Test Bank Medical-Surgical Nursing Concepts
for Interprofessional Collaborative Care 10th
Edition by Donna D. Ignatavicius Chapter 1-69
|Complete Guide A+
lOMoARcPSD|
Chapter 01: Overview of Professional Nursing Concepts for Medical-Surgical Nursing
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A new nurse is working with a preceptor on a medical-surgical unit. The preceptor advises the
new nurse that which is the priority when working as a professional nurse?
a.
Attending to holistic client needs
b. Ensuring client safety
c.
Not making medication errors
d. Providing client-focused care - CORRECT ANS B
All actions are appropriate for the professional nurse. However, ensuring client safety is the
priority. Health care errors have been widely reported for 25 years, many of which result in
client injury, death, and increased health care costs. There are several national and
international organizations that have either recommended or mandated safety initiatives.
Every nurse has the responsibility to guard the client9s safety. The other actions are important
for quality nursing, but they are not as vital as providing safety. Not making medication errors
does provide safety, but is too narrow in scope to be the best answer.
2. A nurse is orienting a new client and family to the medical-surgical unit. What information
does the nurse provide to best help the client promote his or her own safety?
a.
Encourage the client and family to be active partners.
b. Have the client monitor hand hygiene in caregivers.
c.
Offer the family the opportunity to stay with the client.
d. Tell the client to always wear his or her armband. - CORRECT ANS A
Each action could be important for the client or family to perform. However, encouraging the
client to be active in his or her health care as a safety partner is the most critical. The other
actions are very limited in scope and do not provide the broad protection that being active and
involved does.
3. A nurse is caring for a postoperative client on the surgical unit. The client9s blood pressure
was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action would the nurse
take first?
a.
Call the Rapid Response Team.
b. Document and continue to monitor.
c.
Notify the primary health care provider.
d. Repeat the blood pressure in 15 minutes.
- CORRECT ANS A
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The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating
before they suffer either respiratory or cardiac arrest. Since the client has manifested a
significant change, the nurse would call the RRT. Changes in blood pressure, mental status,
heart rate, temperature, oxygen saturation, and last 2 hours9 urine output are particularly
significant and are part of the Modified Early Warning System guide. Documentation is vital,
but the nurse must do more than document. The primary health care provider would be
notified, but this is not more important than calling the RRT. The client9s blood pressure
would be reassessed frequently, but the priority is getting the rapid care to the client.
DIF: Applying
TOP: Integrated Process: Communication and Documentation
KEY: Rapid Response Team (RRT), Clinical judgment
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
4. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse
best demonstrates this concept?
a.
Assesses for cultural influences affecting health care.
b. Ensures that all the client9s basic needs are met.
c.
Tells the client and family about all upcoming tests.
d. Thoroughly orients the client and family to the room. - CORRECT ANS A
Showing respect for the client and family9s preferences and needs is essential to ensure a
holistic or whole-person= approach to care. By assessing the effect of the client9s culture on
health care, this nurse is practicing client-focused care. Providing for basic needs does not
demonstrate this competence. Simply telling the client about all upcoming tests is not
providing empowering education. Orienting the client and family to the room is an important
safety measure, but not directly related to demonstrating client-centered care.
5. A client is going to be admitted for a scheduled surgical procedure. Which action does the
nurse explain is the most important thing the client can do to protect against errors?
a.
Bring a list of all medications and what they are for.
b. Keep the provider9s phone number by the telephone.
c.
Make sure that all providers wash hands before entering the room.
d. Write down the name of each caregiver who comes in the room. - CORRECT ANS A
Medication reconciliation is a formal process in which the client9s actual current medications
are compared to the prescribed medications at the time of admission, transfer, or discharge.
This National client Safety Goal is important to reduce medication errors. The client would
not have to be responsible for providers washing their hands, and even if the client does so,
this is too narrow to be the most important action to prevent errors. Keeping the provider9s
phone number nearby and documenting everyone who enters the room also do not guarantee
safety.
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6. Which action by the nurse working with a client best demonstrates respect for autonomy?
a.
Asks if the client has questions before signing a consent.
b. Gives the client accurate information when questioned.
c.
Keeps the promises made to the client and family.
d. Treats the client fairly compared to other clients. - CORRECT ANS A
Autonomy is self-determination. The client would make decisions regarding care. When the
nurse obtains a signature on the consent form, assessing if the client still has questions is vital,
because without full information the client cannot practice autonomy. Giving accurate
information is practicing with veracity. Keeping promises is upholding fidelity. Treating the
client fairly is providing social justice.
7. A nurse asks a more seasoned colleague to explain best practices when communicating with a
person from the lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ)
community. What answer by the faculty is most accurate?
a.
Avoid embarrassing the client by asking questions.
b. Don9t make assumptions about his or her health needs.
c.
Most LGBTQ people do not want to share information.
d. No differences exist in communicating with this population. - CORRECT ANS B
Many members of the LGBTQ community have faced discrimination from health care
providers and may be reluctant to seek health care. The nurse would never make assumptions
about the needs of members of this population. Rather, respectful questions are appropriate. If
approached with sensitivity, the client with any health care need is more likely to answer
honestly.
8. A nurse is calling the on-call health care provider about a client who had a hysterectomy 2
days ago and has pain that is unrelieved by the prescribed opioid pain medication. Which
statement comprises the background portion of the SBAR format for communication?
a.
I would like you to order a different pain medication.=
b. This client has allergies to morphine and codeine.=
c.
Dr. Smith doesn9t like nonsteroidal anti-inflammatory meds.=
d. This client had a vaginal hysterectomy 2 days ago.= - CORRECT ANS B
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SBAR is a recommended form of communication, and the acronym stands for Situation,
Background, Assessment, and Recommendation. Appropriate background information
includes allergies to medications the on-call health care provider might order. Situation
describes what is happening right now that must be communicated; the client9s surgery 2 days
ago would be considered background. Assessment would include an analysis of the client9s
problem; none of the options has assessment information. Asking for a different pain
medication is a recommendation. Recommendation is a statement of what is needed or what
outcome is desired.
9. A nurse working on a cardiac unit delegated taking vital signs to an experienced assistive
personnel (AP). Four hours later, the nurse notes that the client9s blood pressure taken by the
AP was much higher than previous readings, and the client9s mental status has changed. What
action by the nurse would most likely have prevented this negative outcome?
a.
Determining if the AP knew how to take blood pressure
b. Double-checking the AP by taking another blood pressure
c.
Providing more appropriate supervision of the AP
d. Taking the blood pressure instead of delegating the task - CORRECT ANS C
Supervision is one of the five rights of delegation and includes directing, evaluating, and
following up on delegated tasks. The nurse would either have asked the AP about the vital
signs or instructed the AP to report them right away. An experienced AP would know how to
take vital signs and the nurse would not have to assess this at this point. Double-checking the
work defeats the purpose of delegation. Vital signs are within the scope of practice for a AP
and are permissible to delegate. The only appropriate answer is that the nurse did not provide
adequate instruction to the AP.
10. A newly graduated nurse in the hospital states that because of being so new, participation in
quality improvement (QI) projects is not wise. What response by the precepting nurse is best?
a.
All staff nurses are required to participate in quality improvement here.=
b. Even being new, you can implement activities designed to improve care.=
c.
It9s easy to identify what indicators would be used to measure quality.=
d. You should ask to be assigned to the research and quality committee.= - CORRECT ANS B
The preceptor would try to reassure the nurse that implementing QI measures is not out of line
for a newly licensed nurse. Simply stating that all nurses are required to participate does not
help the nurse understand how that is possible and is dismissive. Identifying indicators of
quality is not an easy, quick process and would not be the best place to suggest a new nurse to
start. Asking to be assigned to the QI committee does not give the nurse information about
how to implement QI in daily practice.
workerwhoist
11. Anurseist
talkingwitha co-
toanewstateandt
needstot
findt
newemployment there. Whatadvicet
movingt
bythet
a.
nurseis best?
Askthehospitalsthereaboutstandardnurse3clientratios.
b. Chooset
thehospitalthathasthenewesttechnology.
c.
Findt
at
hospitalt
thatt
hast
achievedt
Magnett
status.
d. Workint
afacilityaffiliatedwithamedicalornursingschool. - CORRECT ANS C
Client Magnet statust
isawardedbyThe Jointt
Commissiont
(TJC)t
andcertifiesthatnurses can demo
nstratehowbest currentt
evidencet
guidestheirpractice. Newtechnologydoesn9tt
necessarilymea
nthatthehospitalist
safe. Affiliationwithahealtht
professionschool hasseveraladvantages, butsa
fetyismost important.
MULTIPLERESPONSE
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1. Anursemanagerwishestoensuret
thatthenursesonthet
unitaret
practicing at theirhighest levelsof
competency. Which areaswouldt
themanagerassesstodetermineifthet
nursingstaffdemonstratet
competencyaccordingtothe Institutet
of Medicinet
(IOM) reportt
Health Professions Education:
Quality? (Select all thatapply.)
ABridgetot
a.
Collaboratingt
witht
ant
interprofessionalt
team
b. Implementingt
evidence-basedt
care
c.
Providingfamily-focusedcare
d. Routinelyt
usingt
informaticst
int
practice
e.
Usingt
qualityt
improvementt
f.
int
clientt
care
Formalizingsystemsthinkingwhenimplementingt
care
basedt- CORRECT ANS A, B,t
D, E
The IOMreportlistst
fivet
broadcorecompetenciesthatt
allhealtht
careproviderst
shouldpractice.
Theseincludecollaboratingt
withtheinterprofessional team, implementingevidence-
practice, providingt
patient-
focusedcare, usinginformaticsinclient care, andusingt
qualityimprovementint
clientcare. Syste
msthinkingisrequiredforqualityimprovementbutisnotaspecifiedpartofthe IOMreport.
DIF: Remembering
TOP: IntegratedProcess:Nursingt
Process:Assessmentt
KEY: Competencies, Institutet
of Medic
ine (IOM)
MSC: Client Needs Category: SafeandEffectiveCaret
Environment: Safetyand Infection Control
2. Anurseist
interestedt
inmakingt
interprofessionalworkat
highpriority. Whicht
actionst
bythenurs
e best demonstratethisskill? (Select all thatapply.)
a.
Consultst
witht
othert
disciplinest
ont
clientt
care.
b. Coordinatest
discharget
planningt
fort
homet
safety.
c.
Participatest
int
comprehensivet
clientt
rounding.
d. Routinelyt
askst
othert
disciplinest
aboutt
clientt
progress.
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e.
f.
Showsthenursingt
careplanstoother disciplines.
Delegatet
taskst
tot
unlicensedt
ientt
caret
as at
personnelt
appropriately. - CORRECT ANS A,t
B, C, D, F
Collaboratingt
withtheinterprofessional teaminvolvesplanning, implementing, andevaluatingt
cl
teamwithallotherinvolveddisciplinest
included. Simplyshowingothercaregiverst
th
enursingcaret
plant
isnotactivelyinvolvingthemorcollaboratingwitht
them.
DIF: Applying
TOP: IntegratedProcess:CommunicationandDocumentationt
KEY: Teamwor
kand collaboration, Interprofessional team
MSC: Client Needst
Category: Safet
andEffectiveCareEnvironment: Management ofCare
3. Thenurseutilizingt
evidence-
basedpractice(EBP) considerst
whichfactorswhenplanningcare? (Select all thatapply.)
a.
Cost-savingt
measures
b. Nurse9st
expertise
c.
Clientt
preferences
d. Researcht
findings
e.
Valuest
oft
thet
f.
client
Plan-do-study-actmodel
ertisewhent- CORRECT ANS B, C, D, E
EBPconsistsofutilizingcurrentevidence, thet
client9svaluest
andpreferences, andt
thenurse9sexp
includecost-
planningt
savingt
care. Itt
does nott
measures. The PDSAmodelist
asystematic modelforqualityimprovement, but isnotaspe
cifict
componentof EBP.
DIF: Remembering
TOP: IntegratedProcess:Nursingt
Process:Planningt
KEY: Evidence-based practice (EBP)
MSC: Client Needst
Category: Safet
andEffectivet
CareEnvironment: Management ofCare
4. Anursemanagerwantstoimprovet
hand-
offcommunicationamongt
thestaff. What actionst
bythet
managerwould best helpachievethisgoa
l? (Select allthatapply.)
a.
Attendt
hand-offt
roundst
tot
coacht
andt
mentor.
b. Createt
at
templatet
oft
suggestedt
topicst
tot
includet
int
report.
c.
Encouraget
stafft
tot
askt
questionst
duringt
hand-off.
d. Giveraisesbasedoncompliancewithreporting.
e.
Providet
educationt
ont
thet
SBARt- CORRECT ANS A, B, C, E
nt
methodt
oft
communication
The SBARmethodofcommunicationhasbeenidentified as an excellent methodofcommunicatio
betweenhealtht
careprofessionals. It is at
formalizedstructureconsistingoft
Situation, Backgroun
d, Assessment, and Recommendation/Request. Usingaformalizedt
mechanismt
forcommunicatio
nt
helpsensuresuccessfult
hand-
ythet
offandfewerclient errors. Whenestablishingt
thisnewformatforreport, themost helpfulactionsb
managerwouldbetoprovideinitial education on theprocess, developt
atemplatewithsuggest
ed topicsunder each heading, attendroundstocoachandmentor, andencouraget
stafftoaskt
questio
nstoclarifyinformation. Basingraisesoncompliancewouldt
not bethemosthelpfulmethodt
becau
set
raisesareoftendeterminedt
onlyoncea yearandt
aret
basedonmultiplecriteria.
DIF: Applying
TOP: IntegratedProcess:CommunicationandDocumentationt
KEY: Teamwor
kand collaboration, Communication
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MSC: Client Needs Category: Safet
andEffectiveCareEnvironment: Management ofCare
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Chapter 02: Clinical JudgmentandSystems Thinking Ignata
vicius: Medical-Surgical Nursing, 10th Edition
MULTIPLECHOICE
1. Anurseasksthechargenurset
toexplainthet
differencebetweencriticalthinkingandclinical judg
ment. Whatstatementbythet
chargenurseis best?
a.
Clinicaljudgmentisoftencloudedbyerroneoushypotheses.=
b. Clinicaljudgmentisthet
observableoutcomet
ofcriticalthinking.=
c.
Criticalthinkingrequiressynthesizingt
interactionswithinasituation.=
d. Criticalthinkingist
thehighestt
levelofnursingt
judgment.= - CORRECT ANS B
tmostt
oftent
Clinical judgmentist
theobservableoutcomet
ofcriticalthinkinganddecisionmaking. It can be, bu
is not, cloudedbyerroneoushypotheses. Recognizing, understanding, andsynthesizi
nginteractionst
andinterdependenciesinasett
ofcomponentst
designedforaspecificpurposeissyst
emsthinking. Critical thinkingisnotthehighestlevelofnursingjudgment.
DIF: Understanding
TOP:IntegratedProcess:Teaching/Learning KEY: Clinicaljudgment
MSC: Client Needs Category: Safet
andEffectivet
CareEnvironment: Management ofCare
2. Thenurset
understandswhicht
informationregardingpatient-centeredt
care?
a.
Acompetencyrecognizingt
thet
clientt
as thet
sourceofcontrolofhisor her care
b. Aprojectaddressingt
challengesinimplementingpatient-centeredcare
c.
Purposeful, informed,t
andoutcome-focusedcareofclientsorfamilies
d. Theabilitytot
usebest evidencet
andpracticewhenmakingcare-relateddecisions - CORRECT ANS A
Patient-
uret
centeredcareisa QSENcompetencythat recognizes thepatien
Content preview
lOMoARcPSD|240 059 64
Test Bank Medical-Surgical Nursing Concepts
for Interprofessional Collaborative Care 10th
Edition by Donna D. Ignatavicius Chapter 1-69
|Complete Guide A+
, lOMoARcPSD|240 059 64
Chapter 01: Overview of Professional Nursing Concepts for Medical-Surgical Nursing
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A new nurse is working with a preceptor on a medical-surgical unit. The preceptor advises the
new nurse that which is the priority when working as a professional nurse?
a. Attending to holistic client needs
b. Ensuring client safety
c. Not making medication errors
d. Providing client-focused care
- CORRECT ANS>> B
All actions are appropriate for the professional nurse. However, ensuring client safety is the
priority. Health care errors have been widely reported for 25 years, many of which result in
client injury, death, and increased health care costs. There are several national and
international organizations that have either recommended or mandated safety initiatives.
Every nurse has the responsibility to guard the client9s safety. The other actions are important
for quality nursing, but they are not as vital as providing safety. Not making medication errors
does provide safety, but is too narrow in scope to be the best answer.
2. A nurse is orienting a new client and family to the medical-surgical unit. What information
does the nurse provide to best help the client promote his or her own safety?
a. Encourage the client and family to be active partners.
b. Have the client monitor hand hygiene in caregivers.
c. Offer the family the opportunity to stay with the client.
d. Tell the client to always wear his or her armband.
- CORRECT ANS>> A
Each action could be important for the client or family to perform. However, encouraging the
client to be active in his or her health care as a safety partner is the most critical. The other
actions are very limited in scope and do not provide the broad protection that being active and
involved does.
3. A nurse is caring for a postoperative client on the surgical unit. The client9s blood pressure
was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action would the nurse
take first?
a. Call the Rapid Response Team.
b. Document and continue to monitor.
c. Notify the primary health care provider.
d. Repeat the blood pressure in 15 minutes.
, lOMoARcPSD|240 059 64
- CORRECT ANS>> A
The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating
before they suffer either respiratory or cardiac arrest. Since the client has manifested a
significant change, the nurse would call the RRT. Changes in blood pressure, mental status,
heart rate, temperature, oxygen saturation, and last 2 hours9 urine output are particularly
significant and are part of the Modified Early Warning System guide. Documentation is vital,
but the nurse must do more than document. The primary health care provider would be
notified, but this is not more important than calling the RRT. The client9s blood pressure
would be reassessed frequently, but the priority is getting the rapid care to the client.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Rapid Response Team (RRT), Clinical judgment
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
4. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse
best demonstrates this concept?
a. Assesses for cultural influences affecting health care.
b. Ensures that all the client9s basic needs are met.
c. Tells the client and family about all upcoming tests.
d. Thoroughly orients the client and family to the room.
- CORRECT ANS>> A
Showing respect for the client and family9s preferences and needs is essential to ensure a
holistic or <whole-person= approach to care. By assessing the effect of the client9s culture on
health care, this nurse is practicing client-focused care. Providing for basic needs does not
demonstrate this competence. Simply telling the client about all upcoming tests is not
providing empowering education. Orienting the client and family to the room is an important
safety measure, but not directly related to demonstrating client-centered care.
5. A client is going to be admitted for a scheduled surgical procedure. Which action does the
nurse explain is the most important thing the client can do to protect against errors?
a. Bring a list of all medications and what they are for.
b. Keep the provider9s phone number by the telephone.
c. Make sure that all providers wash hands before entering the room.
d. Write down the name of each caregiver who comes in the room.
- CORRECT ANS>> A
Medication reconciliation is a formal process in which the client9s actual current medications
are compared to the prescribed medications at the time of admission, transfer, or discharge.
This National client Safety Goal is important to reduce medication errors. The client would
not have to be responsible for providers washing their hands, and even if the client does so,
this is too narrow to be the most important action to prevent errors. Keeping the provider9s
phone number nearby and documenting everyone who enters the room also do not guarantee
safety.
, lOMoARcPSD|240 059 64
6. Which action by the nurse working with a client best demonstrates respect for autonomy?
a. Asks if the client has questions before signing a consent.
b. Gives the client accurate information when questioned.
c. Keeps the promises made to the client and family.
d. Treats the client fairly compared to other clients.
- CORRECT ANS>> A
Autonomy is self-determination. The client would make decisions regarding care. When the
nurse obtains a signature on the consent form, assessing if the client still has questions is vital,
because without full information the client cannot practice autonomy. Giving accurate
information is practicing with veracity. Keeping promises is upholding fidelity. Treating the
client fairly is providing social justice.
7. A nurse asks a more seasoned colleague to explain best practices when communicating with a
person from the lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ)
community. What answer by the faculty is most accurate?
a. Avoid embarrassing the client by asking questions.
b. Don9t make assumptions about his or her health needs.
c. Most LGBTQ people do not want to share information.
d. No differences exist in communicating with this population.
- CORRECT ANS>> B
Many members of the LGBTQ community have faced discrimination from health care
providers and may be reluctant to seek health care. The nurse would never make assumptions
about the needs of members of this population. Rather, respectful questions are appropriate. If
approached with sensitivity, the client with any health care need is more likely to answer
honestly.
8. A nurse is calling the on-call health care provider about a client who had a hysterectomy 2
days ago and has pain that is unrelieved by the prescribed opioid pain medication. Which
statement comprises the background portion of the SBAR format for communication?
a. <I would like you to order a different pain medication.=
b. <This client has allergies to morphine and codeine.=
c. <Dr. Smith doesn9t like nonsteroidal anti-inflammatory meds.=
d. <This client had a vaginal hysterectomy 2 days ago.=
- CORRECT ANS>> B