Test Bank for Medical-
b b b
Surgical Nursing Critical Thinking in Client Care, 4t
b b b b b b b
h Edition Priscilla LeMon
b b b
Chapter 1 b
1. Thebnursebisbcaringbforbfourbclientsbonbabmedical–
surgicalbunit.bWhichbclientbshouldbthebnursebseebinitially?
1. AbclientbadmittedbwithbhepatitisbAbwhobhasbhadbseverebdiarrheabforbtheblastb2
4bhours
2. Abclientbadmittedbwithbpneumoniabwhobisbhasbsmallbamountsbofbyellowb
productivebsputum
3. Abclientbadmittedbwithbfeverbofbunknownboriginb(FUO)bwhobhasbbeenb
withoutbfeverbforbtheblastb48bhours
4. AbclientbadmittedbwithbabwoundbinfectionbwhosebWBCbisb8,500bmm3
Answer:b1
Rationale:bThebnursebmustbdecidebwhichbclientbshouldbbebseenbonbthebinitialbroundsbofbthebd
ay.bThebnursebmustbrememberbthatbthebfirstbclientbtobbebseenbshouldbbebthebclientbwh
obneedsbthebattentionbofbthebnursebinitially.bAbclientbwithbhepatitisbAbdoesbexperienc
ebdiarrhea,bbutbdiarrheabforbtheblastb24bhoursbcouldbcausebthebclientbtobhavebabproble
mbwithbdehydrationbandbexperiencebabstatebofbfluidbvolumebdeficit.
CognitivebLevel:bApplication
ClientbNeeds:bSafe,bEffectivebCarebEnvironmentbNurs
ingbProcess:bPlanning
2. Thebnursebisbpreparingbtobadministerbinfluenzabvaccinesbtobabmassbdrive-
throughbclinic.bWhichbstatementbbybabclientbwouldbindicatebfurtherbquestioningbpriorbtobgiv
ingbthebclientbthebinfluenzabvaccine?
1. “Ibamballergicbtobhorsebhair.”
2. “Ibtrybtobgetbmybvaccinebeverybyear.”
3. “Ibambnotballergicbtobanythingbexceptbeggs.”
4. “Mybhusbandbhadbabsevereballergicbreactionbafterbhebreceivedbhisbinfluenzab
vaccine.”
Answer:b3
Rationale:bInfluenzabvaccinesbarebrecommendedbforbpersonbatbhighbriskbforbseriousbsequela
ebofbinfluenza.bThebnursebshouldbbebawarebthatbclientbwithbabsensitivitybtobeggsbshou
ldbnotbreceivebthebvaccine.bVaccinesbpreparedbfrombchickenborbduckbembryosbarebc
ontraindicatedbinbclientsbwhobareballergicbtobeggs.
,Test Bank for Medical-
b b b
Surgical Nursing Critical Thinking in Client Care, 4t
b b b b b b b
h Edition Priscilla LeMon
b b b
CognitivebLevel:bApplication
ClientbNeeds:bSafe,bEffectivebCarebEnvironmentbNurs
ingbProcess:bAssessment
3. Thebnursebisbcaringbforbfourbclientsbonbabmedical–
surgicalbunit.bThebsecretarybgivesbthebnursebthebmorningblabs.bWhichbofbthebfollowingblabsb
wouldbrequirebthatbthebnursebcallbthebphysicianbandbinformbthebhealthcarebproviderbaboutbth
ebclient’sbabnormalities?
1. WBCb14,600bmm3
2. Serumbproteinb6.9bg/dL
3. Ib&bDb(incisionbandbdrainage)bshowingbnobgrowthbforbtheblastb24bhours
4. Albuminb4.2bg/dL
Answer:b1
Rationale:bWhenbthebnursebisbcaringbforbseveralbclients,ballbofbtheblabsbshouldbbebcheckedbfreq
uentlybthroughoutbthebshiftbtobassessbforbanybabnormalities.bThebWBCbinboptionb1bisbabnorm
al.b(NormalbWBCb4,000–
10,000bmm3.)bAllbofbthebotherblabbresultsbarebwithinbacceptablebrange;btherefore,bthebresultsbs
houldbnotbbebcalledbinbtobthebphysician.
CognitivebLevel:bApplicationbClien
tbNeeds:bPhysiologicbIntegritybNursi
ngbProcess:bAssessment
4. Thebnursebisborientingbabnewbgraduate.bThebnursebisbreinforcingbthebimportancebofbsta
ndardbprecautions.bWhichbofbthebfollowingbobservationsbbybthebnursebwouldbrequirebfurt
herbeducationbregardingbstandardbprecautions?
1. Thebgraduatebnursebunderstandsbtobwashbhandsbwhenbenteringbandbexitingbt
hebclient’sbroom.
2. Thebgraduatebnursebwearsbglovesbwhenbservingbbreakfastbtraysbtobvariousb
clients.
3. Thebgraduatebnursebwearsbabgown,bgloves,bandbgogglesbwhenbsuctioningbab
client.
4. Thebgraduatebnursebleavesballbsuppliesbinbthebroombofbabclientbwhobisbinbc
ontactbisolation.
Answer:b2
Rationale:bThebnursebmustbhavebanbunderstandingbofbstandardbprecautions.bPreventionbisbth
ebmostbimportantbmeasurebtobpreventbnosocomialbinfections.bStandardbprecautionsb
downloadbfullbfilebatbhttp://testbankinstant.com
,werebpublishedbinb1996bthatbprovidebguidelinesbforbthebhandlingbof
downloadbfullbfilebatbhttp://testbankinstant.com
, bloodbandbotherbbodybfluids.bThesebguidelinesbarebusedbwithballbclients,bregardlessbo
fbwhetherbtheybhavebabknownbinfectiousbdisease.bStandardbprecautionsbarebusedbbyb
allbhealthcarebworkersbwhobhavebdirectbcontactbwithbclientsborbwithbtheirbbodybfluid
s.bItbisbnotbnecessarybforbthebnursebtobwearbglovesbwhilebdeliveringbfoodbtraysbtobtheb
client,bbecausebtherebisbnotbcontactbwithbthebclient.
CognitivebLevel:bApplication
ClientbNeeds:bSafe,bEffectivebCarebEnvironmentbNurs
ingbProcess:bEvaluation
5. Thebadmittingbdepartmentbalertsbthebnursebonbabmedical–
surgicalbunitbthatbabclientbwithbactivebtuberculosisb(TB)bisbbeingbadmittedbtobthebunit.bWhic
hbtypebofbisolationbisbappropriatebbasedbonbthebclient’sbdiagnosis?
1. Standardbprecautions
2. Airbornebprecautions
3. Dropletbprecautions
4. Contactbprecautions
Answer:b2
Inbadditionbtobhandwashingbandbstandardbprecautions,bthebnaturebandbspreadbofbsomebinfect
iousbdiseasesbrequirebthatbspecialbtechniquesbbebusedbtobprotectbuninfectedbclientsbandbwork
ers.bThebclientbwithbpulmonarybtuberculosisbwillbbebplacedbinbairbornebprecautions.bThebcli
entbshouldbbebplacedbinbabprivatebroombwithbspecialbventilationbthatbdoesbnotballowbairbtobcir
culatebtobgeneralbhospitalbventilation;babmaskborbspecialbfilterbrespiratorsbwillbbebusedbforbe
veryonebenteringbthebroom.
CognitivebLevel:bApplication
ClientbNeeds:bSafe,bEffectivebCarebEnvironmentbNurs
ingbProcess:bAssessment
6. AbclientbisbreceivingbIVbvancomycinbforbthebtreatmentbofbClostridiumbdifficile.bThebn
ursebunderstandsbthatbthebclientbwhobdevelopsbflushing,btachycardia,bandbhypotensionbd
uringbthebinfusionbofbvancomycinbindicates:
1. Ototoxicitybeffect.
2. Superinfection.
3. Redbmanbsyndrome.
4. Hives.
Answer:b3
downloadbfullbfilebatbhttp://testbankinstant.com
b b b
Surgical Nursing Critical Thinking in Client Care, 4t
b b b b b b b
h Edition Priscilla LeMon
b b b
Chapter 1 b
1. Thebnursebisbcaringbforbfourbclientsbonbabmedical–
surgicalbunit.bWhichbclientbshouldbthebnursebseebinitially?
1. AbclientbadmittedbwithbhepatitisbAbwhobhasbhadbseverebdiarrheabforbtheblastb2
4bhours
2. Abclientbadmittedbwithbpneumoniabwhobisbhasbsmallbamountsbofbyellowb
productivebsputum
3. Abclientbadmittedbwithbfeverbofbunknownboriginb(FUO)bwhobhasbbeenb
withoutbfeverbforbtheblastb48bhours
4. AbclientbadmittedbwithbabwoundbinfectionbwhosebWBCbisb8,500bmm3
Answer:b1
Rationale:bThebnursebmustbdecidebwhichbclientbshouldbbebseenbonbthebinitialbroundsbofbthebd
ay.bThebnursebmustbrememberbthatbthebfirstbclientbtobbebseenbshouldbbebthebclientbwh
obneedsbthebattentionbofbthebnursebinitially.bAbclientbwithbhepatitisbAbdoesbexperienc
ebdiarrhea,bbutbdiarrheabforbtheblastb24bhoursbcouldbcausebthebclientbtobhavebabproble
mbwithbdehydrationbandbexperiencebabstatebofbfluidbvolumebdeficit.
CognitivebLevel:bApplication
ClientbNeeds:bSafe,bEffectivebCarebEnvironmentbNurs
ingbProcess:bPlanning
2. Thebnursebisbpreparingbtobadministerbinfluenzabvaccinesbtobabmassbdrive-
throughbclinic.bWhichbstatementbbybabclientbwouldbindicatebfurtherbquestioningbpriorbtobgiv
ingbthebclientbthebinfluenzabvaccine?
1. “Ibamballergicbtobhorsebhair.”
2. “Ibtrybtobgetbmybvaccinebeverybyear.”
3. “Ibambnotballergicbtobanythingbexceptbeggs.”
4. “Mybhusbandbhadbabsevereballergicbreactionbafterbhebreceivedbhisbinfluenzab
vaccine.”
Answer:b3
Rationale:bInfluenzabvaccinesbarebrecommendedbforbpersonbatbhighbriskbforbseriousbsequela
ebofbinfluenza.bThebnursebshouldbbebawarebthatbclientbwithbabsensitivitybtobeggsbshou
ldbnotbreceivebthebvaccine.bVaccinesbpreparedbfrombchickenborbduckbembryosbarebc
ontraindicatedbinbclientsbwhobareballergicbtobeggs.
,Test Bank for Medical-
b b b
Surgical Nursing Critical Thinking in Client Care, 4t
b b b b b b b
h Edition Priscilla LeMon
b b b
CognitivebLevel:bApplication
ClientbNeeds:bSafe,bEffectivebCarebEnvironmentbNurs
ingbProcess:bAssessment
3. Thebnursebisbcaringbforbfourbclientsbonbabmedical–
surgicalbunit.bThebsecretarybgivesbthebnursebthebmorningblabs.bWhichbofbthebfollowingblabsb
wouldbrequirebthatbthebnursebcallbthebphysicianbandbinformbthebhealthcarebproviderbaboutbth
ebclient’sbabnormalities?
1. WBCb14,600bmm3
2. Serumbproteinb6.9bg/dL
3. Ib&bDb(incisionbandbdrainage)bshowingbnobgrowthbforbtheblastb24bhours
4. Albuminb4.2bg/dL
Answer:b1
Rationale:bWhenbthebnursebisbcaringbforbseveralbclients,ballbofbtheblabsbshouldbbebcheckedbfreq
uentlybthroughoutbthebshiftbtobassessbforbanybabnormalities.bThebWBCbinboptionb1bisbabnorm
al.b(NormalbWBCb4,000–
10,000bmm3.)bAllbofbthebotherblabbresultsbarebwithinbacceptablebrange;btherefore,bthebresultsbs
houldbnotbbebcalledbinbtobthebphysician.
CognitivebLevel:bApplicationbClien
tbNeeds:bPhysiologicbIntegritybNursi
ngbProcess:bAssessment
4. Thebnursebisborientingbabnewbgraduate.bThebnursebisbreinforcingbthebimportancebofbsta
ndardbprecautions.bWhichbofbthebfollowingbobservationsbbybthebnursebwouldbrequirebfurt
herbeducationbregardingbstandardbprecautions?
1. Thebgraduatebnursebunderstandsbtobwashbhandsbwhenbenteringbandbexitingbt
hebclient’sbroom.
2. Thebgraduatebnursebwearsbglovesbwhenbservingbbreakfastbtraysbtobvariousb
clients.
3. Thebgraduatebnursebwearsbabgown,bgloves,bandbgogglesbwhenbsuctioningbab
client.
4. Thebgraduatebnursebleavesballbsuppliesbinbthebroombofbabclientbwhobisbinbc
ontactbisolation.
Answer:b2
Rationale:bThebnursebmustbhavebanbunderstandingbofbstandardbprecautions.bPreventionbisbth
ebmostbimportantbmeasurebtobpreventbnosocomialbinfections.bStandardbprecautionsb
downloadbfullbfilebatbhttp://testbankinstant.com
,werebpublishedbinb1996bthatbprovidebguidelinesbforbthebhandlingbof
downloadbfullbfilebatbhttp://testbankinstant.com
, bloodbandbotherbbodybfluids.bThesebguidelinesbarebusedbwithballbclients,bregardlessbo
fbwhetherbtheybhavebabknownbinfectiousbdisease.bStandardbprecautionsbarebusedbbyb
allbhealthcarebworkersbwhobhavebdirectbcontactbwithbclientsborbwithbtheirbbodybfluid
s.bItbisbnotbnecessarybforbthebnursebtobwearbglovesbwhilebdeliveringbfoodbtraysbtobtheb
client,bbecausebtherebisbnotbcontactbwithbthebclient.
CognitivebLevel:bApplication
ClientbNeeds:bSafe,bEffectivebCarebEnvironmentbNurs
ingbProcess:bEvaluation
5. Thebadmittingbdepartmentbalertsbthebnursebonbabmedical–
surgicalbunitbthatbabclientbwithbactivebtuberculosisb(TB)bisbbeingbadmittedbtobthebunit.bWhic
hbtypebofbisolationbisbappropriatebbasedbonbthebclient’sbdiagnosis?
1. Standardbprecautions
2. Airbornebprecautions
3. Dropletbprecautions
4. Contactbprecautions
Answer:b2
Inbadditionbtobhandwashingbandbstandardbprecautions,bthebnaturebandbspreadbofbsomebinfect
iousbdiseasesbrequirebthatbspecialbtechniquesbbebusedbtobprotectbuninfectedbclientsbandbwork
ers.bThebclientbwithbpulmonarybtuberculosisbwillbbebplacedbinbairbornebprecautions.bThebcli
entbshouldbbebplacedbinbabprivatebroombwithbspecialbventilationbthatbdoesbnotballowbairbtobcir
culatebtobgeneralbhospitalbventilation;babmaskborbspecialbfilterbrespiratorsbwillbbebusedbforbe
veryonebenteringbthebroom.
CognitivebLevel:bApplication
ClientbNeeds:bSafe,bEffectivebCarebEnvironmentbNurs
ingbProcess:bAssessment
6. AbclientbisbreceivingbIVbvancomycinbforbthebtreatmentbofbClostridiumbdifficile.bThebn
ursebunderstandsbthatbthebclientbwhobdevelopsbflushing,btachycardia,bandbhypotensionbd
uringbthebinfusionbofbvancomycinbindicates:
1. Ototoxicitybeffect.
2. Superinfection.
3. Redbmanbsyndrome.
4. Hives.
Answer:b3
downloadbfullbfilebatbhttp://testbankinstant.com
