Chapter 1: Beginning the Journey
Question 1
Which societal changes have promoted the nurse’s return to school and further
education? (Select all that apply.)
1. Patients have increasingly more complex and varied health needs.
2. Previously unknown diseases are being identified.
3. New technologies are being developed that require continual knowledge updates.
4. Patients are staying longer in the hospital.
5. There is a relative increase in the number of children in the population.
Correct Answer: 1, 2, 3
Rationale: Changes in society have placed new demands on nurses. The population is
aging and these older patients have more complex and varied health problems. New
diseases related to social and environmental problems are being identified. Scientific
discoveries and new technologies require the nurse to continually update his or her
knowledge base in order to provide safe and competent care. Patients are going home
from the hospital earlier (not staying longer), so much more care is being provided in
community and outpatient settings. The population is aging so there is not a relative
increase in the number of children in the population.
Question 2
Which statement regarding age trends of RNs is correct?
1. The average age of persons holding RN licensure has remained the same for the last
10 years.
2. The average age of male RN graduates is decreasing while the age for female RN
graduates is increasing.
3. The average age of RN graduates has increased.
4. Overall, the average age of practicing RNs has decreased.
Correct Answer: 3
Rationale: The average age of RNs has increased. In 2000, the average age of RNs was
45.2 years; in 2013, the average age of RNs had increased to 50 years. There is no
information in the text regarding age as it applies to gender.
Question 3
According to the 2013 National Workforce Survey, what is the highest level of
educational preparation for the majority of RNs?
1. Diploma
2. Associate degree
3. Baccalaureate degree
4. Master’s degree
Correct Answer: 3
Rationale: According to The 2013 National Nursing Workforce Survey of Registered
Nurses by the National Council of State Boards of Nursing and The Forum of State
Nursing Workforce Centers, 8% of nurses hold a diploma, 29% of nurses hold an
,associate degree, 36% of nurses hold a baccalaureate degree, and 13.9% of nurses hold
a master’s or doctoral degree as their highest level of educational preparation.
Question 4
How have the practice settings for nurses changed since 1980?
1. There has been little or no change in these settings.
2. The settings have shifted from the community to the hospital.
3. There has been a shift from the hospital to long-term care settings.
4. They have shifted from acute-care to community or primary care settings.
Correct Answer: 4
Rationale: The focus of professional nursing practice is shifting from acute hospital-
based illness care to primary outpatient-based community care, emphasizing health
promotion and illness/injury preventions. The percentage of RNs working in hospitals
decreased from 66% in 1980 to 56.2% in 2004.
Question 5
What statement about specialty certification in nursing is true?
1. Specialty certification guarantees increase in salary for the nurse.
2. Healthcare agencies rarely recognize certifications by nursing specialty groups.
3. The nurse who works in hospital practice must hold at least one specialty certification.
4. The nurse must demonstrate extensive experience and continuing education in the
specialty area.
Correct Answer: 4
Rationale: To be eligible to take the certification exam, the nurse must demonstrate
extensive experience and continuing education in the specialty area. Although there is
no guarantee that the nurse’s salary will be increased, healthcare agencies do recognize
these certifications. There is no requirement that the nurse hold a specialty certification
to work in a hospital; however, work in specialty areas, such as the emergency
department, critical care areas, or surgery, may require certification.
Question 6
The nurse has been promoted from staff nurse to supervisor and is trying to make a
transition to the new role. Which behavior reflects that the nurse is in the ending phase
of Bridges’ model of transition?
1. The nurse is working to move forward in the job, avoiding the temptation of going
back to familiar ways of thinking.
2. The nurse is beginning to accept the responsibilities of the new position.
3. The nurse has accepted that relationships with former peers on the unit will change.
4. The nurse questions the wisdom of accepting the new position.
Correct Answer: 4
Rationale: Bridges’ model of transition consists of three phases. The first phase, called
the ending phase, consists of the individual “letting go” of the old situation. This phase
consists of four components: disengagement, disidentification, disenchantment, and
disorientation. The nurse who is questioning the wisdom of accepting the new position is
in the letting go phase of disorientation. The second phase, neutral zone, is exemplified
,in this question by the nurse beginning to accept the responsibilities of the new position
and accepting that relationships with former peers will change. As the nurse works to
move forward in the job, resisting the temptation to go back to familiar ways of thinking
and working, the nurse has moved into the final stage of transition, new beginnings.
Question 7
The nurse who has gone back to school to earn a master’s degree is eager to talk with
peers who are also considering going back to school. Which stage of Spencer and Adams’
model of transition does this desire most closely exemplify?
1. Stage 2, minimizing the impact.
2. Stage 4, letting go of the past.
3. Stage 6, searching for meaning.
4. Stage 7, integration.
Correct Answer: 3
Rationale: Spencer and Adams describe a seven-stage model. The nurse’s actions most
closely exemplify Stage 6, searching for meaning. In this stage, the individual desires to
help others who are experiencing a similar situation. In Stage 2, minimizing the impact,
the person feels a need to go back to what was normal or comfortable in order to avoid
the full effect of the changes taking place. In Stage 4, letting go of the past, the
individual begins to focus on the change’s benefits and to look forward to those benefits.
Stage 7, integration, is the stage of completion. In this stage, the individual experiences
satisfaction and self-confidence.
Question 8
The individual going through a transition may experience many feelings. Which feelings
are common? (Select all that apply.)
1. Anger
2. Anxiety
3. Knowledge
4. Confusion
5. Grief
Correct Answer: 1, 2, 4, 5
Rationale: A variety of emotions and feelings are common when an individual is going
through a transition. These feelings include anger, anxiety, confusion, and grief. Feeling
knowledgeable will not occur until the individual has been functioning in the transitioned
role for some time.
Question 9
The nurse has elected to return to school to pursue a baccalaureate degree. After the
first week of classes, the nurse is overwhelmed. Which stage of Spencer and Adams’
model of transition is this nurse most likely experiencing?
1. Losing focus
2. Minimizing the impact
3. The pit
4. Letting go of the past
Correct Answer: 1
Rationale: Losing focus is Stage 1 of Spencer and Adams’ model of transition. In this
stage, the individual has difficulty keeping things in perspective and may feel
overwhelmed and panicked. Minimizing the impact is Stage 2, in which the individual
may resist the change or ignore the need for change. The pit is Stage 3, and the
, individual may have feelings of depression, grief, anger, or powerlessness. Letting go of
the past is Stage 4, in which there is a move toward optimism.
Question 10
The nurse who is returning to school to pursue a baccalaureate degree in nursing states,
“I don’t know why I am putting myself through this. I have practiced just fine for 10 years
as an associate degree nurse.” Which strategy, recommended by a friend, would be
helpful in overcoming this feeling?
1. “Why don’t you take a one semester break from school?”
2. “Remember that a lot of people are depending on you.”
3. “Just think how much better a nurse you will be when you finish.”
4. “Think about all the extra money you will get when you graduate.”
Correct Answer: 3
Rationale: Reframing the nurse’s comment helps to focus on the positive. “Just think
how much better a nurse you will be when you finish” helps the nurse remember the
reason for seeking further education. If the nurse takes a break in this frame of mind,
returning to school is unlikely. This nurse is already stressed, so focus on the dependence
of others on him or her is unlikely to be very comforting. Although there may be some
increase in salary associated with the BS degree, it is usually not substantial. Focus on a
potential salary change that is not close in time will do little to assist the nurse in this
period.
Question 11
The nurse who has decided to seek a master’s degree asks the hospital’s chief nurse for
support. The chief nurse followed a career path from associate degree nurse, to
baccalaureate nurse, to master’s prepared nurse, and eventually obtained a nursing
doctorate. The chief nurse would be acting in which role for the new student?
1. Colleague
2. Friend
3. Faculty
4. Mentor
Correct Answer: 4
Rationale: While the nurses in the scenario may consider themselves friends and
colleagues, the description of the role of the chief nurse most closely describes that of
mentor. There is no indication that the chief nurse is fulfilling the role of faculty.
Question 12
The nurse has decided to go back to school. Which group is most likely to provide
physical and financial support to this nurse?
1. Mentor
2. Family and friends
3. Career ladder organization
4. State nursing organization
Correct Answer: 2
Rationale: Although every person’s situation is different, family and friends are
generally more likely to provide physical and financial support of some type. Mentors
Question 1
Which societal changes have promoted the nurse’s return to school and further
education? (Select all that apply.)
1. Patients have increasingly more complex and varied health needs.
2. Previously unknown diseases are being identified.
3. New technologies are being developed that require continual knowledge updates.
4. Patients are staying longer in the hospital.
5. There is a relative increase in the number of children in the population.
Correct Answer: 1, 2, 3
Rationale: Changes in society have placed new demands on nurses. The population is
aging and these older patients have more complex and varied health problems. New
diseases related to social and environmental problems are being identified. Scientific
discoveries and new technologies require the nurse to continually update his or her
knowledge base in order to provide safe and competent care. Patients are going home
from the hospital earlier (not staying longer), so much more care is being provided in
community and outpatient settings. The population is aging so there is not a relative
increase in the number of children in the population.
Question 2
Which statement regarding age trends of RNs is correct?
1. The average age of persons holding RN licensure has remained the same for the last
10 years.
2. The average age of male RN graduates is decreasing while the age for female RN
graduates is increasing.
3. The average age of RN graduates has increased.
4. Overall, the average age of practicing RNs has decreased.
Correct Answer: 3
Rationale: The average age of RNs has increased. In 2000, the average age of RNs was
45.2 years; in 2013, the average age of RNs had increased to 50 years. There is no
information in the text regarding age as it applies to gender.
Question 3
According to the 2013 National Workforce Survey, what is the highest level of
educational preparation for the majority of RNs?
1. Diploma
2. Associate degree
3. Baccalaureate degree
4. Master’s degree
Correct Answer: 3
Rationale: According to The 2013 National Nursing Workforce Survey of Registered
Nurses by the National Council of State Boards of Nursing and The Forum of State
Nursing Workforce Centers, 8% of nurses hold a diploma, 29% of nurses hold an
,associate degree, 36% of nurses hold a baccalaureate degree, and 13.9% of nurses hold
a master’s or doctoral degree as their highest level of educational preparation.
Question 4
How have the practice settings for nurses changed since 1980?
1. There has been little or no change in these settings.
2. The settings have shifted from the community to the hospital.
3. There has been a shift from the hospital to long-term care settings.
4. They have shifted from acute-care to community or primary care settings.
Correct Answer: 4
Rationale: The focus of professional nursing practice is shifting from acute hospital-
based illness care to primary outpatient-based community care, emphasizing health
promotion and illness/injury preventions. The percentage of RNs working in hospitals
decreased from 66% in 1980 to 56.2% in 2004.
Question 5
What statement about specialty certification in nursing is true?
1. Specialty certification guarantees increase in salary for the nurse.
2. Healthcare agencies rarely recognize certifications by nursing specialty groups.
3. The nurse who works in hospital practice must hold at least one specialty certification.
4. The nurse must demonstrate extensive experience and continuing education in the
specialty area.
Correct Answer: 4
Rationale: To be eligible to take the certification exam, the nurse must demonstrate
extensive experience and continuing education in the specialty area. Although there is
no guarantee that the nurse’s salary will be increased, healthcare agencies do recognize
these certifications. There is no requirement that the nurse hold a specialty certification
to work in a hospital; however, work in specialty areas, such as the emergency
department, critical care areas, or surgery, may require certification.
Question 6
The nurse has been promoted from staff nurse to supervisor and is trying to make a
transition to the new role. Which behavior reflects that the nurse is in the ending phase
of Bridges’ model of transition?
1. The nurse is working to move forward in the job, avoiding the temptation of going
back to familiar ways of thinking.
2. The nurse is beginning to accept the responsibilities of the new position.
3. The nurse has accepted that relationships with former peers on the unit will change.
4. The nurse questions the wisdom of accepting the new position.
Correct Answer: 4
Rationale: Bridges’ model of transition consists of three phases. The first phase, called
the ending phase, consists of the individual “letting go” of the old situation. This phase
consists of four components: disengagement, disidentification, disenchantment, and
disorientation. The nurse who is questioning the wisdom of accepting the new position is
in the letting go phase of disorientation. The second phase, neutral zone, is exemplified
,in this question by the nurse beginning to accept the responsibilities of the new position
and accepting that relationships with former peers will change. As the nurse works to
move forward in the job, resisting the temptation to go back to familiar ways of thinking
and working, the nurse has moved into the final stage of transition, new beginnings.
Question 7
The nurse who has gone back to school to earn a master’s degree is eager to talk with
peers who are also considering going back to school. Which stage of Spencer and Adams’
model of transition does this desire most closely exemplify?
1. Stage 2, minimizing the impact.
2. Stage 4, letting go of the past.
3. Stage 6, searching for meaning.
4. Stage 7, integration.
Correct Answer: 3
Rationale: Spencer and Adams describe a seven-stage model. The nurse’s actions most
closely exemplify Stage 6, searching for meaning. In this stage, the individual desires to
help others who are experiencing a similar situation. In Stage 2, minimizing the impact,
the person feels a need to go back to what was normal or comfortable in order to avoid
the full effect of the changes taking place. In Stage 4, letting go of the past, the
individual begins to focus on the change’s benefits and to look forward to those benefits.
Stage 7, integration, is the stage of completion. In this stage, the individual experiences
satisfaction and self-confidence.
Question 8
The individual going through a transition may experience many feelings. Which feelings
are common? (Select all that apply.)
1. Anger
2. Anxiety
3. Knowledge
4. Confusion
5. Grief
Correct Answer: 1, 2, 4, 5
Rationale: A variety of emotions and feelings are common when an individual is going
through a transition. These feelings include anger, anxiety, confusion, and grief. Feeling
knowledgeable will not occur until the individual has been functioning in the transitioned
role for some time.
Question 9
The nurse has elected to return to school to pursue a baccalaureate degree. After the
first week of classes, the nurse is overwhelmed. Which stage of Spencer and Adams’
model of transition is this nurse most likely experiencing?
1. Losing focus
2. Minimizing the impact
3. The pit
4. Letting go of the past
Correct Answer: 1
Rationale: Losing focus is Stage 1 of Spencer and Adams’ model of transition. In this
stage, the individual has difficulty keeping things in perspective and may feel
overwhelmed and panicked. Minimizing the impact is Stage 2, in which the individual
may resist the change or ignore the need for change. The pit is Stage 3, and the
, individual may have feelings of depression, grief, anger, or powerlessness. Letting go of
the past is Stage 4, in which there is a move toward optimism.
Question 10
The nurse who is returning to school to pursue a baccalaureate degree in nursing states,
“I don’t know why I am putting myself through this. I have practiced just fine for 10 years
as an associate degree nurse.” Which strategy, recommended by a friend, would be
helpful in overcoming this feeling?
1. “Why don’t you take a one semester break from school?”
2. “Remember that a lot of people are depending on you.”
3. “Just think how much better a nurse you will be when you finish.”
4. “Think about all the extra money you will get when you graduate.”
Correct Answer: 3
Rationale: Reframing the nurse’s comment helps to focus on the positive. “Just think
how much better a nurse you will be when you finish” helps the nurse remember the
reason for seeking further education. If the nurse takes a break in this frame of mind,
returning to school is unlikely. This nurse is already stressed, so focus on the dependence
of others on him or her is unlikely to be very comforting. Although there may be some
increase in salary associated with the BS degree, it is usually not substantial. Focus on a
potential salary change that is not close in time will do little to assist the nurse in this
period.
Question 11
The nurse who has decided to seek a master’s degree asks the hospital’s chief nurse for
support. The chief nurse followed a career path from associate degree nurse, to
baccalaureate nurse, to master’s prepared nurse, and eventually obtained a nursing
doctorate. The chief nurse would be acting in which role for the new student?
1. Colleague
2. Friend
3. Faculty
4. Mentor
Correct Answer: 4
Rationale: While the nurses in the scenario may consider themselves friends and
colleagues, the description of the role of the chief nurse most closely describes that of
mentor. There is no indication that the chief nurse is fulfilling the role of faculty.
Question 12
The nurse has decided to go back to school. Which group is most likely to provide
physical and financial support to this nurse?
1. Mentor
2. Family and friends
3. Career ladder organization
4. State nursing organization
Correct Answer: 2
Rationale: Although every person’s situation is different, family and friends are
generally more likely to provide physical and financial support of some type. Mentors
