MEDICAL SURGICAL NURSING PRACTICE IGNATAVICIUS 8TH EDITION TEST BANK
Chapter 1: Introduction to Medical-Surgical Nursing Practice ANS: A
Ignatavicius: Medical-Surgical Nursing, 8th Edition 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 should call the RRT. Changes in blood pressure,
MULTIPLE CHOICE mental status, heart rate, and pain are particularly significant. Documentation is vital, but the
nurse must do more than document. The primary care provider should be notified, but this is
1. A new nurse is working with a preceptor on an inpatient medical-surgical unit. The not the priority over calling the RRT. The client’s blood pressure should be reassessed
preceptor advises the student that which is the priority when working as a professional frequently, but the priority is getting the rapid care to the client.
nurse?
a. Attending to holistic client needs DIF: Applying/Application REF: 3
b. Ensuring client safety KEY: Rapid Response Team (RRT)| medical emergencies
c. Not making medication errors MSC: Integrated Process: Communication and Documentation
d. Providing client-focused care NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
ANS: B
All actions are appropriate for the professional nurse. However, ensuring client safety is the 4. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse
priority. Up to 98,000 deaths result each year from errors in hospital care, according to the best demonstrates this concept?
2000 Institute of Medicine report. Many more clients have suffered injuries and less serious a. Assesses for cultural influences affecting health care
outcomes. Every nurse has the responsibility to guard the client’s safety. b. Ensures that all the clients’ basic needs are met
c. Tells the client and family about all upcoming tests
DIF: Understanding/Comprehension REF: 2 KEY: Patient safety d. Thoroughly orients the client and family to the room
MSC: Integrated Process: Nursing Process: Intervention ANS: A
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Competency in client-focused care is demonstrated when the nurse focuses on
Control communication, culture, respect, compassion, client education, and empowerment. By
assessing the effect of the client’s culture on health care, this nurse is practicing
2. A nurse is orienting a new client and family to the inpatient unit. What information does the client-focused care. Providing for basic needs does not demonstrate this competence.
nurse provide to help the client promote his or her own safety? Simply telling the client about all upcoming tests is not providing empowering education.
a. Encourage the client and family to be active partners. Orienting the client and family to the room is an important safety measure, but not directly
b. Have the client monitor hand hygiene in caregivers. related to demonstrating client-centered care.
c. Offer the family the opportunity to stay with the client.
d. Tell the client to always wear his or her armband. DIF: Understanding/Comprehension REF: 3
ANS: A KEY: Patient-centered care| culture MSC: Integrated Process: Caring
Each action could be important for the client or family to perform. However, encouraging NOT: Client Needs Category: Psychosocial Integrity
the client to be active in his or her health care as a partner is the most critical. The other
actions are very limited in scope and do not provide the broad protection that being active 5. A client is going to be admitted for a scheduled surgical procedure. Which action does the
and involved does. 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.
DIF: Understanding/Comprehension REF: 3 KEY: Patient safety b. Keep the doctor’s phone number by the telephone.
MSC: Integrated Process: Teaching/Learning c. Make sure all providers wash hands before entering the room.
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection d. Write down the name of each caregiver who comes in the room.
Control ANS: A
Medication errors are the most common type of health care mistake. The Joint
3. A nurse is caring for a postoperative client on the surgical unit. The client’s blood pressure Commission’s Speak Up campaign encourages clients to help ensure their safety. One
was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is recommendation is for clients to know all their medications and why they take them. This
best? will help prevent medication errors.
a. Call the Rapid Response Team.
b. Document and continue to monitor. DIF: Applying/Application REF: 4
c. Notify the primary care provider. KEY: Speak Up campaign| patient safety MSC: Integrated Process: Teaching/Learning
d. Repeat blood pressure measurement in 15 minutes.
, NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection SBAR is a recommended form of communication, and the acronym stands for Situation,
Control Background, Assessment, and Recommendation. Appropriate background information
includes allergies to medications the on-call physician might order. Situation describes what
6. Which action by the nurse working with a client best demonstrates respect for autonomy? is happening right now that must be communicated; the client’s surgery 2 days ago would
a. Asks if the client has questions before signing a consent be considered background. Assessment would include an analysis of the client’s problem;
b. Gives the client accurate information when questioned asking for a different pain medication is a recommendation. Recommendation is a statement
c. Keeps the promises made to the client and family of what is needed or what outcome is desired; this information about the surgeon’s
d. Treats the client fairly compared to other clients preference might be better placed in background.
ANS: A DIF: Applying/Application REF: 5
Autonomy is self-determination. The client should make decisions regarding care. When the KEY: SBAR| communication
nurse obtains a signature on the consent form, assessing if the client still has questions is MSC: Integrated Process: Communication and Documentation
vital, because without full information the client cannot practice autonomy. Giving accurate NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
information is practicing with veracity. Keeping promises is upholding fidelity. Treating the
client fairly is providing social justice. 9. A nurse working on a cardiac unit delegated taking vital signs to an experienced unlicensed
assistive personnel (UAP). Four hours later, the nurse notes the client’s blood pressure is
DIF: Applying/Application REF: 4 much higher than previous readings, and the client’s mental status has changed. What action
KEY: Autonomy| ethical principles MSC: Integrated Process: Caring by the nurse would most likely have prevented this negative outcome?
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care a. Determining if the UAP knew how to take blood pressure
b. Double-checking the UAP by taking another blood pressure
7. A student nurse asks the faculty to explain best practices when communicating with a c. Providing more appropriate supervision of the UAP
person from the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) d. Taking the blood pressure instead of delegating the task
community. What answer by the faculty is most accurate?
a. Avoid embarrassing the client by asking questions. ANS: C
b. Don’t make assumptions about their health needs. Supervision is one of the five rights of delegation and includes directing, evaluating, and
c. Most LGBTQ people do not want to share information. following up on delegated tasks. The nurse should either have asked the UAP about the vital
d. No differences exist in communicating with this population. signs or instructed the UAP to report them right away. An experienced UAP should know
how to take vital signs and the nurse should not have to assess this at this point.
ANS: B Double-checking the work defeats the purpose of delegation. Vital signs are within the
Many members of the LGBTQ community have faced discrimination from health care scope of practice for a UAP and are permissible to delegate. The only appropriate answer is
providers and may be reluctant to seek health care. The nurse should never make that the nurse did not provide adequate instruction to the UAP.
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 DIF: Applying/Application REF: 6
likely to answer honestly. KEY: Supervision| delegation| unlicensed assistive personnel
MSC: Integrated Process: Communication and Documentation
DIF: Understanding/Comprehension REF: 4 KEY: LGBTQ| diversity NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Psychosocial Integrity 10. A newly graduated nurse in the hospital states that, since she is so new, she cannot
participate in quality improvement (QI) projects. What response by the precepting nurse is
8. A nurse is calling the on-call physician about a client who had a hysterectomy 2 days ago best?
and has pain that is unrelieved by the prescribed narcotic pain medication. Which statement a. “All staff nurses are required to participate in quality improvement here.”
is part of the SBAR format for communication? b. “Even being new, you can implement activities designed to improve care.”
a. A: “I would like you to order a different pain medication.” c. “It’s easy to identify what indicators should be used to measure quality.”
b. B: “This client has allergies to morphine and codeine.” d. “You should ask to be assigned to the research and quality committee.”
c. R: “Dr. Smith doesn’t like nonsteroidal anti-inflammatory meds.”
d. S: “This client had a vaginal hysterectomy 2 days ago.” ANS: B
ANS: B
, The preceptor should try to reassure the nurse that implementing QI measures is not out of DIF: Remembering/Knowledge REF: 3
line for a newly licensed nurse. Simply stating that all nurses are required to participate does KEY: Competencies| Institute of Medicine (IOM)
not help the nurse understand how that is possible and is dismissive. Identifying indicators MSC: Integrated Process: Nursing Process: Assessment
of quality is not an easy, quick process and would not be the best place to suggest a new NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
nurse to start. Asking to be assigned to the QI committee does not give the nurse Control
information about how to implement QI in daily practice.
2. A nurse is interested in making interdisciplinary work a high priority. Which actions by the
DIF: Applying/Application REF: 6 nurse best demonstrate this skill? (Select all that apply.)
KEY: Quality improvement a. Consults with other disciplines on client care
MSC: Integrated Process: Communication and Documentation b. Coordinates discharge planning for home safety
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care c. Participates in comprehensive client rounding
d. Routinely asks other disciplines about client progress
11. A nurse is talking with a client who is moving to a new state and needs to find a new doctor e. Shows the nursing care plans to other disciplines
and hospital there. What advice by the nurse is best?
a. Ask the hospitals there about standard nurse-client ratios. ANS: A, B, C, D
b. Choose the hospital that has the newest technology. Collaborating with the interdisciplinary team involves planning, implementing, and
c. Find a hospital that is accredited by The Joint Commission. evaluating client care as a team with all other disciplines included. Simply showing other
d. Use a facility affiliated with a medical or nursing school. caregivers the nursing care plan is not actively involving them or collaborating with them.
ANS: C DIF: Applying/Application REF: 4
Accreditation by The Joint Commission (TJC) or other accrediting body gives assurance KEY: Collaboration| interdisciplinary team
that the facility has a focus on safety. Nurse-client ratios differ by unit type and change over MSC: Integrated Process: Communication and Documentation
time. New technology doesn’t necessarily mean the hospital is safe. Affiliation with a health NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
professions school has several advantages, but safety is most important.
3. The nurse utilizing evidence-based practice (EBP) considers which factors when planning
DIF: Understanding/Comprehension REF: 2 care? (Select all that apply.)
KEY: The Joint Commission (TJC)| accreditation a. Cost-saving measures
MSC: Integrated Process: Communication and Documentation b. Nurse’s expertise
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection c. Client preferences
Control d. Research findings
e. Values of the client
MULTIPLE RESPONSE ANS: B, C, D, E
EBP consists of utilizing current evidence, the client’s values and preferences, and the
1. A nurse manager wishes to ensure that the nurses on the unit are practicing at their highest nurse’s expertise when planning care. It does not include cost-saving measures.
levels of competency. Which areas should the manager assess to determine if the nursing
staff demonstrate competency according to the Institute of Medicine (IOM) report Health DIF: Remembering/Knowledge REF: 6
Professions Education: A Bridge to Quality? (Select all that apply.) KEY: Evidence-based practice (EBP)
a. Collaborating with an interdisciplinary team MSC: Integrated Process: Nursing Process: Planning
b. Implementing evidence-based care NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
c. Providing family-focused care
d. Routinely using informatics in practice 4. A nurse manager wants to improve hand-off communication among the staff. What actions
e. Using quality improvement in client care by the manager would best help achieve this goal? (Select all that apply.)
a. Attend hand-off rounds to coach and mentor.
ANS: A, B, D, E
b. Conduct audits of staff using a new template.
The IOM report lists five broad core competencies that all health care providers should
c. Create a template of topics to include in report.
practice. These include collaborating with the interdisciplinary team, implementing
d. Encourage staff to ask questions during hand-off.
evidence-based practice, providing client-focused care, using informatics in client care, and
e. Give raises based on compliance with reporting.
using quality improvement in client care.
ANS: A, B, C, D
, A good tool for standardizing hand-off reports and other critical communication is the Chapter 2: Common Health Problems of Older Adults
SHARE model. SHARE stands for standardize critical information, hardwire within your Ignatavicius: Medical-Surgical Nursing, 8th Edition
system, allow opportunities to ask questions, reinforce quality and measurement, and
educate and coach. Attending hand-off report gives the manager opportunities to educate
and coach. Conducting audits is part of reinforcing quality. Creating a template is MULTIPLE CHOICE
hardwiring within the system. Encouraging staff to ask questions and think critically about
the information is allowing opportunities to ask questions. The manager may need to tie 1. A nursing faculty member working with students explains that the fastest growing subset of
raises into compliance if the staff is resistive and other measures have failed, but this is not the older population is which group?
part of the SHARE model. a. Elite old
b. Middle old
DIF: Applying/Application REF: 5 c. Old old
KEY: SHARE| hand-off communication d. Young old
MSC: Integrated Process: Nursing Process: Intervention
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care ANS: C
The old old is the fastest growing subset of the older population. This is the group
comprising those 85 to 99 years of age. The young old are between 65 and 74 years of age;
the middle old are between 75 and 84 years of age; and the elite old are over 100 years of
age.
DIF: Remembering/Knowledge REF: 9
KEY: Adulthood| aging| old old MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance
2. A nurse working with older adults in the community plans programming to improve morale
and emotional health in this population. What activity would best meet this goal?
a. Exercise program to improve physical function
b. Financial planning seminar series for older adults
c. Social events such as dances and group dinners
d. Workshop on prevention from becoming an abuse victim
ANS: A
All activities would be beneficial for the older population in the community. However,
failure in performing one’s own activities of daily living and participating in society has
direct effects on morale and life satisfaction. Those who lose the ability to function
independently often feel worthless and empty. An exercise program designed to maintain
and/or improve physical functioning would best address this need.
DIF: Applying/Application REF: 12
KEY: Independence| autonomy| older adult
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Psychosocial Integrity
3. A nurse caring for an older client on a medical-surgical unit notices the client reports
frequent constipation and only wants to eat softer foods such as rice, bread, and puddings.
What assessment should the nurse perform first?
a. Auscultate bowel sounds.
b. Check skin turgor.
c. Perform an oral assessment.
d. Weigh the client.
Chapter 1: Introduction to Medical-Surgical Nursing Practice ANS: A
Ignatavicius: Medical-Surgical Nursing, 8th Edition 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 should call the RRT. Changes in blood pressure,
MULTIPLE CHOICE mental status, heart rate, and pain are particularly significant. Documentation is vital, but the
nurse must do more than document. The primary care provider should be notified, but this is
1. A new nurse is working with a preceptor on an inpatient medical-surgical unit. The not the priority over calling the RRT. The client’s blood pressure should be reassessed
preceptor advises the student that which is the priority when working as a professional frequently, but the priority is getting the rapid care to the client.
nurse?
a. Attending to holistic client needs DIF: Applying/Application REF: 3
b. Ensuring client safety KEY: Rapid Response Team (RRT)| medical emergencies
c. Not making medication errors MSC: Integrated Process: Communication and Documentation
d. Providing client-focused care NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
ANS: B
All actions are appropriate for the professional nurse. However, ensuring client safety is the 4. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse
priority. Up to 98,000 deaths result each year from errors in hospital care, according to the best demonstrates this concept?
2000 Institute of Medicine report. Many more clients have suffered injuries and less serious a. Assesses for cultural influences affecting health care
outcomes. Every nurse has the responsibility to guard the client’s safety. b. Ensures that all the clients’ basic needs are met
c. Tells the client and family about all upcoming tests
DIF: Understanding/Comprehension REF: 2 KEY: Patient safety d. Thoroughly orients the client and family to the room
MSC: Integrated Process: Nursing Process: Intervention ANS: A
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Competency in client-focused care is demonstrated when the nurse focuses on
Control communication, culture, respect, compassion, client education, and empowerment. By
assessing the effect of the client’s culture on health care, this nurse is practicing
2. A nurse is orienting a new client and family to the inpatient unit. What information does the client-focused care. Providing for basic needs does not demonstrate this competence.
nurse provide to help the client promote his or her own safety? Simply telling the client about all upcoming tests is not providing empowering education.
a. Encourage the client and family to be active partners. Orienting the client and family to the room is an important safety measure, but not directly
b. Have the client monitor hand hygiene in caregivers. related to demonstrating client-centered care.
c. Offer the family the opportunity to stay with the client.
d. Tell the client to always wear his or her armband. DIF: Understanding/Comprehension REF: 3
ANS: A KEY: Patient-centered care| culture MSC: Integrated Process: Caring
Each action could be important for the client or family to perform. However, encouraging NOT: Client Needs Category: Psychosocial Integrity
the client to be active in his or her health care as a partner is the most critical. The other
actions are very limited in scope and do not provide the broad protection that being active 5. A client is going to be admitted for a scheduled surgical procedure. Which action does the
and involved does. 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.
DIF: Understanding/Comprehension REF: 3 KEY: Patient safety b. Keep the doctor’s phone number by the telephone.
MSC: Integrated Process: Teaching/Learning c. Make sure all providers wash hands before entering the room.
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection d. Write down the name of each caregiver who comes in the room.
Control ANS: A
Medication errors are the most common type of health care mistake. The Joint
3. A nurse is caring for a postoperative client on the surgical unit. The client’s blood pressure Commission’s Speak Up campaign encourages clients to help ensure their safety. One
was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is recommendation is for clients to know all their medications and why they take them. This
best? will help prevent medication errors.
a. Call the Rapid Response Team.
b. Document and continue to monitor. DIF: Applying/Application REF: 4
c. Notify the primary care provider. KEY: Speak Up campaign| patient safety MSC: Integrated Process: Teaching/Learning
d. Repeat blood pressure measurement in 15 minutes.
, NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection SBAR is a recommended form of communication, and the acronym stands for Situation,
Control Background, Assessment, and Recommendation. Appropriate background information
includes allergies to medications the on-call physician might order. Situation describes what
6. Which action by the nurse working with a client best demonstrates respect for autonomy? is happening right now that must be communicated; the client’s surgery 2 days ago would
a. Asks if the client has questions before signing a consent be considered background. Assessment would include an analysis of the client’s problem;
b. Gives the client accurate information when questioned asking for a different pain medication is a recommendation. Recommendation is a statement
c. Keeps the promises made to the client and family of what is needed or what outcome is desired; this information about the surgeon’s
d. Treats the client fairly compared to other clients preference might be better placed in background.
ANS: A DIF: Applying/Application REF: 5
Autonomy is self-determination. The client should make decisions regarding care. When the KEY: SBAR| communication
nurse obtains a signature on the consent form, assessing if the client still has questions is MSC: Integrated Process: Communication and Documentation
vital, because without full information the client cannot practice autonomy. Giving accurate NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
information is practicing with veracity. Keeping promises is upholding fidelity. Treating the
client fairly is providing social justice. 9. A nurse working on a cardiac unit delegated taking vital signs to an experienced unlicensed
assistive personnel (UAP). Four hours later, the nurse notes the client’s blood pressure is
DIF: Applying/Application REF: 4 much higher than previous readings, and the client’s mental status has changed. What action
KEY: Autonomy| ethical principles MSC: Integrated Process: Caring by the nurse would most likely have prevented this negative outcome?
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care a. Determining if the UAP knew how to take blood pressure
b. Double-checking the UAP by taking another blood pressure
7. A student nurse asks the faculty to explain best practices when communicating with a c. Providing more appropriate supervision of the UAP
person from the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) d. Taking the blood pressure instead of delegating the task
community. What answer by the faculty is most accurate?
a. Avoid embarrassing the client by asking questions. ANS: C
b. Don’t make assumptions about their health needs. Supervision is one of the five rights of delegation and includes directing, evaluating, and
c. Most LGBTQ people do not want to share information. following up on delegated tasks. The nurse should either have asked the UAP about the vital
d. No differences exist in communicating with this population. signs or instructed the UAP to report them right away. An experienced UAP should know
how to take vital signs and the nurse should not have to assess this at this point.
ANS: B Double-checking the work defeats the purpose of delegation. Vital signs are within the
Many members of the LGBTQ community have faced discrimination from health care scope of practice for a UAP and are permissible to delegate. The only appropriate answer is
providers and may be reluctant to seek health care. The nurse should never make that the nurse did not provide adequate instruction to the UAP.
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 DIF: Applying/Application REF: 6
likely to answer honestly. KEY: Supervision| delegation| unlicensed assistive personnel
MSC: Integrated Process: Communication and Documentation
DIF: Understanding/Comprehension REF: 4 KEY: LGBTQ| diversity NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Psychosocial Integrity 10. A newly graduated nurse in the hospital states that, since she is so new, she cannot
participate in quality improvement (QI) projects. What response by the precepting nurse is
8. A nurse is calling the on-call physician about a client who had a hysterectomy 2 days ago best?
and has pain that is unrelieved by the prescribed narcotic pain medication. Which statement a. “All staff nurses are required to participate in quality improvement here.”
is part of the SBAR format for communication? b. “Even being new, you can implement activities designed to improve care.”
a. A: “I would like you to order a different pain medication.” c. “It’s easy to identify what indicators should be used to measure quality.”
b. B: “This client has allergies to morphine and codeine.” d. “You should ask to be assigned to the research and quality committee.”
c. R: “Dr. Smith doesn’t like nonsteroidal anti-inflammatory meds.”
d. S: “This client had a vaginal hysterectomy 2 days ago.” ANS: B
ANS: B
, The preceptor should try to reassure the nurse that implementing QI measures is not out of DIF: Remembering/Knowledge REF: 3
line for a newly licensed nurse. Simply stating that all nurses are required to participate does KEY: Competencies| Institute of Medicine (IOM)
not help the nurse understand how that is possible and is dismissive. Identifying indicators MSC: Integrated Process: Nursing Process: Assessment
of quality is not an easy, quick process and would not be the best place to suggest a new NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
nurse to start. Asking to be assigned to the QI committee does not give the nurse Control
information about how to implement QI in daily practice.
2. A nurse is interested in making interdisciplinary work a high priority. Which actions by the
DIF: Applying/Application REF: 6 nurse best demonstrate this skill? (Select all that apply.)
KEY: Quality improvement a. Consults with other disciplines on client care
MSC: Integrated Process: Communication and Documentation b. Coordinates discharge planning for home safety
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care c. Participates in comprehensive client rounding
d. Routinely asks other disciplines about client progress
11. A nurse is talking with a client who is moving to a new state and needs to find a new doctor e. Shows the nursing care plans to other disciplines
and hospital there. What advice by the nurse is best?
a. Ask the hospitals there about standard nurse-client ratios. ANS: A, B, C, D
b. Choose the hospital that has the newest technology. Collaborating with the interdisciplinary team involves planning, implementing, and
c. Find a hospital that is accredited by The Joint Commission. evaluating client care as a team with all other disciplines included. Simply showing other
d. Use a facility affiliated with a medical or nursing school. caregivers the nursing care plan is not actively involving them or collaborating with them.
ANS: C DIF: Applying/Application REF: 4
Accreditation by The Joint Commission (TJC) or other accrediting body gives assurance KEY: Collaboration| interdisciplinary team
that the facility has a focus on safety. Nurse-client ratios differ by unit type and change over MSC: Integrated Process: Communication and Documentation
time. New technology doesn’t necessarily mean the hospital is safe. Affiliation with a health NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
professions school has several advantages, but safety is most important.
3. The nurse utilizing evidence-based practice (EBP) considers which factors when planning
DIF: Understanding/Comprehension REF: 2 care? (Select all that apply.)
KEY: The Joint Commission (TJC)| accreditation a. Cost-saving measures
MSC: Integrated Process: Communication and Documentation b. Nurse’s expertise
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection c. Client preferences
Control d. Research findings
e. Values of the client
MULTIPLE RESPONSE ANS: B, C, D, E
EBP consists of utilizing current evidence, the client’s values and preferences, and the
1. A nurse manager wishes to ensure that the nurses on the unit are practicing at their highest nurse’s expertise when planning care. It does not include cost-saving measures.
levels of competency. Which areas should the manager assess to determine if the nursing
staff demonstrate competency according to the Institute of Medicine (IOM) report Health DIF: Remembering/Knowledge REF: 6
Professions Education: A Bridge to Quality? (Select all that apply.) KEY: Evidence-based practice (EBP)
a. Collaborating with an interdisciplinary team MSC: Integrated Process: Nursing Process: Planning
b. Implementing evidence-based care NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
c. Providing family-focused care
d. Routinely using informatics in practice 4. A nurse manager wants to improve hand-off communication among the staff. What actions
e. Using quality improvement in client care by the manager would best help achieve this goal? (Select all that apply.)
a. Attend hand-off rounds to coach and mentor.
ANS: A, B, D, E
b. Conduct audits of staff using a new template.
The IOM report lists five broad core competencies that all health care providers should
c. Create a template of topics to include in report.
practice. These include collaborating with the interdisciplinary team, implementing
d. Encourage staff to ask questions during hand-off.
evidence-based practice, providing client-focused care, using informatics in client care, and
e. Give raises based on compliance with reporting.
using quality improvement in client care.
ANS: A, B, C, D
, A good tool for standardizing hand-off reports and other critical communication is the Chapter 2: Common Health Problems of Older Adults
SHARE model. SHARE stands for standardize critical information, hardwire within your Ignatavicius: Medical-Surgical Nursing, 8th Edition
system, allow opportunities to ask questions, reinforce quality and measurement, and
educate and coach. Attending hand-off report gives the manager opportunities to educate
and coach. Conducting audits is part of reinforcing quality. Creating a template is MULTIPLE CHOICE
hardwiring within the system. Encouraging staff to ask questions and think critically about
the information is allowing opportunities to ask questions. The manager may need to tie 1. A nursing faculty member working with students explains that the fastest growing subset of
raises into compliance if the staff is resistive and other measures have failed, but this is not the older population is which group?
part of the SHARE model. a. Elite old
b. Middle old
DIF: Applying/Application REF: 5 c. Old old
KEY: SHARE| hand-off communication d. Young old
MSC: Integrated Process: Nursing Process: Intervention
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care ANS: C
The old old is the fastest growing subset of the older population. This is the group
comprising those 85 to 99 years of age. The young old are between 65 and 74 years of age;
the middle old are between 75 and 84 years of age; and the elite old are over 100 years of
age.
DIF: Remembering/Knowledge REF: 9
KEY: Adulthood| aging| old old MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance
2. A nurse working with older adults in the community plans programming to improve morale
and emotional health in this population. What activity would best meet this goal?
a. Exercise program to improve physical function
b. Financial planning seminar series for older adults
c. Social events such as dances and group dinners
d. Workshop on prevention from becoming an abuse victim
ANS: A
All activities would be beneficial for the older population in the community. However,
failure in performing one’s own activities of daily living and participating in society has
direct effects on morale and life satisfaction. Those who lose the ability to function
independently often feel worthless and empty. An exercise program designed to maintain
and/or improve physical functioning would best address this need.
DIF: Applying/Application REF: 12
KEY: Independence| autonomy| older adult
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Psychosocial Integrity
3. A nurse caring for an older client on a medical-surgical unit notices the client reports
frequent constipation and only wants to eat softer foods such as rice, bread, and puddings.
What assessment should the nurse perform first?
a. Auscultate bowel sounds.
b. Check skin turgor.
c. Perform an oral assessment.
d. Weigh the client.
