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 adult client becomes restless and says, “I feel
like I cannot get enough air.” The nurse notes RR 30/min, SpO₂
89%, and use of accessory muscles.
Question Stem
What is the nurse’s priority action?
Answer Options
A. Reassure the client and encourage slow breathing
B. Apply oxygen and assess airway and breathing immediately
C. Document the findings and recheck in 15 minutes
D. Give the prescribed pain medication first
Correct Answer
B. Apply oxygen and assess airway and breathing immediately
Detailed Rationale
The client has acute respiratory compromise. In clinical
judgment, the nurse must recognize cues of hypoxia and take
immediate action to support oxygenation. Airway and
breathing take priority before documentation, routine
reassessment, or comfort measures.
Incorrect Option Analysis
• A. Reassure the client and encourage slow breathing —
Incorrect because reassurance does not treat hypoxemia.
Misconception: Anxiety is the primary problem.
Safety risk: Delays oxygen delivery during a deteriorating
respiratory event.
, • C. Document the findings and recheck in 15 minutes —
Incorrect because this delays urgent intervention.
Misconception: Stable documentation is more important
than immediate response.
Safety risk: Worsening hypoxia, respiratory failure, or
arrest.
• D. Give the prescribed pain medication first — Incorrect
because opioids may worsen respiratory depression.
Misconception: Pain control should always come before
physiologic stabilization.
Safety risk: Further oxygen suppression and delayed
rescue.
Nursing Process Linkage
Assessment
NCJMM Competencies
Recognize Cues; Take Action
Difficulty Level
Moderate
Bloom’s Cognitive Level
Apply
NCLEX Client Needs Category
Physiological Adaptation
Key Learning Objective
Prioritize immediate nursing action for acute oxygenation
compromise.
, 2) MCQ
Clinical Scenario
A medical-surgical unit plans to replace one fall-prevention
strategy with another. The nurse manager asks how the team
should decide which approach to use.
Question Stem
Which action best reflects evidence-based nursing care?
Answer Options
A. Use the strategy that has always been used on the unit
B. Choose the intervention that is easiest for staff to perform
C. Review current research, unit outcome data, and patient
needs before deciding
D. Ask only one experienced nurse what she prefers
Correct Answer
C. Review current research, unit outcome data, and patient
needs before deciding
Detailed Rationale
Evidence-based practice combines best available research,
clinical expertise, and patient preferences/values. Unit
outcome data help determine whether the intervention
improves safety and quality.
Incorrect Option Analysis
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 adult client becomes restless and says, “I feel
like I cannot get enough air.” The nurse notes RR 30/min, SpO₂
89%, and use of accessory muscles.
Question Stem
What is the nurse’s priority action?
Answer Options
A. Reassure the client and encourage slow breathing
B. Apply oxygen and assess airway and breathing immediately
C. Document the findings and recheck in 15 minutes
D. Give the prescribed pain medication first
Correct Answer
B. Apply oxygen and assess airway and breathing immediately
Detailed Rationale
The client has acute respiratory compromise. In clinical
judgment, the nurse must recognize cues of hypoxia and take
immediate action to support oxygenation. Airway and
breathing take priority before documentation, routine
reassessment, or comfort measures.
Incorrect Option Analysis
• A. Reassure the client and encourage slow breathing —
Incorrect because reassurance does not treat hypoxemia.
Misconception: Anxiety is the primary problem.
Safety risk: Delays oxygen delivery during a deteriorating
respiratory event.
, • C. Document the findings and recheck in 15 minutes —
Incorrect because this delays urgent intervention.
Misconception: Stable documentation is more important
than immediate response.
Safety risk: Worsening hypoxia, respiratory failure, or
arrest.
• D. Give the prescribed pain medication first — Incorrect
because opioids may worsen respiratory depression.
Misconception: Pain control should always come before
physiologic stabilization.
Safety risk: Further oxygen suppression and delayed
rescue.
Nursing Process Linkage
Assessment
NCJMM Competencies
Recognize Cues; Take Action
Difficulty Level
Moderate
Bloom’s Cognitive Level
Apply
NCLEX Client Needs Category
Physiological Adaptation
Key Learning Objective
Prioritize immediate nursing action for acute oxygenation
compromise.
, 2) MCQ
Clinical Scenario
A medical-surgical unit plans to replace one fall-prevention
strategy with another. The nurse manager asks how the team
should decide which approach to use.
Question Stem
Which action best reflects evidence-based nursing care?
Answer Options
A. Use the strategy that has always been used on the unit
B. Choose the intervention that is easiest for staff to perform
C. Review current research, unit outcome data, and patient
needs before deciding
D. Ask only one experienced nurse what she prefers
Correct Answer
C. Review current research, unit outcome data, and patient
needs before deciding
Detailed Rationale
Evidence-based practice combines best available research,
clinical expertise, and patient preferences/values. Unit
outcome data help determine whether the intervention
improves safety and quality.
Incorrect Option Analysis
