tr
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Medical Surgical Nursing 10th Edition Ign
tr tr tr tr tr
atavicius Workman Test Bank tr tr tr
Chaptertr01:trOverviewtroftrProfessionaltrNursingtrConceptstrfortrMedical-
SurgicaltrNursingtrIgnatavicius:trMedical-SurgicaltrNursing,tr10thtrEdition
MULTIPLEtrCHOICE
1. Atrnewtrnursetristrworkingtrwithtratrpreceptortrontratrmedical-
surgicaltrunit.trThetrpreceptortradvisestrthetrnewtrnursetrthattrwhichtristrthetrprioritytrwhentrworkingtr
astratrprofessionaltrnurse?
a. Attendingtrtotrholistictrclienttrneeds
b. Ensuringtrclienttrsafety
c. Nottrmakingtrmedicationtrerrors
d. Providingtrclient-focusedtrcare
ANS:t r B
Alltractionstraretrappropriatetrfortrthetrprofessionaltrnurse.trHowever,trensuringtrclienttrsafetytristrth
etrpriority.trHealthtrcaretrerrorstrhavetrbeentrwidelytrreportedtrfortr25tryears,trmanytroftrwhichtrresult
trintrclienttrinjury,trdeath,trandtrincreasedtrhealthtrcaretrcosts.trTheretraretrseveraltrnationaltrandtrinte
rnationaltrorganizationstrthattrhavetreithertrrecommendedtrortrmandatedtrsafetytrinitiatives.
Everytrnursetrhastrthetrresponsibilitytrtotrguardtrthetrclient9strsafety.trThetrothertractionstraretrimporta
nttrfortrqualitytrnursing,trbuttrtheytraretrnottrastrvitaltrastrprovidingtrsafety.trNottrmakingtrmedicationtrer
rorstrdoestrprovidetrsafety,trbuttristrtootrnarrowtrintrscopetrtotrbetrthetrbesttranswer.
DIF: Understanding
TOP:t r IntegratedtrProcess:trNursingtrProcess:trInterventiontrKEY:trClienttrsafety
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trSafetytrandtrInfectiontrControl
2. Atrnursetristrorientingtratrnewtrclienttrandtrfamilytrtotrthetrmedical-
surgicaltrunit.trWhattrinformationtrdoestrthetrnursetrprovidetrtotrbesttrhelptrthetrclienttrpromotetrhis
trortrhertrowntrsafety?
a. Encouragetrthetrclienttrandtrfamilytrtotrbetractivetrpartners.
b. Havetrthetrclienttrmonitortrhandtrhygienetrintrcaregivers.
c. Offertrthetrfamilytrthetropportunitytrtotrstaytrwithtrthetrclient.
d. Telltrthetrclienttrtotralwaystrweartrhistrortrhertrarmband.
ANS:t r A
Eachtractiontrcouldtrbetrimportanttrfortrthetrclienttrortrfamilytrtotrperform.trHowever,trencouragingtrth
etrclienttrtotrbetractivetrintrhistrortrhertrhealthtrcaretrastratrsafetytrpartnertristrthetrmosttrcritical.trThetrothe
rtractionstraretrverytrlimitedtrintrscopetrandtrdotrnottrprovidetrthetrbroadtrprotectiontrthattrbeingtractivetra
ndtrinvolvedtrdoes.
DIF: Understanding
TOP:trIntegratedtrProcess:trTeaching/LearningtrKEY:trClienttrsafety
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trSafetytrandtrInfectiontrControl
3. Atrnursetristrcaringtrfortratrpostoperativetrclienttrontrthetrsurgicaltrunit.trThetrclient9strbloodtrpressur
etrwastr142/76trmmtrHgtr30trminutestrago,trandtrnowtristr88/50trmmtrHg.trWhattractiontrwouldtrthetrn
ursetrtaketrfirst?
a. CalltrthetrRapidtrResponsetrTeam.
b. Documenttrandtrcontinuetrtotrmonitor.
c. Notifytrthetrprimarytrhealthtrcaretrprovider.
d. Repeattrthetrbloodtrpressuretrintr15trminutes.
, tr
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ANS:t r A
ThetrpurposetroftrthetrRapidtrResponsetrTeamtr(RRT)tristrtotrintervenetrwhentrclientstraretrdeterioratin
gtrbeforetrtheytrsuffertreithertrrespiratorytrortrcardiactrarrest.trSincetrthetrclienttrhastrmanifestedtratrsig
nificanttrchange,trthetrnursetrwouldtrcalltrthetrRRT.trChangestrintrbloodtrpressure,trmentaltrstatus,trhe
arttrrate,trtemperature,troxygentrsaturation,trandtrlasttr2trhours9trurinetroutputtraretrparticularlytrsigni
ficanttrandtraretrparttroftrthetrModifiedtrEarlytrWarningtrSystemtrguide.trDocumentationtristrvital,trbu
ttrthetrnursetrmusttrdotrmoretrthantrdocument.trThetrprimarytrhealthtrcaretrprovidertrwouldtrbetrnotifie
d,trbuttrthistristrnottrmoretrimportanttrthantrcallingtrthetrRRT.trThetrclient9strbloodtrpressuretrwouldtrb
etrreassessedtrfrequently,trbuttrthetrprioritytristrgettingtrthetrrapidtrcaretrtotrthetrclient.
DIF: Applying
TOP:t r IntegratedtrProcess:trCommunicationtrandtrDocumentationtrKEY:trRapidtr
ResponsetrTeamtr(RRT),trClinicaltrjudgment
MSC:t r ClienttrNeedstrCategory:trPhysiologicaltrIntegrity:trPhysiologicaltrAdaptation
4. Atrnursetrwishestrtotrprovidetrclient-centeredtrcaretrintralltrinteractions.trWhichtractiontrbytrthetrnurse
besttrdemonstratestrthistrconcept?
a. Assessestrfortrculturaltrinfluencestraffectingtrhealthtrcare.
b. Ensurestrthattralltrthetrclient9strbasictrneedstraretrmet.
c. Tellstrthetrclienttrandtrfamilytrabouttralltrupcomingtrtests.
d. Thoroughlytrorientstrthetrclienttrandtrfamilytrtotrthetrroom.
ANS:t r A
Showingtrrespecttrfortrthetrclienttrandtrfamily9strpreferencestrandtrneedstristressentialtrtotrensuretratrh
olistictrortr<whole-
person=trapproachtrtotrcare.trBytrassessingtrthetreffecttroftrthetrclient9strculturetrontrhealthtrcare,trthistrn
ursetristrpracticingtrclient-
focusedtrcare.trProvidingtrfortrbasictrneedstrdoestrnottrdemonstratetrthistrcompetence.trSimplytrtellin
gtrthetrclienttrabouttralltrupcomingtrteststristrnottrprovidingtrempoweringtreducation.trOrientingtrthetrc
lienttrandtrfamilytrtotrthetrroomtristrantrimportanttrsafetytrmeasure,trbuttrnottrdirectlytrrelatedtrtotrdemo
nstratingtrclient-centeredtrcare.
DIF: Understanding
TOP:trIntegratedtrProcess:trCulturetrandtrSpiritualitytrKEY:t r Client-centeredtrcare,trCulture
MSC:t r ClienttrNeedstrCategory:trPsychosocialtrIntegrity
5. Atrclienttristrgoingtrtotrbetradmittedtrfortratrscheduledtrsurgicaltrprocedure.trWhichtractiontrdoestrth
etrnursetrexplaintristrthetrmosttrimportanttrthingtrthetrclienttrcantrdotrtotrprotecttragainsttrerrors?
a. Bringtratrlisttroftralltrmedicationstrandtrwhattrtheytraretrfor.
b. Keeptrthetrprovider9strphonetrnumbertrbytrthetrtelephone.
c. Maketrsuretrthattralltrproviderstrwashtrhandstrbeforetrenteringtrthetrroom.
d. Writetrdowntrthetrnametroftreachtrcaregivertrwhotr comestrintrthetrroom.
ANS:t r A
Medicationtrreconciliationtristratrformaltrprocesstrintrwhichtrthetrclient9stractualtrcurrenttrmedicationstr
aretrcomparedtrtotrthetrprescribedtrmedicationstrattrthetrtimetroftradmission,trtransfer,trortrdischarge.tr
ThistrNationaltrclienttrSafetytrGoaltristrimportanttrtotrreducetrmedicationtrerrors.trThetrclienttrwouldtr
nottrhavetrtotrbetrresponsibletrfortrproviderstrwashingtrtheirtrhands,trandtreventriftrthetrclienttrdoestrso,t
rthistristrtootrnarrowtrtotrbetrthetrmosttrimportanttractiontrtotrpreventtrerrors.trKeepingtrthetrprovider9st
rphonetrnumbertrnearbytrandtrdocumentingtreveryonetrwhotrenterstrthetrroomtralsotrdotrnottrguarante
etrsafety.
DIF: Applying
TOP:t r IntegratedtrProcess:trTeaching/LearningtrKEY:trClienttr
safety,trInformatics
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trSafetytrandtrInfectiontrControl
, tr
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6. Whichtractiontrbytrthetrnursetrworkingtrwithtratrclienttrbesttrdemonstratestrrespecttrfortrautonomy?
a. Askstriftrthetrclienttrhastrquestionstrbeforetrsigningtratrconsent.
b. Givestrthetrclienttraccuratetrinformationtrwhentrquestioned.
c. Keepstrthetrpromisestrmadetrtotrthetrclienttrandtrfamily.
d. Treatstrthetrclienttrfairlytrcomparedtrtotrothertrclients.
ANS:t r A
Autonomytristrself-
determination.trThetrclienttrwouldtrmaketrdecisionstrregardingtrcare.trWhentrthetrnursetrobtainstratrsig
naturetrontrthetrconsenttrform,trassessingtriftrthetrclienttrstilltrhastrquestionstristrvital,trbecausetrwithouttrf
ulltrinformationtrthetrclienttrcannottrpracticetrautonomy.trGivingtraccuratetrinformationtristrpracticin
gtrwithtrveracity.trKeepingtrpromisestristrupholdingtrfidelity.trTreatingtrthetrclienttrfairlytristrprovidin
gtrsocialtrjustice.
DIF: Applying TOP:t r IntegratedtrProcess:trCaring
KEY:trEthics,trAutonomytrMSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrE
nvironment:trManagementtroftrCare
7. Atrnursetraskstratrmoretrseasonedtrcolleaguetrtotrexplaintrbesttrpracticestrwhentrcommunicatingtrwithtr
atrpersontrfromtrthetrlesbian,trgay,trbisexual,trtransgender,trandtrquestioning/queertr(LGBTQ)trcom
munity.trWhattranswertrbytrthetrfacultytristrmosttraccurate?
a. Avoidtrembarrassingtrthetrclienttrbytraskingtrquestions.
b. Don9ttrmaketrassumptionstrabouttrhistrortrhertrhealthtrneeds.
c. MosttrLGBTQtrpeopletrdotrnottrwanttrtotrsharetrinformation.
d. Notrdifferencestrexisttr intrcommunicatingtrwithtrthistrpopulation.
ANS:t r B
ManytrmemberstroftrthetrLGBTQtrcommunitytrhavetrfacedtrdiscriminationtrfromtrhealthtrcaretrprovi
derstrandtrmaytrbetrreluctanttrtotrseektrhealthtrcare.trThetrnursetrwouldtrnevertrmaketrassumptionstrabo
uttrthetrneedstroftrmemberstroftrthistrpopulation.trRather,trrespectfultrquestionstraretrappropriate.trIftrap
proachedtrwithtrsensitivity,trthetrclienttrwithtranytrhealthtrcaretrneedtristrmoretrlikelytrtotranswertrhones
tly.
DIF: Understanding TOP:t r IntegratedtrProcess:trTeaching/Learning
KEY:t r Healthtrcaretrdisparities,trLGBTQ MSC:t r ClienttrNeedstrCategory:trPsychosocialtrIntegrity
8. Atrnursetristrcallingtrthetron-
calltrhealthtrcaretrprovidertrabouttratrclienttrwhotrhadtratrhysterectomytr2trdaystragotrandtrhastrpaintr
thattristrunrelievedtrbytrthetrprescribedtropioidtrpaintrmedication.trWhichtrstatementtrcomprisestr
thetrbackgroundtrportiontroftrthetrSBARtrformattrfortrcommunication?
a. <Itrwouldtrliketryoutrtotrordertratrdifferenttrpaintrmedication.=
b. <Thistrclienttrhastrallergiestrtotrmorphinetrandtrcodeine.=
c. <Dr.tr Smithtr doesn9ttr liketr nonsteroidaltr anti-inflammatorytrmeds.=
d. <Thistrclienttrhadtratrvaginaltrhysterectomytr2trdaystrago.=
ANS:t r B
, tr
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SBARtristratrrecommendedtrformtroftrcommunication,trandtrthetracronymtrstandstrfortrSituation,trBa
ckground,trAssessment,trandtrRecommendation.trAppropriatetrbackgroundtrinformationtrincludestr
allergiestrtotrmedicationstrthetron-
calltrhealthtrcaretrprovidertrmighttrorder.trSituationtrdescribestrwhattristrhappeningtrrighttrnowtrthattrm
usttrbetrcommunicated;trthetrclient9strsurgerytr2trdaystragotrwouldtrbetrconsideredtrbackground.trAsse
ssmenttrwouldtrincludetrantranalysistroftrthetrclient9strproblem;trnonetroftrthetroptionstrhastrassessme
nttrinformation.trAskingtrfortratrdifferenttrpaintrmedicationtristratrrecommendation.trRecommendati
ontristratrstatementtroftrwhattristrneededtrortrwhattroutcometristrdesired.
DIF: Applying
TOP:t r IntegratedtrProcess:trCommunicationtrandtrDocumentationtrKEY:trTeam
worktrandtrcollaboration,trSBAR
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trManagementtroftrCare
9. Atrnursetrworkingtrontratrcardiactrunittrdelegatedtrtakingtrvitaltrsignstrtotrantrexperiencedtrassistivetrp
ersonneltr(AP).trFourtrhourstrlater,trthetrnursetrnotestrthattrthetrclient9strbloodtrpressuretrtakentrbytrthe
trAPtrwastrmuchtrhighertrthantrprevioustrreadings,trandtrthetrclient9strmentaltrstatustrhastrchanged.trWh
attractiontrbytrthetrnursetrwouldtrmosttrlikelytrhavetrpreventedtrthistrnegativetroutcome?
a. DeterminingtriftrthetrAPtrknewtrhowtrtotrtaketrbloodtrpressure
b. Double-checkingtrthetrAPtrbytrtakingtranothertrbloodtrpressure
c. ProvidingtrmoretrappropriatetrsupervisiontroftrthetrAP
d. Takingtrthetrbloodtrpressuretrinsteadtroftrdelegatingtrthetrtask
ANS:t r C
Supervisiontristronetroftrthetrfivetrrightstroftrdelegationtrandtrincludestrdirecting,trevaluating,trandtrfo
llowingtruptrontrdelegatedtrtasks.trThetrnursetrwouldtreithertrhavetraskedtrthetrAPtrabouttrthetrvitaltrsig
nstrortrinstructedtrthetrAPtrtotrreporttrthemtrrighttraway.trAntrexperiencedtrAPtrwouldtrknowtrhowtrtotrt
aketrvitaltrsignstrandtrthetrnursetrwouldtrnottrhavetrtotrassesstrthistrattrthistrpoint.trDouble-
checkingtrthetrworktrdefeatstrthetrpurposetroftrdelegation.trVitaltrsignstraretrwithintrthetrscopetroftrpra
cticetrfortratrAPtrandtraretrpermissibletrtotrdelegate.trThetronlytrappropriatetranswertristrthattrthetrnursetr
didtrnottrprovidetradequatetrinstructiontrtotrthetrAP.
DIF: Analyzing
TOP:t r IntegratedtrProcess:trCommunicationtrandtrDocumentationtrKEY:trTeam
worktrandtrcollaboration,trDelegation
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trManagementtroftrCare
10. Atrnewlytrgraduatedtrnursetrintrthetrhospitaltrstatestrthattrbecausetroftrbeingtrsotrnew,trparticipationtri
ntrqualitytrimprovementtr(QI)trprojectstristrnottrwise.trWhattrresponsetrbytrthetrpreceptingtrnursetristrbe
st?
a. <Alltrstafftrnursestraretrrequiredtrtotrparticipatetrintrqualitytrimprovementtrhere.=
b. <Eventrbeingtrnew,tryoutrcantrimplementtractivitiestrdesignedtrtotrimprovetrcare.=
c. <It9streasytrtotridentifytrwhattrindicatorstrwouldtrbetrusedtrtotrmeasuretrquality.=
d. <Youtrshouldtrasktrtotrbetrassignedtrtotrthetrresearchtrandtrqualitytrcommittee.=
ANS:t r B
ThetrpreceptortrwouldtrtrytrtotrreassuretrthetrnursetrthattrimplementingtrQItrmeasurestristrnottrouttroftrli
netrfortratrnewlytrlicensedtrnurse.trSimplytrstatingtrthattralltrnursestraretrrequiredtrtotrparticipatetrdoestr
nottrhelptrthetrnursetrunderstandtrhowtrthattristrpossibletrandtristrdismissive.trIdentifyingtrindicatorstro
ftrqualitytristrnottrantreasy,trquicktrprocesstrandtrwouldtrnottrbetrthetrbesttrplacetrtotrsuggesttratrnewtrnurs
etrtotrstart.trAskingtrtotrbetrassignedtrtotrthetrQItrcommitteetrdoestrnottrgivetrthetrnursetrinformationtrab
outtrhowtrtotrimplementtrQItrintrdailytrpractice.
DIF: Applying TOP:t r IntegratedtrProcess:trCommunicationtrandtrDocumentation
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Medical Surgical Nursing 10th Edition Ign
tr tr tr tr tr
atavicius Workman Test Bank tr tr tr
Chaptertr01:trOverviewtroftrProfessionaltrNursingtrConceptstrfortrMedical-
SurgicaltrNursingtrIgnatavicius:trMedical-SurgicaltrNursing,tr10thtrEdition
MULTIPLEtrCHOICE
1. Atrnewtrnursetristrworkingtrwithtratrpreceptortrontratrmedical-
surgicaltrunit.trThetrpreceptortradvisestrthetrnewtrnursetrthattrwhichtristrthetrprioritytrwhentrworkingtr
astratrprofessionaltrnurse?
a. Attendingtrtotrholistictrclienttrneeds
b. Ensuringtrclienttrsafety
c. Nottrmakingtrmedicationtrerrors
d. Providingtrclient-focusedtrcare
ANS:t r B
Alltractionstraretrappropriatetrfortrthetrprofessionaltrnurse.trHowever,trensuringtrclienttrsafetytristrth
etrpriority.trHealthtrcaretrerrorstrhavetrbeentrwidelytrreportedtrfortr25tryears,trmanytroftrwhichtrresult
trintrclienttrinjury,trdeath,trandtrincreasedtrhealthtrcaretrcosts.trTheretraretrseveraltrnationaltrandtrinte
rnationaltrorganizationstrthattrhavetreithertrrecommendedtrortrmandatedtrsafetytrinitiatives.
Everytrnursetrhastrthetrresponsibilitytrtotrguardtrthetrclient9strsafety.trThetrothertractionstraretrimporta
nttrfortrqualitytrnursing,trbuttrtheytraretrnottrastrvitaltrastrprovidingtrsafety.trNottrmakingtrmedicationtrer
rorstrdoestrprovidetrsafety,trbuttristrtootrnarrowtrintrscopetrtotrbetrthetrbesttranswer.
DIF: Understanding
TOP:t r IntegratedtrProcess:trNursingtrProcess:trInterventiontrKEY:trClienttrsafety
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trSafetytrandtrInfectiontrControl
2. Atrnursetristrorientingtratrnewtrclienttrandtrfamilytrtotrthetrmedical-
surgicaltrunit.trWhattrinformationtrdoestrthetrnursetrprovidetrtotrbesttrhelptrthetrclienttrpromotetrhis
trortrhertrowntrsafety?
a. Encouragetrthetrclienttrandtrfamilytrtotrbetractivetrpartners.
b. Havetrthetrclienttrmonitortrhandtrhygienetrintrcaregivers.
c. Offertrthetrfamilytrthetropportunitytrtotrstaytrwithtrthetrclient.
d. Telltrthetrclienttrtotralwaystrweartrhistrortrhertrarmband.
ANS:t r A
Eachtractiontrcouldtrbetrimportanttrfortrthetrclienttrortrfamilytrtotrperform.trHowever,trencouragingtrth
etrclienttrtotrbetractivetrintrhistrortrhertrhealthtrcaretrastratrsafetytrpartnertristrthetrmosttrcritical.trThetrothe
rtractionstraretrverytrlimitedtrintrscopetrandtrdotrnottrprovidetrthetrbroadtrprotectiontrthattrbeingtractivetra
ndtrinvolvedtrdoes.
DIF: Understanding
TOP:trIntegratedtrProcess:trTeaching/LearningtrKEY:trClienttrsafety
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trSafetytrandtrInfectiontrControl
3. Atrnursetristrcaringtrfortratrpostoperativetrclienttrontrthetrsurgicaltrunit.trThetrclient9strbloodtrpressur
etrwastr142/76trmmtrHgtr30trminutestrago,trandtrnowtristr88/50trmmtrHg.trWhattractiontrwouldtrthetrn
ursetrtaketrfirst?
a. CalltrthetrRapidtrResponsetrTeam.
b. Documenttrandtrcontinuetrtotrmonitor.
c. Notifytrthetrprimarytrhealthtrcaretrprovider.
d. Repeattrthetrbloodtrpressuretrintr15trminutes.
, tr
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ANS:t r A
ThetrpurposetroftrthetrRapidtrResponsetrTeamtr(RRT)tristrtotrintervenetrwhentrclientstraretrdeterioratin
gtrbeforetrtheytrsuffertreithertrrespiratorytrortrcardiactrarrest.trSincetrthetrclienttrhastrmanifestedtratrsig
nificanttrchange,trthetrnursetrwouldtrcalltrthetrRRT.trChangestrintrbloodtrpressure,trmentaltrstatus,trhe
arttrrate,trtemperature,troxygentrsaturation,trandtrlasttr2trhours9trurinetroutputtraretrparticularlytrsigni
ficanttrandtraretrparttroftrthetrModifiedtrEarlytrWarningtrSystemtrguide.trDocumentationtristrvital,trbu
ttrthetrnursetrmusttrdotrmoretrthantrdocument.trThetrprimarytrhealthtrcaretrprovidertrwouldtrbetrnotifie
d,trbuttrthistristrnottrmoretrimportanttrthantrcallingtrthetrRRT.trThetrclient9strbloodtrpressuretrwouldtrb
etrreassessedtrfrequently,trbuttrthetrprioritytristrgettingtrthetrrapidtrcaretrtotrthetrclient.
DIF: Applying
TOP:t r IntegratedtrProcess:trCommunicationtrandtrDocumentationtrKEY:trRapidtr
ResponsetrTeamtr(RRT),trClinicaltrjudgment
MSC:t r ClienttrNeedstrCategory:trPhysiologicaltrIntegrity:trPhysiologicaltrAdaptation
4. Atrnursetrwishestrtotrprovidetrclient-centeredtrcaretrintralltrinteractions.trWhichtractiontrbytrthetrnurse
besttrdemonstratestrthistrconcept?
a. Assessestrfortrculturaltrinfluencestraffectingtrhealthtrcare.
b. Ensurestrthattralltrthetrclient9strbasictrneedstraretrmet.
c. Tellstrthetrclienttrandtrfamilytrabouttralltrupcomingtrtests.
d. Thoroughlytrorientstrthetrclienttrandtrfamilytrtotrthetrroom.
ANS:t r A
Showingtrrespecttrfortrthetrclienttrandtrfamily9strpreferencestrandtrneedstristressentialtrtotrensuretratrh
olistictrortr<whole-
person=trapproachtrtotrcare.trBytrassessingtrthetreffecttroftrthetrclient9strculturetrontrhealthtrcare,trthistrn
ursetristrpracticingtrclient-
focusedtrcare.trProvidingtrfortrbasictrneedstrdoestrnottrdemonstratetrthistrcompetence.trSimplytrtellin
gtrthetrclienttrabouttralltrupcomingtrteststristrnottrprovidingtrempoweringtreducation.trOrientingtrthetrc
lienttrandtrfamilytrtotrthetrroomtristrantrimportanttrsafetytrmeasure,trbuttrnottrdirectlytrrelatedtrtotrdemo
nstratingtrclient-centeredtrcare.
DIF: Understanding
TOP:trIntegratedtrProcess:trCulturetrandtrSpiritualitytrKEY:t r Client-centeredtrcare,trCulture
MSC:t r ClienttrNeedstrCategory:trPsychosocialtrIntegrity
5. Atrclienttristrgoingtrtotrbetradmittedtrfortratrscheduledtrsurgicaltrprocedure.trWhichtractiontrdoestrth
etrnursetrexplaintristrthetrmosttrimportanttrthingtrthetrclienttrcantrdotrtotrprotecttragainsttrerrors?
a. Bringtratrlisttroftralltrmedicationstrandtrwhattrtheytraretrfor.
b. Keeptrthetrprovider9strphonetrnumbertrbytrthetrtelephone.
c. Maketrsuretrthattralltrproviderstrwashtrhandstrbeforetrenteringtrthetrroom.
d. Writetrdowntrthetrnametroftreachtrcaregivertrwhotr comestrintrthetrroom.
ANS:t r A
Medicationtrreconciliationtristratrformaltrprocesstrintrwhichtrthetrclient9stractualtrcurrenttrmedicationstr
aretrcomparedtrtotrthetrprescribedtrmedicationstrattrthetrtimetroftradmission,trtransfer,trortrdischarge.tr
ThistrNationaltrclienttrSafetytrGoaltristrimportanttrtotrreducetrmedicationtrerrors.trThetrclienttrwouldtr
nottrhavetrtotrbetrresponsibletrfortrproviderstrwashingtrtheirtrhands,trandtreventriftrthetrclienttrdoestrso,t
rthistristrtootrnarrowtrtotrbetrthetrmosttrimportanttractiontrtotrpreventtrerrors.trKeepingtrthetrprovider9st
rphonetrnumbertrnearbytrandtrdocumentingtreveryonetrwhotrenterstrthetrroomtralsotrdotrnottrguarante
etrsafety.
DIF: Applying
TOP:t r IntegratedtrProcess:trTeaching/LearningtrKEY:trClienttr
safety,trInformatics
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trSafetytrandtrInfectiontrControl
, tr
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6. Whichtractiontrbytrthetrnursetrworkingtrwithtratrclienttrbesttrdemonstratestrrespecttrfortrautonomy?
a. Askstriftrthetrclienttrhastrquestionstrbeforetrsigningtratrconsent.
b. Givestrthetrclienttraccuratetrinformationtrwhentrquestioned.
c. Keepstrthetrpromisestrmadetrtotrthetrclienttrandtrfamily.
d. Treatstrthetrclienttrfairlytrcomparedtrtotrothertrclients.
ANS:t r A
Autonomytristrself-
determination.trThetrclienttrwouldtrmaketrdecisionstrregardingtrcare.trWhentrthetrnursetrobtainstratrsig
naturetrontrthetrconsenttrform,trassessingtriftrthetrclienttrstilltrhastrquestionstristrvital,trbecausetrwithouttrf
ulltrinformationtrthetrclienttrcannottrpracticetrautonomy.trGivingtraccuratetrinformationtristrpracticin
gtrwithtrveracity.trKeepingtrpromisestristrupholdingtrfidelity.trTreatingtrthetrclienttrfairlytristrprovidin
gtrsocialtrjustice.
DIF: Applying TOP:t r IntegratedtrProcess:trCaring
KEY:trEthics,trAutonomytrMSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrE
nvironment:trManagementtroftrCare
7. Atrnursetraskstratrmoretrseasonedtrcolleaguetrtotrexplaintrbesttrpracticestrwhentrcommunicatingtrwithtr
atrpersontrfromtrthetrlesbian,trgay,trbisexual,trtransgender,trandtrquestioning/queertr(LGBTQ)trcom
munity.trWhattranswertrbytrthetrfacultytristrmosttraccurate?
a. Avoidtrembarrassingtrthetrclienttrbytraskingtrquestions.
b. Don9ttrmaketrassumptionstrabouttrhistrortrhertrhealthtrneeds.
c. MosttrLGBTQtrpeopletrdotrnottrwanttrtotrsharetrinformation.
d. Notrdifferencestrexisttr intrcommunicatingtrwithtrthistrpopulation.
ANS:t r B
ManytrmemberstroftrthetrLGBTQtrcommunitytrhavetrfacedtrdiscriminationtrfromtrhealthtrcaretrprovi
derstrandtrmaytrbetrreluctanttrtotrseektrhealthtrcare.trThetrnursetrwouldtrnevertrmaketrassumptionstrabo
uttrthetrneedstroftrmemberstroftrthistrpopulation.trRather,trrespectfultrquestionstraretrappropriate.trIftrap
proachedtrwithtrsensitivity,trthetrclienttrwithtranytrhealthtrcaretrneedtristrmoretrlikelytrtotranswertrhones
tly.
DIF: Understanding TOP:t r IntegratedtrProcess:trTeaching/Learning
KEY:t r Healthtrcaretrdisparities,trLGBTQ MSC:t r ClienttrNeedstrCategory:trPsychosocialtrIntegrity
8. Atrnursetristrcallingtrthetron-
calltrhealthtrcaretrprovidertrabouttratrclienttrwhotrhadtratrhysterectomytr2trdaystragotrandtrhastrpaintr
thattristrunrelievedtrbytrthetrprescribedtropioidtrpaintrmedication.trWhichtrstatementtrcomprisestr
thetrbackgroundtrportiontroftrthetrSBARtrformattrfortrcommunication?
a. <Itrwouldtrliketryoutrtotrordertratrdifferenttrpaintrmedication.=
b. <Thistrclienttrhastrallergiestrtotrmorphinetrandtrcodeine.=
c. <Dr.tr Smithtr doesn9ttr liketr nonsteroidaltr anti-inflammatorytrmeds.=
d. <Thistrclienttrhadtratrvaginaltrhysterectomytr2trdaystrago.=
ANS:t r B
, tr
lOMoARcPSD| 240 05
tr
9 64
SBARtristratrrecommendedtrformtroftrcommunication,trandtrthetracronymtrstandstrfortrSituation,trBa
ckground,trAssessment,trandtrRecommendation.trAppropriatetrbackgroundtrinformationtrincludestr
allergiestrtotrmedicationstrthetron-
calltrhealthtrcaretrprovidertrmighttrorder.trSituationtrdescribestrwhattristrhappeningtrrighttrnowtrthattrm
usttrbetrcommunicated;trthetrclient9strsurgerytr2trdaystragotrwouldtrbetrconsideredtrbackground.trAsse
ssmenttrwouldtrincludetrantranalysistroftrthetrclient9strproblem;trnonetroftrthetroptionstrhastrassessme
nttrinformation.trAskingtrfortratrdifferenttrpaintrmedicationtristratrrecommendation.trRecommendati
ontristratrstatementtroftrwhattristrneededtrortrwhattroutcometristrdesired.
DIF: Applying
TOP:t r IntegratedtrProcess:trCommunicationtrandtrDocumentationtrKEY:trTeam
worktrandtrcollaboration,trSBAR
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trManagementtroftrCare
9. Atrnursetrworkingtrontratrcardiactrunittrdelegatedtrtakingtrvitaltrsignstrtotrantrexperiencedtrassistivetrp
ersonneltr(AP).trFourtrhourstrlater,trthetrnursetrnotestrthattrthetrclient9strbloodtrpressuretrtakentrbytrthe
trAPtrwastrmuchtrhighertrthantrprevioustrreadings,trandtrthetrclient9strmentaltrstatustrhastrchanged.trWh
attractiontrbytrthetrnursetrwouldtrmosttrlikelytrhavetrpreventedtrthistrnegativetroutcome?
a. DeterminingtriftrthetrAPtrknewtrhowtrtotrtaketrbloodtrpressure
b. Double-checkingtrthetrAPtrbytrtakingtranothertrbloodtrpressure
c. ProvidingtrmoretrappropriatetrsupervisiontroftrthetrAP
d. Takingtrthetrbloodtrpressuretrinsteadtroftrdelegatingtrthetrtask
ANS:t r C
Supervisiontristronetroftrthetrfivetrrightstroftrdelegationtrandtrincludestrdirecting,trevaluating,trandtrfo
llowingtruptrontrdelegatedtrtasks.trThetrnursetrwouldtreithertrhavetraskedtrthetrAPtrabouttrthetrvitaltrsig
nstrortrinstructedtrthetrAPtrtotrreporttrthemtrrighttraway.trAntrexperiencedtrAPtrwouldtrknowtrhowtrtotrt
aketrvitaltrsignstrandtrthetrnursetrwouldtrnottrhavetrtotrassesstrthistrattrthistrpoint.trDouble-
checkingtrthetrworktrdefeatstrthetrpurposetroftrdelegation.trVitaltrsignstraretrwithintrthetrscopetroftrpra
cticetrfortratrAPtrandtraretrpermissibletrtotrdelegate.trThetronlytrappropriatetranswertristrthattrthetrnursetr
didtrnottrprovidetradequatetrinstructiontrtotrthetrAP.
DIF: Analyzing
TOP:t r IntegratedtrProcess:trCommunicationtrandtrDocumentationtrKEY:trTeam
worktrandtrcollaboration,trDelegation
MSC:t r ClienttrNeedstrCategory:trSafetrandtrEffectivetrCaretrEnvironment:trManagementtroftrCare
10. Atrnewlytrgraduatedtrnursetrintrthetrhospitaltrstatestrthattrbecausetroftrbeingtrsotrnew,trparticipationtri
ntrqualitytrimprovementtr(QI)trprojectstristrnottrwise.trWhattrresponsetrbytrthetrpreceptingtrnursetristrbe
st?
a. <Alltrstafftrnursestraretrrequiredtrtotrparticipatetrintrqualitytrimprovementtrhere.=
b. <Eventrbeingtrnew,tryoutrcantrimplementtractivitiestrdesignedtrtotrimprovetrcare.=
c. <It9streasytrtotridentifytrwhattrindicatorstrwouldtrbetrusedtrtotrmeasuretrquality.=
d. <Youtrshouldtrasktrtotrbetrassignedtrtotrthetrresearchtrandtrqualitytrcommittee.=
ANS:t r B
ThetrpreceptortrwouldtrtrytrtotrreassuretrthetrnursetrthattrimplementingtrQItrmeasurestristrnottrouttroftrli
netrfortratrnewlytrlicensedtrnurse.trSimplytrstatingtrthattralltrnursestraretrrequiredtrtotrparticipatetrdoestr
nottrhelptrthetrnursetrunderstandtrhowtrthattristrpossibletrandtristrdismissive.trIdentifyingtrindicatorstro
ftrqualitytristrnottrantreasy,trquicktrprocesstrandtrwouldtrnottrbetrthetrbesttrplacetrtotrsuggesttratrnewtrnurs
etrtotrstart.trAskingtrtotrbetrassignedtrtotrthetrQItrcommitteetrdoestrnottrgivetrthetrnursetrinformationtrab
outtrhowtrtotrimplementtrQItrintrdailytrpractice.
DIF: Applying TOP:t r IntegratedtrProcess:trCommunicationtrandtrDocumentation
