Culture and ethnic background
b. Educational ability
c. Family structure
d. Home environment

80. Behavioral objectives should be

a. Comprehensive and complete.
b. Observable, measurable, and clearly communicated.
c. Specific and detailed.
d. Written on the teaching plan.

Situation: To be effective in reconceptualized roles and to be seen and

accepted as leaders, nurse’s must see policy as something they can shape
and develop rather than something that happens to them, whether at the
local organizational level or the national level.

81. When goals/outcomes are somewhat unclear in early preparation for a

complex change, the manager and the change management team develop several
acceptable goals/outcomes. This change in management approach is termed:
a. Unfreezing.
b. Nonlinear.
c. Cybernetic.
d. Linear.

82. The home health agency hired an expert in financial management to

evaluate and propose a plan for reversing growing expenses and decreasing
revenues. The expert is well respected, both personally and
professionally, by members living in this small community. To be
effective, staff will need to perceive this change agent as:
a. Trusted, quiet.
b. Flexible, informal.
c. Credible, enthusiastic
d. Communicative, personable.

83. The nurse manager frequently interacts with staff and other hospice
facility employees. Communication is purposeful because the manager
assesses current issues, such as specific satisfactions and
dissatisfactions with the newly implemented computerized documentation
system. Informally, the manager gathers available staff members to address
similar learning needs. Many times, staff members are found coaching other
staff about improving use of the new system. According to Senge (1990),
the activities demonstrated in this example are:
a. Dialogue, team learning.

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b. Resilience, personal mastery.
c. Shared vision, systems thinking.
d. Mental models, teachable moments.

84. The clinical coordinator expects the position description of the new
wound care specialist to change nurse’s responsibilities in caring for
clients with skin integrity problems. The best approach to address this
need for change, yet to have the best outcomes for clients, staff nurse’s,
and the organization, is to:
a. Select one of the change models.
b. Use Lewin’s model and principles of change.
c. Apply both planned and complexity theory approaches.
d. Form a task force of nursing staff and wound care specialists.

85. Complex change situations require that the change leader promote
ongoing visioning among staff members. One strategy is to:
a. Consciously evaluate invisible mental models.
b. Allow for individual outcomes.
c. Encourage cooperative activities.
d. Operate between order and disorder.

86. To effectively achieve a change goal/outcome in a change situation,

the wound care specialist will:
a. Preserve the status quo.
b. Diminish facilitators and reinforce barriers.
c. Weigh the strength of forces.
d. Strengthen facilitating forces.

87. The wound care nurse decided to involve those to be affected by change
early in the change management process. This can positively result in:
a. Coordination.
b. Resistance.
c. Anticipation.
d. Participation.

88. The oncology clinic manager and the educational coordinator asked
nursing staff to complete a brief written survey to assess their attitudes
and knowledge related to having used the new infusion equipment for 6
weeks. The stage of change in this situation is:
a. Developing awareness.
b. Experiencing the change.
c. Integrating the change.
d. Perceiving awareness.

89. An example of one strategy to improve participation in the change

process by staff fitting the behavioral descriptions of laggards, early
majority, late majority, and rejecters is to:
a. Encourage teamwork.
b. Transfer to a different unit.
c. Require attendance at staff meetings.

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d. Delegate the roles and tasks of change.

90. An example of one strategy used to improve participation in the change

process by staff fitting the behavioral description of innovators and
early adopters is to:
a. Repeat the benefits of the change.
b. Share change experiences early in the process.
c. Initiate frequent interactions among staff.
d. Provide select information to the staff.

91. As a new manager, you are shocked to learn that your unit is still
using heparin in heparin locks. You are aware of evidence related to this
practice and want to change this practice as quickly as possible on your
unit. You are in which stage of Lewin’s stages of change?
a. Unfreezing
b. Experiencing the change
c. Moving
d. Refreezing

92. To engage your staff in awareness of their current practice and how it
is affirmed or not by evidence, you plan a short series of learning
presentations on evidence and use of heparin and saline to maintain IV
patency. You meet with the educator to plan out the goals for each session
with the overall purpose of increasing knowledge and awareness of staff in
readiness to consider questions related to the IV practice. This learning
approach is an example of which change management approach?
a. Linear
b. First-order
c. Facilitative
d. Integrative

93. To engage your staff in awareness of their current practice and how it
is affirmed or not by evidence, you plan a short series of learning
presentations on evidence and use of heparin and saline to maintain IV
patency. You meet with the educator to plan out the goals for each session
with the overall purpose of increasing knowledge and awareness of staff in
readiness to consider questions related to the IV practice. Staff nurse’s
who gain information on current IV therapy practices are engaging in which
phase of Rogers decision-making process?
a. Persuasion
b. Knowledge
c. Confirmation
d. Decision

94. Elizabeth, an RN with approximately 15 years of service on your unit,

walks away from one of the learning sessions on IV care and you overhear
her telling a colleague that she thought the session was a waste of time
because the unit has been using heparin for years and there has never been
any adverse effects. According to Havelock (1973), this comment may
originate from failure in which phase of the six phases of planned change?

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a. Generating self-renewal
b. Choosing the solution
c. Diagnosing the problem
d. Building a relationship

95. Elizabeth, an RN with approximately 15 years of service on your unit,

walks away from one of the learning sessions on IV care and you overhear
her telling a colleague that she thought the session was a waste of time
because the unit has been using heparin for years and there has never been
any adverse effects. You follow up with Elizabeth and discover that she is
really quite angry about the information sessions because she feels that
you are implying that what she has been doing all these years means that
she is incompetent and doesn’t care about her patients. Your response to
her indicates that:
a. Elizabeth will never adopt the change.
b. Elizabeth is insecure in her practice.
c. Elizabeth requires more information about the practice.
d. Change involves emotions.

96. Elizabeth, an RN with approximately 15 years of service on your unit,

walks away from one of the learning sessions on IV care and you overhear
her telling a colleague that she thought the session was a waste of time
because the unit has been using heparin for years and there has never been
any adverse effects. You follow up with Elizabeth and discover that she is
really quite angry about the information sessions because she feels that
you are implying that what she has been doing all these years means that
she is incompetent and doesn’t care about her patients. Which of the
following would be the most effective response to Elizabeth?
a. I understand how you feel, but you are going to have to change.
b. It is unfortunate that you feel this way. Others seem quite excited
about the new information.
c. It is difficult sometimes to change what we know very well. Sometimes
it can be frightening.
d. Perhaps I can arrange some more information sessions for you, so you
can see just how important this change is to patient safety.

97. Elizabeth is an example of a(n):

a. Early adopter.
b. Late majority.
c. Laggard.
d. Resister.

98. Elizabeth, an RN with approximately 15 years of service on your unit,

walks away from one of the learning sessions on IV care and you overhear
her telling a colleague that she thought the session was a waste of time
because the unit has been using heparin for years and there has never been
any adverse effects. You follow up with Elizabeth and discover that she is
really quite angry about the information sessions because she feels that
you are implying that what she has been doing all these years means that
she is incompetent and doesn’t care about her patients. After speaking

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 with Elizabeth a few days later you discover that she is now fine with the
change but is concerned that other areas of the organization might resist
the change because of perceptions related to patient safety and cost. She
suggests that it is important to bring pharmacy on board as they have had
previous concerns about the use of heparin. In relation to change theory,
this is indicative of:
a. Systems level thinking.
b. Linear thinking.
c. Interprofessional collaboration.
d. First-order change.

99. Based on Elizabeth’s insights and suggestions, you involve pharmacy,

only to discover that the change in practice involves practice committees,
a medical practice committee, and concerns from administration about
potential costs and safety of the proposed change to the IV protocols. The
change process at this point is:
a. Linear.
b. Nonlinear.
c. Sabotaged.
d. Neutralized.

100. Resistance is most likely when change:

a. Is not well understood.
b. Involves many layers in an organization.
c. Involves nonprofessional workers.
d. Threatens personal security.

***** END OF EXAMINATION *****

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