Test Bank for Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition by Donna D. Ignatavicius | Complete All 65 Chapters | Multiple Choice Questions with Rationales

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, Medical Surgical Nursing 11th Editi
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on Ignatavicius
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Chapter 01: Overview of Professional Nursing Concepts for Medical-
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Surgical NursingIgnatavicius: Medical-Surgical Nursing, 11th Edition
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MULTIPLE CHOICE
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, 1. A new nurse is working with a preceptor on a medical-
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surgical unit. The preceptor advises thenew nurse that which is the priority when wor
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king as a professional nurse? qx qx qx qx


a. Attending to holistic client needs qx qx qx qx


b. Ensuring client safety qx qx


c. Not making medication errors qx qx qx


d. Providing client-focused care qx qx




ANS: B qx


All actions are appropriate for the professional nurse. However, ensuring client safety is the
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priority. Health care errors have been widely reported for 25 years, many of which result in
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client injury, death, and increased health care costs. There are several national and internat
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ional organizations that have either recommended or mandated safety initiatives.
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Every nurse has the responsibility to guard the client’s safety. The other actions are importa
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ntfor quality nursing, but they are not as vital as providing safety. Not making medication err
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ors does provide safety, but is too narrow in scope to be the best answer.
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2. A nurse is orienting a new client and family to the medical-
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surgical unit. What informationdoes the nurse provide to best help the client prom
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ote his or her own safety?
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a. Encourage the client and family to be active partners. qx qx qx qx qx qx qx qx


b. Have the client monitor hand hygiene in caregivers.
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c. Offer the family the opportunity to stay with the client.
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d. Tell the client to always wear his or her armband.
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ANS: A qx


Each action could be important for the client or family to perform. However, encouraging t
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he client to be active in his or her health care as a safety partner is the most critical. The o
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ther actions are very limited in scope and do not provide the broad protection that being active
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andinvolved does.
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3. A nurse is caring for a postoperative client on the surgical unit. The client’s blood pr
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essure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action wo
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uld the nursetake first?
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a. Call the Rapid Response Team. qx qx qx qx


b. Document and continue to monitor. qx qx qx qx


c. Notify the primary health care provider. qx qx qx qx qx


d. Repeat the blood pressure in 15 minutes. qx qx qx qx qx qx



ANS: A qx


The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating
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before they suffer either respiratory or cardiac arrest. Since the client has manifested a sign
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ificant change, the nurse would call the RRT. Changes in blood pressure, mental status,hea
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rt rate, temperature, oxygen saturation, and last 2 hours’ urine output are particularly signif
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icant and are part of the Modified Early Warning System guide. Documentation is vital, bu
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t the nurse must do more than document. The primary health care provider would be notifi
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ed, but this is not more important than calling the RRT. The client’s blood pressure would
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be reassessed frequently, but the priority is getting the rapid care to the client.
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