Davis Advantage for Medical-
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,Question 1
Type: MCQ
Clinical Scenario
A nurse is caring for a patient admitted with community-
acquired pneumonia. During a routine reassessment, the
patient says, “I feel much more short of breath than I did an
hour ago.”
Question Stem
What is the nurse’s best initial action?
Answer Options
A. Call the provider immediately with the update
B. Place the patient in high-Fowler position and apply oxygen
C. Assess respiratory rate, lung sounds, and oxygen saturation
D. Reassure the patient that shortness of breath is expected
Correct Answer
C. Assess respiratory rate, lung sounds, and oxygen saturation
Detailed Rationale
The nurse’s first step is to recognize the cue and gather focused
data before acting. A sudden increase in dyspnea may indicate
worsening oxygenation, mucus plugging, fatigue, or evolving
respiratory failure. Assessment provides the information
,needed to prioritize actions and determine whether escalation
is required.
Incorrect Option Analysis
• A. Call the provider immediately
o Why incorrect: Escalation may be needed, but the
nurse should first assess the patient to describe the
problem accurately.
o Common misconception: Thinking any change
requires immediate provider notification before
assessment.
o Safety risk: Incomplete communication may delay the
right intervention.
• B. Place the patient in high-Fowler position and apply
oxygen
o Why incorrect: These actions may be appropriate
after assessment, especially if hypoxemia is
confirmed, but assessment comes first unless the
patient is in obvious distress.
o Common misconception: Jumping directly to
interventions without confirming severity.
o Safety risk: Could mask worsening condition or miss
another cause.
• D. Reassure the patient that shortness of breath is
expected
, o Why incorrect: New or worsening dyspnea is not
something to dismiss.
o Common misconception: Normalizing deterioration.
o Safety risk: Delayed recognition of respiratory
decline.
Nursing Process Linkage
Assessment
NCJMM Competencies
Recognize Cues; Analyze Cues
Difficulty Level
Easy
Bloom’s Cognitive Level
Apply
NCLEX Client Needs Category
Physiological Adaptation
Key Learning Objective
Identify the nurse’s priority action when a patient reports an
acute change in respiratory status.
Question 2
Type: MCQ
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,Question 1
Type: MCQ
Clinical Scenario
A nurse is caring for a patient admitted with community-
acquired pneumonia. During a routine reassessment, the
patient says, “I feel much more short of breath than I did an
hour ago.”
Question Stem
What is the nurse’s best initial action?
Answer Options
A. Call the provider immediately with the update
B. Place the patient in high-Fowler position and apply oxygen
C. Assess respiratory rate, lung sounds, and oxygen saturation
D. Reassure the patient that shortness of breath is expected
Correct Answer
C. Assess respiratory rate, lung sounds, and oxygen saturation
Detailed Rationale
The nurse’s first step is to recognize the cue and gather focused
data before acting. A sudden increase in dyspnea may indicate
worsening oxygenation, mucus plugging, fatigue, or evolving
respiratory failure. Assessment provides the information
,needed to prioritize actions and determine whether escalation
is required.
Incorrect Option Analysis
• A. Call the provider immediately
o Why incorrect: Escalation may be needed, but the
nurse should first assess the patient to describe the
problem accurately.
o Common misconception: Thinking any change
requires immediate provider notification before
assessment.
o Safety risk: Incomplete communication may delay the
right intervention.
• B. Place the patient in high-Fowler position and apply
oxygen
o Why incorrect: These actions may be appropriate
after assessment, especially if hypoxemia is
confirmed, but assessment comes first unless the
patient is in obvious distress.
o Common misconception: Jumping directly to
interventions without confirming severity.
o Safety risk: Could mask worsening condition or miss
another cause.
• D. Reassure the patient that shortness of breath is
expected
, o Why incorrect: New or worsening dyspnea is not
something to dismiss.
o Common misconception: Normalizing deterioration.
o Safety risk: Delayed recognition of respiratory
decline.
Nursing Process Linkage
Assessment
NCJMM Competencies
Recognize Cues; Analyze Cues
Difficulty Level
Easy
Bloom’s Cognitive Level
Apply
NCLEX Client Needs Category
Physiological Adaptation
Key Learning Objective
Identify the nurse’s priority action when a patient reports an
acute change in respiratory status.
Question 2
Type: MCQ
