Test Bank for Understanding Medical-
; ; ; ;
Surgical Nursing 6th Edition Linda S. Williams P
; ; ; ; ; ; ;
aula D. Hopper ; ;
;
, Test Bank for Understanding Medical-
; ; ; ;
Surgical Nursing 6th Edition Linda S. Williams P
; ; ; ; ; ; ;
aula D. Hopper ; ;
Chapter;1
1. The;nurse;is;caring;for;four;clients;on;a;medical–
surgical;unit.;Which;client;should;the;nurse;see;initially?
1. A;client;admitted;with;hepatitis;A;who;has;had;severe;diarrhea;for;the;last;24;
hours
2. A;client;admitted;with;pneumonia;who;is;has;small;amounts;of;yellow;pr
oductive;sputum
3. A;client;admitted;with;fever;of;unknown;origin;(FUO);who;has;been;w
ithout;fever;for;the;last;48;hours
4. A;client;admitted;with;a;wound;infection;whose;WBC;is;8,500;mm3
Answer:;1
Rationale:;The;nurse;must;decide;which;client;should;be;seen;on;the;initial;rounds;of;the;day.
;The;nurse;must;remember;that;the;first;client;to;be;seen;should;be;the;client;who;nee
ds;the;attention;of;the;nurse;initially.;A;client;with;hepatitis;A;does;experience;diarr
hea,;but;diarrhea;for;the;last;24;hours;could;cause;the;client;to;have;a;problem;with;d
ehydration;and;experience;a;state;of;fluid;volume;deficit.
Cognitive;Level:;Application
Client;Needs:;Safe,;Effective;Care;Environment;Nursi
ng;Process:;Planning
2. The;nurse;is;preparing;to;administer;influenza;vaccines;to;a;mass;drive-
through;clinic.;Which;statement;by;a;client;would;indicate;further;questioning;prior;to;givi
ng;the;client;the;influenza;vaccine?
1. ―I;am;allergic;to;horse;hair.‖
2. ―I;try;to;get;my;vaccine;every;year.‖
3. ―I;am;not;allergic;to;anything;except;eggs.‖
4. ―My;husband;had;a;severe;allergic;reaction;after;he;received;his;influenza;va
ccine.‖
Answer:;3
Rationale:;Influenza;vaccines;are;recommended;for;person;at;high;risk;for;serious;sequelae;
of;influenza.;The;nurse;should;be;aware;that;client;with;a;sensitivity;to;eggs;should;n
ot;receive;the;vaccine.;Vaccines;prepared;from;chicken;or;duck;embryos;are;contrai
ndicated;in;clients;who;are;allergic;to;eggs.
Cognitive;Level:;Application
;
, Test Bank for Understanding Medical-
; ; ; ;
Surgical Nursing 6th Edition Linda S. Williams P
; ; ; ; ; ; ;
aula D. Hopper ; ;
Client;Needs:;Safe,;Effective;Care;Environment;Nursi
ng;Process:;Assessment
3. The;nurse;is;caring;for;four;clients;on;a;medical–
surgical;unit.;The;secretary;gives;the;nurse;the;morning;labs.;Which;of;the;following;labs;w
ould;require;that;the;nurse;call;the;physician;and;inform;the;healthcare;provider;about;the;cl
ient‘s;abnormalities?
1. WBC;14,600;mm3
2. Serum;protein;6.9;g/dL
3. I;&;D;(incision;and;drainage);showing;no;growth;for;the;last;24;hours
4. Albumin;4.2;g/dL
Answer:;1
Rationale:;When;the;nurse;is;caring;for;several;clients,;all;of;the;labs;should;be;checked;frequentl
y;throughout;the;shift;to;assess;for;any;abnormalities.;The;WBC;in;option;1;is;abnormal.;(Norma
l;WBC;4,000–
10,000;mm3.);All;of;the;other;lab;results;are;within;acceptable;range;;therefore,;the;results;shoul
d;not;be;called;in;to;the;physician.
Cognitive;Level:;Application;Clien
t;Needs:;Physiologic;Integrity;Nursi
ng;Process:;Assessment
4. The;nurse;is;orienting;a;new;graduate.;The;nurse;is;reinforcing;the;importance;of;stan
dard;precautions.;Which;of;the;following;observations;by;the;nurse;would;require;furthe
r;education;regarding;standard;precautions?
1. The;graduate;nurse;understands;to;wash;hands;when;entering;and;exiting;th
e;client‘s;room.
2. The;graduate;nurse;wears;gloves;when;serving;breakfast;trays;to;various;cl
ients.
3. The;graduate;nurse;wears;a;gown,;gloves,;and;goggles;when;suctioning;a;cli
ent.
4. The;graduate;nurse;leaves;all;supplies;in;the;room;of;a;client;who;is;in;co
ntact;isolation.
Answer:;2
Rationale:;The;nurse;must;have;an;understanding;of;standard;precautions.;Prevention;is;the;
most;important;measure;to;prevent;nosocomial;infections.;Standard;precautions;we
re;published;in;1996;that;provide;guidelines;for;the;handling;of;blood;and;other;bod
y;fluids.;These;guidelines;are;used;with;all;clients,;regardless;of;whether;they;have;a;
known;infectious;disease.;Standard;precautions;are;used
;
, Test Bank for Understanding Medical-
; ; ; ;
Surgical Nursing 6th Edition Linda S. Williams P
; ; ; ; ; ; ;
aula D. Hopper ; ;
by;all;healthcare;workers;who;have;direct;contact;with;clients;or;with;their;body;flu
ids.;It;is;not;necessary;for;the;nurse;to;wear;gloves;while;delivering;food;trays;to;the;
client,;because;there;is;not;contact;with;the;client.
Cognitive;Level:;Application
Client;Needs:;Safe,;Effective;Care;Environment;Nursi
ng;Process:;Evaluation
5. The;admitting;department;alerts;the;nurse;on;a;medical–
surgical;unit;that;a;client;with;active;tuberculosis;(TB);is;being;admitted;to;the;unit.;Which;
type;of;isolation;is;appropriate;based;on;the;client‘s;diagnosis?
1. Standard;precautions
2. Airborne;precautions
3. Droplet;precautions
4. Contact;precautions
Answer:;2
In;addition;to;handwashing;and;standard;precautions,;the;nature;and;spread;of;some;infecti
ous;diseases;require;that;special;techniques;be;used;to;protect;uninfected;clients;and;worker
s.;The;client;with;pulmonary;tuberculosis;will;be;placed;in;airborne;precautions.;The;client;
should;be;placed;in;a;private;room;with;special;ventilation;that;does;not;allow;air;to;circulate
;to;general;hospital;ventilation;;a;mask;or;special;filter;respirators;will;be;used;for;everyone;
entering;the;room.
Cognitive;Level:;Application
Client;Needs:;Safe,;Effective;Care;Environment;Nursi
ng;Process:;Assessment
6. A;client;is;receiving;IV;vancomycin;for;the;treatment;of;Clostridium;difficile.;The;nu
rse;understands;that;the;client;who;develops;flushing,;tachycardia,;and;hypotension;duri
ng;the;infusion;of;vancomycin;indicates:
1. Ototoxicity;effect.
2. Superinfection.
3. Red;man;syndrome.
4. Hives.
Answer:;3
Rationale:;Vancomycin;inhibits;cell;wall;synthesis,;and;is;used;for;serious;infections.;It;is;onl
y;effective;against;gram-positive;bacteria,;especially;Staphylococcus;aureus;and
;
; ; ; ;
Surgical Nursing 6th Edition Linda S. Williams P
; ; ; ; ; ; ;
aula D. Hopper ; ;
;
, Test Bank for Understanding Medical-
; ; ; ;
Surgical Nursing 6th Edition Linda S. Williams P
; ; ; ; ; ; ;
aula D. Hopper ; ;
Chapter;1
1. The;nurse;is;caring;for;four;clients;on;a;medical–
surgical;unit.;Which;client;should;the;nurse;see;initially?
1. A;client;admitted;with;hepatitis;A;who;has;had;severe;diarrhea;for;the;last;24;
hours
2. A;client;admitted;with;pneumonia;who;is;has;small;amounts;of;yellow;pr
oductive;sputum
3. A;client;admitted;with;fever;of;unknown;origin;(FUO);who;has;been;w
ithout;fever;for;the;last;48;hours
4. A;client;admitted;with;a;wound;infection;whose;WBC;is;8,500;mm3
Answer:;1
Rationale:;The;nurse;must;decide;which;client;should;be;seen;on;the;initial;rounds;of;the;day.
;The;nurse;must;remember;that;the;first;client;to;be;seen;should;be;the;client;who;nee
ds;the;attention;of;the;nurse;initially.;A;client;with;hepatitis;A;does;experience;diarr
hea,;but;diarrhea;for;the;last;24;hours;could;cause;the;client;to;have;a;problem;with;d
ehydration;and;experience;a;state;of;fluid;volume;deficit.
Cognitive;Level:;Application
Client;Needs:;Safe,;Effective;Care;Environment;Nursi
ng;Process:;Planning
2. The;nurse;is;preparing;to;administer;influenza;vaccines;to;a;mass;drive-
through;clinic.;Which;statement;by;a;client;would;indicate;further;questioning;prior;to;givi
ng;the;client;the;influenza;vaccine?
1. ―I;am;allergic;to;horse;hair.‖
2. ―I;try;to;get;my;vaccine;every;year.‖
3. ―I;am;not;allergic;to;anything;except;eggs.‖
4. ―My;husband;had;a;severe;allergic;reaction;after;he;received;his;influenza;va
ccine.‖
Answer:;3
Rationale:;Influenza;vaccines;are;recommended;for;person;at;high;risk;for;serious;sequelae;
of;influenza.;The;nurse;should;be;aware;that;client;with;a;sensitivity;to;eggs;should;n
ot;receive;the;vaccine.;Vaccines;prepared;from;chicken;or;duck;embryos;are;contrai
ndicated;in;clients;who;are;allergic;to;eggs.
Cognitive;Level:;Application
;
, Test Bank for Understanding Medical-
; ; ; ;
Surgical Nursing 6th Edition Linda S. Williams P
; ; ; ; ; ; ;
aula D. Hopper ; ;
Client;Needs:;Safe,;Effective;Care;Environment;Nursi
ng;Process:;Assessment
3. The;nurse;is;caring;for;four;clients;on;a;medical–
surgical;unit.;The;secretary;gives;the;nurse;the;morning;labs.;Which;of;the;following;labs;w
ould;require;that;the;nurse;call;the;physician;and;inform;the;healthcare;provider;about;the;cl
ient‘s;abnormalities?
1. WBC;14,600;mm3
2. Serum;protein;6.9;g/dL
3. I;&;D;(incision;and;drainage);showing;no;growth;for;the;last;24;hours
4. Albumin;4.2;g/dL
Answer:;1
Rationale:;When;the;nurse;is;caring;for;several;clients,;all;of;the;labs;should;be;checked;frequentl
y;throughout;the;shift;to;assess;for;any;abnormalities.;The;WBC;in;option;1;is;abnormal.;(Norma
l;WBC;4,000–
10,000;mm3.);All;of;the;other;lab;results;are;within;acceptable;range;;therefore,;the;results;shoul
d;not;be;called;in;to;the;physician.
Cognitive;Level:;Application;Clien
t;Needs:;Physiologic;Integrity;Nursi
ng;Process:;Assessment
4. The;nurse;is;orienting;a;new;graduate.;The;nurse;is;reinforcing;the;importance;of;stan
dard;precautions.;Which;of;the;following;observations;by;the;nurse;would;require;furthe
r;education;regarding;standard;precautions?
1. The;graduate;nurse;understands;to;wash;hands;when;entering;and;exiting;th
e;client‘s;room.
2. The;graduate;nurse;wears;gloves;when;serving;breakfast;trays;to;various;cl
ients.
3. The;graduate;nurse;wears;a;gown,;gloves,;and;goggles;when;suctioning;a;cli
ent.
4. The;graduate;nurse;leaves;all;supplies;in;the;room;of;a;client;who;is;in;co
ntact;isolation.
Answer:;2
Rationale:;The;nurse;must;have;an;understanding;of;standard;precautions.;Prevention;is;the;
most;important;measure;to;prevent;nosocomial;infections.;Standard;precautions;we
re;published;in;1996;that;provide;guidelines;for;the;handling;of;blood;and;other;bod
y;fluids.;These;guidelines;are;used;with;all;clients,;regardless;of;whether;they;have;a;
known;infectious;disease.;Standard;precautions;are;used
;
, Test Bank for Understanding Medical-
; ; ; ;
Surgical Nursing 6th Edition Linda S. Williams P
; ; ; ; ; ; ;
aula D. Hopper ; ;
by;all;healthcare;workers;who;have;direct;contact;with;clients;or;with;their;body;flu
ids.;It;is;not;necessary;for;the;nurse;to;wear;gloves;while;delivering;food;trays;to;the;
client,;because;there;is;not;contact;with;the;client.
Cognitive;Level:;Application
Client;Needs:;Safe,;Effective;Care;Environment;Nursi
ng;Process:;Evaluation
5. The;admitting;department;alerts;the;nurse;on;a;medical–
surgical;unit;that;a;client;with;active;tuberculosis;(TB);is;being;admitted;to;the;unit.;Which;
type;of;isolation;is;appropriate;based;on;the;client‘s;diagnosis?
1. Standard;precautions
2. Airborne;precautions
3. Droplet;precautions
4. Contact;precautions
Answer:;2
In;addition;to;handwashing;and;standard;precautions,;the;nature;and;spread;of;some;infecti
ous;diseases;require;that;special;techniques;be;used;to;protect;uninfected;clients;and;worker
s.;The;client;with;pulmonary;tuberculosis;will;be;placed;in;airborne;precautions.;The;client;
should;be;placed;in;a;private;room;with;special;ventilation;that;does;not;allow;air;to;circulate
;to;general;hospital;ventilation;;a;mask;or;special;filter;respirators;will;be;used;for;everyone;
entering;the;room.
Cognitive;Level:;Application
Client;Needs:;Safe,;Effective;Care;Environment;Nursi
ng;Process:;Assessment
6. A;client;is;receiving;IV;vancomycin;for;the;treatment;of;Clostridium;difficile.;The;nu
rse;understands;that;the;client;who;develops;flushing,;tachycardia,;and;hypotension;duri
ng;the;infusion;of;vancomycin;indicates:
1. Ototoxicity;effect.
2. Superinfection.
3. Red;man;syndrome.
4. Hives.
Answer:;3
Rationale:;Vancomycin;inhibits;cell;wall;synthesis,;and;is;used;for;serious;infections.;It;is;onl
y;effective;against;gram-positive;bacteria,;especially;Staphylococcus;aureus;and
;
