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Chapter 01: Overview of Professional Nursing Concepts for Medical-Surgical
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Nursing Ignatavicius: Medical-Surgical Nursing, 10th Edition
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MULTIPLE CHOICE gf
1. A new nurse is working with a preceptor on a medical-
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surgicalVunit.VTheVpreceptor advises the new nurse that which is the priority
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whenVworkingVasVaVprofessionalVnurse?
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a. Attending to holistic client needs gf g f g f g f
b. Ensuring client safety gf g f
c. Not making medication errors g f gf gf
d. Providing client-focused care gf g f
ANS: g f B
All actions are appropriate for the professional nurse.
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However,VensuringVclientVsafetyVis the priority. Health care errors have been
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widely reportedVforV25Vyears,VmanyVofVwhich result in client injury, death, and
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increased health careVcosts.VThereVareVseveralVnational and international organizations
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that have eitherVrecommendedVorVmandatedVsafety initiatives.
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Every nurse has the responsibility to Vguard the client‘s Vsafety. VThe Vother Vactions Vare
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important for quality nursing, but they are Vnot Vas vital Vas Vproviding Vsafety. VNot
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Vmaking medication
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the best answer.
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DIF: Understanding TOP: Integrated Process: Nursing g f gf gf
Process: Intervention KEY: Client safety
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MSC: Client Needs Category:VSafeVandVEffective Care Environment: Safety and Infection Control
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2. A nurse is orientingVaVnewVclient and family to the medical-surgical unit.
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What information does the nurseVprovide to best help the client promote
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his or her own safety?
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a. Encourage theVclientVand family to be active partners. gf gf gf g f gf g f g f g f
b. Have theVclientVmonitor hand hygiene in caregivers.
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c. OfferVtheVfamily the opportunity to stay with the client. gf gf g f gf g f gf g f g f
d. Tell theVclient to always wear his or her armband.
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ANS: V A gf gf
EachVaction could be important for the client or family to perform. However,
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encouraging the client to be active in his or her health care as a safety
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partner is the most critical. The other actions are very limited in scope and
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do not provide the broad protection that being active and involved does.
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DIF: Understanding TOP: Integrated Process: gf gf
Teaching/Learning KEY: Client safety
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, MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
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Control
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3. A nurse is caring for a postoperative client on the surgical unit. The
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client‘s blood pressure was 142/76 mm Hg 30 minutes ago, and now is
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88/50 mm Hg. What action would the nurse take first?
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a. Call the Rapid Response Team.
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b. Document and continue to monitor. g f g f g f g f
c. Notify the primary health care provider.
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d. Repeat the blood pressure in 15 minutes.
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,Test bank Medical-Surgical Nursing Concepts for Interprofessional Collaborative Care
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10th
ANS: g f A
The purpose of the Rapid Response Team (RRT) is to intervene when clients
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are deteriorating before they suffer either respiratory or cardiac arrest. Since
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the client has manifested a significant change, the nurse would call the
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RRT. Changes in blood pressure, mental status, heart rate, temperature,
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oxygen saturation, and last 2 hours‘ urine output are particularly significant
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and are part of the Modified Early Warning System guide. Documentation is
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vital, but the nurse must do more than document. The primary health care
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provider would be notified, but this is not more important than calling the
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RRT. The client‘s blood pressure would be reassessed frequently, but the
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priority is getting the rapid care to the client.
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DIF: Applying TOP: Integrated Process: Communication and g f gf gf gf
Documentation KEY: Rapid Response Team (RRT), Clinical
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judgment
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MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
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4. A nurse wishes to provide client-centered care in all interactions. Which action by the
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nurse
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best demonstrates this concept?
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a. Assesses for cultural influences affecting health care. gf g f gf g f gf g f
b. Ensures that all the client‘s basic needs are met. gf g f g f g f g f gf g f g f
c. Tells the client and family about all upcoming tests.
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d. Thoroughly orients the client and family to the room. gf g f g f g f g f gf g f g f
ANS: g f A
Showing respect for the client and family‘s preferences and needs is essential
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to ensure a holistic or ―whole-person‖ approach to care. By assessing the
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effect of the client‘s culture on health care, this nurse is practicing client-
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focused care. Providing for basic needs does not demonstrate this competence.
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Simply telling the client about all upcoming tests is not providing
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empowering education. Orienting the client and family to the room is an
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important safety measure, but not directly related to demonstrating client-
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centered care. g f
DIF: Understanding TOP: Integrated Process: Culture and gf g f g f g f g f
Spirituality KEY: Client-centered care, Culture MSC: Client Needs Category:
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Psychosocial Integrity
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5. A client is going to be admitted for a scheduled surgical procedure.
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Which action does the nurse explain is the most important thing the
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client can do to protect against errors?
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a. Bring a list of all medications and what they are for.
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b. Keep the provider‘s phone number by the telephone.
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c. Make sure that all providers wash hands before entering the room.
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d. Write down the name of each caregiver who comes in the room.
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ANS: g f A
Medication reconciliation is a formal process in which the client‘s actual current
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medications are compared to the prescribed medications at the time of
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admission, transfer, or discharge. This National client Safety Goal is important
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to reduce medication errors. The client would not have to be responsible for
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providers washing their hands, and even if the client does so, this is too
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narrow to be the most important action to prevent errors. Keeping the
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provider‘s phone number nearby and documenting everyone who enters the
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room also do not guarantee safety.
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DIF: Applying TOP: Integrated Process: g f gf
Teaching/Learning KEY: Client safety, Informatics g f g f g f g f
, Test bank Medical-Surgical Nursing Concepts for Interprofessional Collaborative Care
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10th MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
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Control
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