Davis Advantage for Medical-
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• PublisherPublished by F.A.
Davis Copyright© 2024
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
Clinical Scenario:
A 72-year-old patient is admitted with new-onset heart failure.
During teaching, the patient says, “I want my daughter
involved, but I do not want my son to know details about my
condition yet.”
Question Stem:
What is the nurse’s best response?
Answer Options:
A. “Your son is family, so he should be included in all teaching.”
B. “I will provide teaching only after your son is present.”
C. “Tell me who you want included, and I will respect your
preferences during teaching and planning.”
D. “I will document that you refuse family involvement.”
Correct Answer:
C
Detailed Rationale:
Patient-centered care respects the patient’s preferences,
values, and choices. The nurse should clarify whom the patient
wants involved and then plan care accordingly. This supports
autonomy, trust, and shared decision-making while maintaining
privacy and confidentiality.
Incorrect Option Analysis:
, • A: Incorrect because family involvement must be guided
by the patient’s wishes, not assumed by relationship.
Misconception: family always has decision-making
priority. Risk: violation of confidentiality and loss of trust.
• B: Incorrect because teaching should not be delayed
unnecessarily. Misconception: family presence is required
for effective education. Risk: delayed understanding and
delayed discharge readiness.
• D: Incorrect because the patient is not refusing care; they
are expressing a preference. Misconception: preference
equals refusal. Risk: inaccurate documentation and poor
collaboration.
Nursing Process Linkage: Implementation
NCJMM Competencies: Recognize Cues, Prioritize Hypotheses,
Take Action
Difficulty Level: Easy
Bloom’s Level: Apply
NCLEX Client Needs Category: Psychosocial Integrity
Key Learning Objective: Demonstrate patient-centered
communication and respect for autonomy.
2) MCQ
Clinical Scenario:
A postoperative patient becomes restless and says, “I feel like I
, cannot catch my breath.” The pulse oximeter reads 88% on
room air, and the respiratory rate is 30/min.
Question Stem:
What is the nurse’s priority action?
Answer Options:
A. Document the findings and reassess in 30 minutes.
B. Encourage deep breathing and turning.
C. Apply oxygen and assess airway and breathing.
D. Offer pain medication because anxiety is likely the cause.
Correct Answer:
C
Detailed Rationale:
The patient is showing cues of impaired oxygenation. The nurse
must respond using the ABCs: support breathing immediately
and continue assessment. Restlessness is often an early sign of
hypoxemia and should not be dismissed.
Incorrect Option Analysis:
• A: Incorrect because the patient needs immediate
intervention. Misconception: documentation can precede
stabilization. Risk: delayed treatment of hypoxemia.
• B: Incorrect because turning and deep breathing may help
but are not the first priority when oxygen saturation is
low. Risk: worsening respiratory compromise.
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• PublisherPublished by F.A.
Davis Copyright© 2024
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
Clinical Scenario:
A 72-year-old patient is admitted with new-onset heart failure.
During teaching, the patient says, “I want my daughter
involved, but I do not want my son to know details about my
condition yet.”
Question Stem:
What is the nurse’s best response?
Answer Options:
A. “Your son is family, so he should be included in all teaching.”
B. “I will provide teaching only after your son is present.”
C. “Tell me who you want included, and I will respect your
preferences during teaching and planning.”
D. “I will document that you refuse family involvement.”
Correct Answer:
C
Detailed Rationale:
Patient-centered care respects the patient’s preferences,
values, and choices. The nurse should clarify whom the patient
wants involved and then plan care accordingly. This supports
autonomy, trust, and shared decision-making while maintaining
privacy and confidentiality.
Incorrect Option Analysis:
, • A: Incorrect because family involvement must be guided
by the patient’s wishes, not assumed by relationship.
Misconception: family always has decision-making
priority. Risk: violation of confidentiality and loss of trust.
• B: Incorrect because teaching should not be delayed
unnecessarily. Misconception: family presence is required
for effective education. Risk: delayed understanding and
delayed discharge readiness.
• D: Incorrect because the patient is not refusing care; they
are expressing a preference. Misconception: preference
equals refusal. Risk: inaccurate documentation and poor
collaboration.
Nursing Process Linkage: Implementation
NCJMM Competencies: Recognize Cues, Prioritize Hypotheses,
Take Action
Difficulty Level: Easy
Bloom’s Level: Apply
NCLEX Client Needs Category: Psychosocial Integrity
Key Learning Objective: Demonstrate patient-centered
communication and respect for autonomy.
2) MCQ
Clinical Scenario:
A postoperative patient becomes restless and says, “I feel like I
, cannot catch my breath.” The pulse oximeter reads 88% on
room air, and the respiratory rate is 30/min.
Question Stem:
What is the nurse’s priority action?
Answer Options:
A. Document the findings and reassess in 30 minutes.
B. Encourage deep breathing and turning.
C. Apply oxygen and assess airway and breathing.
D. Offer pain medication because anxiety is likely the cause.
Correct Answer:
C
Detailed Rationale:
The patient is showing cues of impaired oxygenation. The nurse
must respond using the ABCs: support breathing immediately
and continue assessment. Restlessness is often an early sign of
hypoxemia and should not be dismissed.
Incorrect Option Analysis:
• A: Incorrect because the patient needs immediate
intervention. Misconception: documentation can precede
stabilization. Risk: delayed treatment of hypoxemia.
• B: Incorrect because turning and deep breathing may help
but are not the first priority when oxygen saturation is
low. Risk: worsening respiratory compromise.
