Chapter 02: Academic Progression
Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition

MULTIPLE CHOICE

	1.	A faculty member explains to students that one concern of the American Nurses Association’s 1965 position statement designating the baccalaureate degree (BSN) as the educational entry point for nursing is that:
a.	diploma programs remain the most popular educational program for nurses.	
b.	it is difficult to monitor other programs for congruency with BSN programs.	
c.	multiple educational paths create confusion for the public and the profession.	
d.	some states are creating different licensure exams for different pathways.	

ANS:	C
The existence of multiple entry paths for nursing education is confusing both to the public and to aspiring nursing students, who may have difficulty understanding and comprehending the differences and what they mean. Diploma programs have declined sharply in number, with only 47 programs remaining in the United States in 2013. The ANA does not monitor different programs to evaluate congruency with BSN programs. States are not creating different licensure examinations for graduates of different programs.

	2.	A hospital-based nursing administrator is responsible for the diploma nursing program affiliated with that hospital. In deciding to keep the program open, the administrator develops changes that address a major historical concern with this type of program. In doing so, the administrator would most likely:
a.	arrange for faculty from the local college to teach science courses.	
b.	limit the hours students are expected to work in the hospital.	
c.	lower the tuition rate and apply for increased federal student grants.	
d.	require nursing faculty to be doctorally prepared to remain on staff.	

ANS:	B
Diploma students were traditionally expected to staff the hospital with which their program was affiliated, often to the detriment of their educational experiences. This exploitation was described in several important studies of nursing education. Traditional diploma programs do not offer college credit, no matter who teaches the courses. Diploma programs were expensive to operate and expensive to students, and this had a part in their decreasing numbers. Federal funding (through a variety of means) is available for individual students, and although it is administered by institutions, it is not granted to the institution itself. Requiring doctorally prepared faculty would not address an historic concern with diploma education.

	3.	In analyzing trends within the profession that are correlated to the rise in baccalaureate nursing (BSN) programs, the nurse historian would outline that:
a.	degree inflation is contributing to the demand for BSN programs.	
b.	increased social status and pay correspond to education at the college level.	
c.	men in nursing demand an increase in BSN programs compared with other programs.	
d.	the rise in doctorally prepared nurses corresponds to an increase in BSN programs.	

ANS:	D
BSN programs were often hampered by the lack of faculty prepared to teach at the collegiate level, which led to a reluctance of colleges and universities to establish BSN programs. Doctoral programs have been preparing nurse scholars and researchers, who have contributed to nursing’s scientific backbone. The rise in these programs can be seen as a parallel development with the rise in BSN programs. The proliferation of advanced degrees in nursing is not the result of degree inflation; rather, it is a response to the increased sophistication and complexity of the health care environment today. Although nurses today do enjoy better pay and improved social status than in the past, this trend is not strongly correlated to the rise in BSN programs. Men in nursing are not a driving force for the increase in BSN programs.

	4.	A member of a state board of nursing explains to senior nursing students that liberal arts, communication, and health care policy are all appropriate subjects for study in a BSN program because:
a.	a broad range of knowledge is important to work with educated consumers.	
b.	as nurses they will care for patients from increasingly diverse backgrounds.	
c.	physicians rely on the nursing staff to educate their patients on such issues.	
d.	they are prepared to assume entry-level leadership positions in various settings.	

ANS:	D
BSN-prepared nurses are able to function as generalists and as entry-level leaders in a multitude of settings, leading to the need for inclusion of topics other than nursing care in their education. Consumers are more educated today than before, but this is not germane to the inclusion of these topics in nursing education. Diversity is increasing, but this is not related to the need for education in liberal arts and health care policy. These topics are not taught so that nurses can teach their patients.

	5.	A nursing dean in a baccalaureate nursing (BSN) program wishes to create a program that meets the needs of multiple and diverse students, responds to current trends, and increases enrollment. What modification to the existing program would best meet this goal?
a.	Allow RNs to validate community health nursing through volunteer work.	
b.	Bring faculty and classes to major hospitals employing non-BSN nurses.	
c.	Create seamless entry points and tracts for RN and second-degree students.	
d.	Find alternative times and days for classroom and clinical experiences.	

ANS:	C
A large group of diploma and associate degree (ADN) nurses could benefit from seamless entry points and BSN tracts designed especially for them. Another group of potential BSN-prepared nurses consists of individuals changing careers after completing degrees in other fields. Programs to address the needs of these students have proliferated. RN-BSN and accelerated nursing programs that are seamless and easy to navigate would go far in helping nursing meet the goal of the National Advisory Council for Nursing Education that at least two thirds of the nursing workforce hold a BSN or higher degree. Programs that offer specialized tracts for RNs and second-degree students would also help ease the nursing shortage because they are typically shorter in duration. Although the inclusion of community health nursing was an early differentiator between diploma and BSN programs, BSN programs have expanded well beyond this, and coursework for the BSN is more varied and complex than just simply adding a course in community health nursing. Bringing faculty and classes to major hospitals might make it more convenient for non-BSN nurses to complete their degrees, but the logistics would be difficult, and enrollment might be small. This also only capitalizes on the non-BSN nurse working in hospitals and does not address the needs of second-degree students or those employed in other settings. Alternative days and times for classroom and clinical experiences may help those who are juggling family or work commitments but would not address current trends in nursing or specifically meet the needs of students with diverse educational backgrounds.

	6.	An advanced-degree nurse working in a hospital is responsible for evaluating and synthesizing new knowledge and applying it to the population with whom he or she works. Other nurses recognize that this nurse probably has which degree?
a.	Doctor of nursing practice (DNP)	
b.	Doctor of nursing science (DNSc)	
c.	Doctor of philosophy (PhD)	
d.	Nursing doctorate (ND)	

ANS:	A
The clinical practice doctorate in nursing is the DNP. This degree would prepare the nurse to translate and apply knowledge to the clinical setting rather than be responsible for generating new knowledge. The DNSc (or DNS) degree is a research-focused degree culminating in preparing and defending the student’s dissertation. The PhD is another degree awarded to nurses completing a research-focused doctoral level program. The holder of this degree must also prepare and defend a dissertation based on original research. The ND degree, originally intended for research utilization, has lost favor, with only four schools granting it in 2004. With the advent of the DNP program, ND programs made the transition to the DNP model.

	7.	To discriminate between the two major branches of doctoral education for nurses, the aspiring student would classify the differences between them as primarily:
a.	cognate versus practice emphasis.	
b.	knowledge formulation versus utilization.	
c.	systems generation versus systems thinking.	
d.	tool generation versus tool application.	

ANS:	B
The main difference between the two programs of study is that the research-focused programs (PhD and DNSc) produce scholars who are capable of generating new knowledge, but the practice-focused programs (DNP) produce highly specialized practitioners who use knowledge in the clinical setting. The DNSc program is gradually being phased out. Both types of doctoral programs have cognate core courses. The DNP programs do prepare their graduates in highly skilled systems thinking, but the research-focused programs do not restrict their emphasis to the creation of new systems. Tool generation may be part of a research study but is not necessarily a component.

	8.	A potential nursing student is worried about the cost of attending a baccalaureate degree program. After examining the available options, the student would conclude that which of the following is probably the best route for an affordable education?
a.	Attending an in-state government-sponsored institution	
b.	Investigating work-study options at all program types	
c.	Obtaining scholarships to attend a private institution	
d.	Working part time while attending nursing school	

ANS:	A
State- and government-sponsored institutions are nearly always much less expensive than private education and give significant tuition discounts to in-state students.
Work-study plans are just one component of financial aid. Although obtaining work-study financing will help with the cost of the education, this alone may not offer significant reduction in actual costs, especially if the student attends a private school.
Scholarships for private institutions can significantly decrease the cost of attending, but students may not be eligible or may not be awarded scholarships because they are based on need or scholarship or a combination of both. Considering that private education is usually significantly more expensive than public education at a government-sponsored college, this option is not the most affordable, but it should be investigated because the possibility does exist for this option to make education quite affordable.
Working part time will probably not gain the student enough income to make a significant difference in the cost of attending college.

	9.	A prospective nursing student is researching nursing schools. One of the schools is fully accredited by the CCNE, has no history of adverse actions taken by its state board of nursing, and is staffed by faculty members who appear to be appropriately credentialed for their positions. What inference can the student make about this program?
a.	CCNE accreditation is the only option for nursing school accreditation.	
b.	Faculty credentials have little bearing on the quality of nursing programs.	
c.	The findings ensure that the program meets at least minimal requirements.	
d.	This is a top-rated program whose graduates are ultimately successful.	

ANS:	C
Students are protected from marginal programs by both regional and specialty accreditation and by approval of the program by state legal regulatory bodies, specifically state boards of nursing. Accreditation by specialty bodies means that programs at least meet, and may exceed, minimum standards.
Faculty qualifications are a vital component when assessing program quality.
Both the Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) are approved by the Department of Education as official accreditations agencies.
The information described means that the school at least meets basic requirements; however, it does not help rank it. Perhaps a better measure of the rank of schools can be found in the percentage of first-time writers of the board examination who are successful over several years.

	10.	A nurse practicing in a specialty area wishes to be recognized for the specialized skill set and knowledge obtained in order to be an effective member of the health care team serving that particular patient population. The nurse would best complete this goal by:
a.	completing a rigorous continuing education program.	
b.	gaining admission to a graduate nursing degree program.	
c.	obtaining a secondary license in that area of practice.	
d.	passing the certification examination in that particular specialty.	

ANS:	D
Certification by specialty nursing organizations recognizes the knowledge and clinical practices associated with high-quality practice in a specialty area of nursing.
Continuing education is vital and is required to maintain nursing licensure, but it will not ensure public and professional recognition for proficiency in a specialty area.
Gaining admission to a graduate degree program is admirable, but it will not reward current knowledge and skill with recognition. A higher degree focuses on attainment of new knowledge.
There are no secondary licenses.

	11.	A panel of nursing deans and faculty has met to discuss increasing the number of baccalaureate-prepared nurses in a mostly rural state. What collaborative project could the panel design that would be best for meeting this goal?
a.	A summer-intensive program where students live and study at the university during the summer	
b.	A “weekend college” program offered every other weekend at the university for working RNs	
c.	An on-campus accelerated-track BSN program designed for the student who has a degree in another area	
d.	An online program with outlying clinical sites that are run jointly between the university and community colleges	

ANS:	D
An online program would greatly enhance accessibility. More nurses are educated in associate degree programs from junior or community colleges than in either diploma or BSN programs. The coursework would be directed and taught by faculty with appropriate credentials for teaching at the BSN level, and clinical experiences could be managed locally by community college faculty with supervision by the parent university faculty.
In a mostly rural state, creating a summer-intensive program where students would still have to live and study outside their hometowns does not increase accessibility.
The weekend college idea would still require students from the rural areas to travel perhaps long distances to attend school.
Programs designed to capture non-nursing majors who wish to enter nursing are growing in popularity, but this does not improve accessibility for the rural population.

	12.	An analysis of the three major types of basic nursing education would reveal to the student that the biggest difference in programs is that:
a.	ADN nurses lack the education in community health that other program graduates have.	
b.	BSN nurses are educated to work independently and enter leadership roles.	
c.	collegiate experiences in BSN programs ensure that graduates have a well-rounded education.	
d.	diploma graduates are trained to function under the supervision of a BSN nurse.	

ANS:	B
BSN programs include coursework in liberal arts, humanities, leadership, and management, enabling the BSN graduate to use sound critical thinking skills, to function independently as a generalist nurse, and to assume entry-level leadership roles.
Although ADN nurses do not usually have community health in their curricula, this is not the biggest difference among programs.
Associate degree programs are also offered in collegiate environments, including junior and community colleges and universities.
Diploma graduates were envisioned as complete bedside nurses. The ADN nurse is a technical nurse trained to function under direct BSN supervision.

	13.	A recent high school graduate wants to pursue registered nursing education in the local community. What type of program would this student most likely investigate?
a.	Associate degree program	
b.	Baccalaureate degree program	
c.	Diploma program	
d.	Licensed practical nurse program	

ANS:	A
The associate degree program is often offered at local community colleges. Baccalaureate programs are usually found at larger colleges or universities. The few remaining diploma programs are associated with hospitals. Because the nurse wants RN education, a licensed practical nurse program would not be considered.

	14.	A registered nurse is considering doctoral programs but is concerned with accessibility. Which type of program is probably most accessible to this RN?
a.	Clinical nurse leader program	
b.	Nursing doctorate (ND) program	
c.	Practice-focused program	
d.	Research-focused program	

ANS:	C
The practice-focused doctoral programs are growing rapidly as APRN programs are converting to the DNP. The clinical nurse leader is a master’s level education. The ND programs are being phased out. The research-focused programs are less accessible than the practice-focused programs.

	15.	The student of nursing history learns what information about the advent of nursing education?
a.	Baccalaureate programs caught on quickly after being started.	
b.	Collegiate forces advocated for early university education.	
c.	Early programs were patterned after the Nightingale model.	
d.	Physicians were against using any trained nurse in hospitals.	

ANS:	C
The earliest nursing education occurred in hospital-based programs patterned after the Nightingale model of collegiate nursing education. However, anticollegiate forces prevailed, and the diploma process became the standard for nursing education. Baccalaureate programs did not catch on well until after World War II. Physicians recognized the value of a trained nursing staff.

	16.	A university nursing dean is particularly interested in attracting more male students. What action by the dean would most likely result in the best outcome for this goal?
a.	Create an accelerated baccalaureate degree program.	
b.	Establish a “fast track” program for business leaders.	
c.	Partner with the local community college on seamless entry.	
d.	Recruit heavily among male-dominated occupations.	

ANS:	A
Accelerated BSN programs are an important point of entry for underrepresented groups in nursing, including men. Although it may be difficult to recruit men directly from high school, the accelerated program offers men an attractive way to change careers later in life. Business leaders may not be all male. A seamless transition from an associate degree to an RN-completion degree is an important step in increasing the number of BSN-prepared nurses but does not specifically target men. Recruiting men from traditional “male” occupations may or may not be successful.

MULTIPLE RESPONSE

	1.	In comparing and contrasting licensed practical nursing (LPN) programs with associate degree (ADN) programs, the potential nursing student notices similarities between the two, including: (Select all that apply.)
a.	both programs prepare graduates to be supervised by BSN nurses.	
b.	graduates of both programs are considered to be technical nurses.	
c.	licensure exams for graduates of both programs are interchangeable.	
d.	LPN and ADN programs offer similar college credit for coursework.	
e.	the programs both take a similar length of time to complete.	

ANS:	A, B
Both the LPN and ADN programs envision nurses who will be supervised by higher prepared RNs. Both the LPN and ADN programs prepare nurses who are considered technical in nature. Whereas the LPN takes the NCLEX-PN examination, the ADN graduate takes the NCLEX-RN examination. LPN programs often do not carry college credit, which makes it difficult to matriculate into RN programs. LPN programs generally are 9 to 15 months long, whereas ADN programs are typically 2 years in duration.

	2.	In evaluating the success of a clinical nurse leader (CNL) program, a nursing dean would determine that program goals had been met when graduates were able to successfully: (Select all that apply.)
a.	demonstrate leadership in hospital nursing departments.	
b.	function effectively in an advanced specialty nursing role.	
c.	oversee care coordination of a distinct group of patients.	
d.	provide direct patient care in complex situations.	
e.	supervise ancillary and adjunctive nursing staff members.	

ANS:	C, D
One of the two major roles of the CNL is to oversee the care coordination of a distinct group of patients. The other major role of the CNL is to provide direct patient care in complex situations. CNLs design and implement care and are accountable for care outcomes, but they do not necessarily serve in departmental leadership positions. CNLs are considered generalists, not specialists. The CNL role is not designed as a direct supervisory role, such as a charge nurse.

	3.	A high school guidance counselor is working with a student who wants to attend a baccalaureate nursing school. The counselor explains that the main considerations when choosing a nursing program are: (Select all that apply.)
a.	accessibility.	
b.	cost.	
c.	location.	
d.	program length.	
e.	quality.	

ANS:	A, B, E
Accessibility is one of three major considerations when choosing a nursing program. Cost is one of the three major considerations when choosing a nursing program. Quality is one of the three major considerations when choosing a nursing program. Location may be important to students either wishing or not wishing to relocate, but it is not generally one of the major considerations in choosing a program. Nearly all baccalaureate programs are designed to be 4 years in length, assuming a full-time load.

	4.	A nurse is discussing certification with a co-worker and explains that goals of the certification process include: (Select all that apply.)
a.	endorsing demonstrated knowledge.	
b.	enhancing nurses’ professionalism.	
c.	helping boost pay scales for nursing.	
d.	providing for differentiated practice.	
e.	serving as a quality control activity.	

ANS:	A, B, E
Certification is directed to endorsing demonstrated knowledge and skill associated with high-quality performance in a specialty area. Certification also enhances professionalism and allows the public and other professionals to recognize those with professional achievements. Certification does serve as a quality control activity, because nurses who obtain certification must demonstrate superior knowledge and clinical behaviors. Certification does not include boosting pay scales as a goal, although in some institutions, certified nurses do receive a monetary benefit. Although many certification exams require a BSN, differentiating practice is not a goal of certification.

	5.	A nursing dean oversees a BSN program that is taught partially online. In evaluating program effectiveness and sustainability, the dean should pay special attention to the: (Select all that apply.)
a.	effect of online learning on the process of professional socialization.	
b.	comparison of online graduates’ NCLEX-RN pass rates with traditional BSN pass rates.	
c.	consequences of distance education on availability of financial aid.	
d.	correlation of online learning strategies with students’ learning needs.	
e.	impact of distance technology needs on donor willingness to contribute.	

ANS:	A, B, C, D
Professional socialization can be profoundly affected by distance technology and should be evaluated during reviews of program effectiveness. Socialization into the professional role is vital to maintain ethical and moral standards. A comparison of board pass rates will allow evaluation of the effectiveness of both program types. Students’ ability to obtain financial aid may be affected by distance education, particularly when looking for work-study positions, tutoring, and assistantships. Matching student learning needs with online teaching styles to create effective learning environments would be another area to evaluate. Donations, although important, would be a secondary consideration. Not all donors designate their contributions to specific needs.

	6.	A nursing dean wants to recruit students who more closely match demographic trends. In planning activities with the marketing department, the dean should plan activities to attract: (Select all that apply.)
a.	students with disabilities.	
b.	ethnic minorities.	
c.	men.	
d.	recent high school graduates.	
e.	underemployed groups.	

ANS:	B, C
Ethnic and racial minorities make up only about 18% of nursing students in baccalaureate and graduate programs today. The trends reflect growing ethnic and racial diversity in the country. Men account for only 10% of BSN students today despite making up approximately 50% of the population. Recent high school graduates are not included in demographic trends. Underemployed groups rise and fall sporadically with economic changes and are not reflected in trends that nursing schools typically follow. Recruitment of disabled students is not a trend in nursing school admissions.

	7.	When analyzing the development of nursing education for a research paper, the nursing student notes that certain factors have been important contributors to the current system of nursing education in this country, including: (Select all that apply.)
a.	changing demographics.	
b.	cost of education.	
c.	historical events.	
d.	societal health care needs.	
e.	women’s roles.	

ANS:	C, D
Historical events, particularly wars, were vital contributors to our current system of nursing education. Changes in the health care needs of society have helped spur the development of our current system of nursing education. Changing demographics were not responsible for the current system of nursing education. The cost of education was not germane to the rise of our current system of nursing education. Women’s roles were not important in the development of our current system of nursing education.

	8.	A potential nursing student is evaluating a local hospital-based diploma program. The student favors this program because several relatives are alumni. In helping the student critically evaluate the strengths and weaknesses of this program, what information does the high school guidance counselor offer? (Select all that apply.)
a.	Courses typically do not carry any college credit for transfer.	
b.	Diploma programs are not accredited by any national organization.	
c.	Short program duration leads to career entry sooner than other programs.	
d.	Students typically have strong clinical skills upon graduation.	
e.	Tuition in these programs is often the least expensive.	

ANS:	A, D
Diploma programs usually graduate nurses with strong clinical skills, but courses usually do not carry any college credit. Diploma programs are accredited and graduates are eligible for the NCLEX-RN examination. These programs are typically 2 to 3 years long. Tuition in community colleges is usually the cheapest option.