3rd Edition
Making Connections to Practice
3rd Edition
Author(s)Janice Hoffman; Nancy Sullivan
TEST BANK
,
,Question 1
A medical-surgical nurse receives handoff on four patients. Which
patient should the nurse assess first?
A. A patient who reports pain of 6/10 after ambulating
B. A patient with chronic heart failure who has bilateral ankle edema
C. A patient with pneumonia who has a new respiratory rate of 30/min
and oxygen saturation of 88% on room air
D. A patient with type 2 diabetes whose premeal blood glucose is 198
mg/dL
Correct Answer:
C. A patient with pneumonia who has a new respiratory rate of 30/min
and oxygen saturation of 88% on room air
Rationale:
The patient with pneumonia has signs of impaired oxygenation and
possible respiratory deterioration, making this the priority assessment.
The nurse should recognize the new respiratory findings as an
immediate safety concern. Pain, chronic edema, and moderate
hyperglycemia require attention but are not as urgent as compromised
breathing.
Question 2
Which nursing action best demonstrates patient-centered care in the
medical-surgical setting?
, A. Giving each patient the same discharge instructions
B. Asking the patient about preferences and incorporating them into the
care plan
C. Scheduling treatments according to the nurse's preferred routine
D. Limiting patient participation to avoid confusion
Correct Answer:
B. Asking the patient about preferences and incorporating them into the
care plan
Rationale:
Patient-centered care involves respecting the patient's values,
preferences, needs, and goals while planning and delivering care.
Standardized information may be necessary, but individualized care is
essential. The nurse's convenience should not determine the plan, and
patients should be active participants whenever possible.
Question 3
A nurse uses current clinical guidelines, patient assessment findings,
and the patient's preferences when planning care for a patient with a
chronic illness. Which concept is the nurse applying?
A. Evidence-based nursing care
B. Delegation
C. Incident reporting
D. Organizational hierarchy
Correct Answer:
A. Evidence-based nursing care