Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius;
Cherie R. Rebar; Nicole M.
Heimgartner
• Print ISBN: 9780323878265
TEST BANK
Question 1
,A nurse on a medical-surgical unit is caring for four clients.
Which client should the nurse assess first?
A. A client reporting mild incisional pain rated 3/10
B. A client with a blood pressure of 138/82 mm Hg awaiting
discharge instructions
C. A client experiencing new-onset shortness of breath and
restlessness
D. A client requesting assistance to the bathroom
Correct Answer: C
Rationale:
The client experiencing new-onset shortness of breath and
restlessness may be showing signs of respiratory compromise
and requires immediate assessment. Airway and breathing
concerns take priority. Mild pain, discharge teaching, and
toileting needs are important but are lower priorities than
potential respiratory deterioration.
Source:
Medical-Surgical Nursing, 8th Edition — Unit I: Aspects of
Medical-Surgical Nursing
Question 2
A nurse receives a prescription that appears unclear and
potentially unsafe. What is the nurse's priority action?
,A. Carry out the prescription as written
B. Ask another nurse to interpret the prescription
C. Clarify the prescription with the healthcare provider
D. Delay all care until the next shift
Correct Answer: C
Rationale:
The nurse has a legal and ethical responsibility to clarify
questionable prescriptions before implementation. Carrying out
an unclear prescription could jeopardize client safety. Another
nurse cannot independently interpret a prescription for
implementation. Delaying all care is inappropriate.
Source:
Medical-Surgical Nursing, 8th Edition — Unit I: Aspects of
Medical-Surgical Nursing
Question 3
NGN Case Scenario
A nurse is caring for a client who states, "I do not want this
procedure performed."
Which nursing action best demonstrates advocacy?
A. Encourage the client to comply with the provider's
recommendation
B. Notify the healthcare provider of the client's decision
, C. Explain that refusal may delay recovery and obtain consent
D. Ask the family to convince the client to proceed
Correct Answer: B
Rationale:
Advocacy involves supporting the client's right to make
informed decisions regarding care. The nurse should
communicate the client's wishes to the healthcare provider and
ensure the client's autonomy is respected. Coercion or
persuasion is inconsistent with advocacy.
Source:
Medical-Surgical Nursing, 8th Edition — Unit I: Aspects of
Medical-Surgical Nursing
Question 4
A charge nurse is assigning care. Which task is appropriate to
delegate to unlicensed assistive personnel (UAP)?
A. Assess a client's pain level after medication administration
B. Teach a client about wound care
C. Obtain and record routine vital signs for a stable client
D. Evaluate a client's response to treatment
Correct Answer: C
Rationale:
11th Edition
• Author(s)Donna D. Ignatavicius;
Cherie R. Rebar; Nicole M.
Heimgartner
• Print ISBN: 9780323878265
TEST BANK
Question 1
,A nurse on a medical-surgical unit is caring for four clients.
Which client should the nurse assess first?
A. A client reporting mild incisional pain rated 3/10
B. A client with a blood pressure of 138/82 mm Hg awaiting
discharge instructions
C. A client experiencing new-onset shortness of breath and
restlessness
D. A client requesting assistance to the bathroom
Correct Answer: C
Rationale:
The client experiencing new-onset shortness of breath and
restlessness may be showing signs of respiratory compromise
and requires immediate assessment. Airway and breathing
concerns take priority. Mild pain, discharge teaching, and
toileting needs are important but are lower priorities than
potential respiratory deterioration.
Source:
Medical-Surgical Nursing, 8th Edition — Unit I: Aspects of
Medical-Surgical Nursing
Question 2
A nurse receives a prescription that appears unclear and
potentially unsafe. What is the nurse's priority action?
,A. Carry out the prescription as written
B. Ask another nurse to interpret the prescription
C. Clarify the prescription with the healthcare provider
D. Delay all care until the next shift
Correct Answer: C
Rationale:
The nurse has a legal and ethical responsibility to clarify
questionable prescriptions before implementation. Carrying out
an unclear prescription could jeopardize client safety. Another
nurse cannot independently interpret a prescription for
implementation. Delaying all care is inappropriate.
Source:
Medical-Surgical Nursing, 8th Edition — Unit I: Aspects of
Medical-Surgical Nursing
Question 3
NGN Case Scenario
A nurse is caring for a client who states, "I do not want this
procedure performed."
Which nursing action best demonstrates advocacy?
A. Encourage the client to comply with the provider's
recommendation
B. Notify the healthcare provider of the client's decision
, C. Explain that refusal may delay recovery and obtain consent
D. Ask the family to convince the client to proceed
Correct Answer: B
Rationale:
Advocacy involves supporting the client's right to make
informed decisions regarding care. The nurse should
communicate the client's wishes to the healthcare provider and
ensure the client's autonomy is respected. Coercion or
persuasion is inconsistent with advocacy.
Source:
Medical-Surgical Nursing, 8th Edition — Unit I: Aspects of
Medical-Surgical Nursing
Question 4
A charge nurse is assigning care. Which task is appropriate to
delegate to unlicensed assistive personnel (UAP)?
A. Assess a client's pain level after medication administration
B. Teach a client about wound care
C. Obtain and record routine vital signs for a stable client
D. Evaluate a client's response to treatment
Correct Answer: C
Rationale:
