Davis Advantage for Medical-
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
Clinical Scenario: A postoperative patient is difficult to arouse,
has a respiratory rate of 10/min, and an oxygen saturation of
88% on room air.
Question Stem: What is the nurse’s priority action?
Answer Options:
A. Document the findings and reassess in 30 minutes
B. Apply supplemental oxygen, raise the head of the bed, and
perform an immediate respiratory assessment
C. Encourage incentive spirometry only
D. Offer oral fluids and notify the unit clerk
Correct Answer: B
Detailed Rationale:
The patient shows cues of possible respiratory depression and
hypoxemia. Airway and breathing take priority, so the nurse
should immediately support oxygenation, position the patient
to improve ventilation, and assess the respiratory status
further. Rapid intervention reduces the risk of deterioration.
Incorrect Option Analysis:
• A: Incorrect because delaying action risks worsening
hypoxemia. Common misconception: charting first is safer
than intervening first. Patient safety risk: respiratory
arrest.
, • C: Incorrect because incentive spirometry is not the
immediate priority for an unstable patient. Misconception:
all postoperative breathing issues are corrected by deep
breathing. Risk: delayed treatment of hypoxemia.
• D: Incorrect because oral fluids do not address the
breathing problem. Misconception: altered arousal may be
dehydration-related. Risk: aspiration and delayed
emergency response.
Nursing Process Linkage: Assessment / Implementation
NCJMM Competencies: Recognize Cues, Take Action
Difficulty Level: Difficult
Bloom’s Cognitive Level: Apply
NCLEX Client Needs Category: Physiological Adaptation
Key Learning Objective: Prioritize immediate interventions for
airway/breathing compromise.
2) MCQ
Clinical Scenario: A patient says, “I want to go home as soon as
possible, but I’m worried I won’t remember all the
instructions.”
Question Stem: Which nurse response best demonstrates
patient-centered care?
Answer Options:
A. “The provider has already decided the discharge plan.”
B. “Let’s focus on the standard discharge paperwork first.”
, C. “Tell me what matters most to you so we can plan your
teaching around your concerns.”
D. “Your family can learn the instructions and explain them to
you later.”
Correct Answer: C
Detailed Rationale:
Patient-centered care begins with the patient’s goals, values,
and concerns. This response invites shared planning and
supports individualized teaching, which improves adherence
and understanding.
Incorrect Option Analysis:
• A: Incorrect because it dismisses the patient’s role in the
plan. Misconception: providers control all decisions. Risk:
poor engagement and low adherence.
• B: Incorrect because it is task-focused rather than patient-
focused. Misconception: handing out paperwork equals
teaching. Risk: ineffective discharge education.
• D: Incorrect because it shifts responsibility away from the
patient without assessing their preferences.
Misconception: family can replace patient education. Risk:
misunderstanding and reduced self-management.
Nursing Process Linkage: Planning
NCJMM Competencies: Recognize Cues, Generate Solutions
Difficulty Level: Moderate
Bloom’s Cognitive Level: Analyze
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
Clinical Scenario: A postoperative patient is difficult to arouse,
has a respiratory rate of 10/min, and an oxygen saturation of
88% on room air.
Question Stem: What is the nurse’s priority action?
Answer Options:
A. Document the findings and reassess in 30 minutes
B. Apply supplemental oxygen, raise the head of the bed, and
perform an immediate respiratory assessment
C. Encourage incentive spirometry only
D. Offer oral fluids and notify the unit clerk
Correct Answer: B
Detailed Rationale:
The patient shows cues of possible respiratory depression and
hypoxemia. Airway and breathing take priority, so the nurse
should immediately support oxygenation, position the patient
to improve ventilation, and assess the respiratory status
further. Rapid intervention reduces the risk of deterioration.
Incorrect Option Analysis:
• A: Incorrect because delaying action risks worsening
hypoxemia. Common misconception: charting first is safer
than intervening first. Patient safety risk: respiratory
arrest.
, • C: Incorrect because incentive spirometry is not the
immediate priority for an unstable patient. Misconception:
all postoperative breathing issues are corrected by deep
breathing. Risk: delayed treatment of hypoxemia.
• D: Incorrect because oral fluids do not address the
breathing problem. Misconception: altered arousal may be
dehydration-related. Risk: aspiration and delayed
emergency response.
Nursing Process Linkage: Assessment / Implementation
NCJMM Competencies: Recognize Cues, Take Action
Difficulty Level: Difficult
Bloom’s Cognitive Level: Apply
NCLEX Client Needs Category: Physiological Adaptation
Key Learning Objective: Prioritize immediate interventions for
airway/breathing compromise.
2) MCQ
Clinical Scenario: A patient says, “I want to go home as soon as
possible, but I’m worried I won’t remember all the
instructions.”
Question Stem: Which nurse response best demonstrates
patient-centered care?
Answer Options:
A. “The provider has already decided the discharge plan.”
B. “Let’s focus on the standard discharge paperwork first.”
, C. “Tell me what matters most to you so we can plan your
teaching around your concerns.”
D. “Your family can learn the instructions and explain them to
you later.”
Correct Answer: C
Detailed Rationale:
Patient-centered care begins with the patient’s goals, values,
and concerns. This response invites shared planning and
supports individualized teaching, which improves adherence
and understanding.
Incorrect Option Analysis:
• A: Incorrect because it dismisses the patient’s role in the
plan. Misconception: providers control all decisions. Risk:
poor engagement and low adherence.
• B: Incorrect because it is task-focused rather than patient-
focused. Misconception: handing out paperwork equals
teaching. Risk: ineffective discharge education.
• D: Incorrect because it shifts responsibility away from the
patient without assessing their preferences.
Misconception: family can replace patient education. Risk:
misunderstanding and reduced self-management.
Nursing Process Linkage: Planning
NCJMM Competencies: Recognize Cues, Generate Solutions
Difficulty Level: Moderate
Bloom’s Cognitive Level: Analyze
