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SURGICAL NURSING: CLINICAL REASONING
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IN HOSPITAL CLIENT CARE 7THEDITION/ALL
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CHAPTERS 1-52
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,Chapter1 k
1. The caregiver is caring for four Hospital clients ona medical–
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surgicalunit.WhichHospitalclientshouldthecaregiverseeinitially?
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1. AHospitalclientadmittedwithhepatitisAwho hashadseverediarrheaf or k k k k k d k k k k k
thelast 24 hours k k d
2. AHospitalclientadmittedwithpneumoniawho ishas smallamou k k k k k d k d k
nts ofyellow productive sputum
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3. AHospital client admitted withfever ofunknownorigin(FUO) w ho k d d k k k k k k k
hasbeen without fever for the last 48 hours
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4. AHospitalclient admittedwitha woundinfectionwhoseWBCis8,500
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mm3ACCURATEANSWER:-1
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Reasoning:-
>>>The caregiver must decide which Hospital client should be seen on theinitial r
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ounds ofthe day. The caregiver must remember that the first
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Hospital client to be seen should be the Hospital client who needs the attention of t
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he caregiver initially. A Hospital client with hepatitis A does experience diarrhea,
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but diarrhea for the last 24 hours could cause the Hospital client to have a problem
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withdehydration and experience a state of fluid volume deficit.
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CognitiveLevel:Application k k
Hospital clientNeeds:Safe,EffectiveCareEnvironme
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nt Nursing Process: Planning
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2. The caregiver is preparing to administerinfluenza vaccines to amass drive-
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throughclinic.Whichstatementb ya Hospitalclientwouldindicatefurtherquestioning pr ior
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to giving the Hospital client the influenza vaccine?
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1. ―I am allergic to horse hair.‖
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2. ―I try to get my vaccine every year.‖
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3. ―I am not allergic to anything except eggs.‖
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4. ―Myhusband hadasevereallergicreactionafterhereceivedhisinfluenzava d k k k k k k k k
ccine.‖
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ACCURATEANSWER:-3 k
Reasoning:-
>>>Influenza vaccines are recommended for person at high risk for serious sequela e of k k k k k k k k k k k k k
influenza. The caregiver should be aware that Hospital client with a sensitivity t o eggs
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should not receive the vaccine. Vaccines prepared from chicken or duck emb ryos are
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contraindicated in Hospital clients who are allergic to eggs.
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,CognitiveLevel:Application k k
Hospital client Needs: Safe, Effective Care Environme
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ntNursing Process: Assessment
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3. The caregiveris caring forfourHospital clients on amedical–
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surgical unit. The secretary gives the caregiver the morning labs. Which of the following la bs
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would require that the caregiver call the physician and inform the healthcare provider ab out the
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Hospital client‘s abnormalities?
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1. WBC14,600 mm3 k k d
2. Serum protein6.9g/dL d k k
3. I&D(incisionanddrainage)showing no growth forthelast24hours
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4. Albumin4.2g/dL k k
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Reasoning:-
>>>Whenthecaregiveriscaring forseveralHospitalclients,allofthelabsshouldbeche cked
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frequentlythroughouttheshift toassessforanyabnormalities.TheWBC inoption 1 is
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abnormal. (Normal WBC 4,000–
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10,000mm3.)Alloftheotherlabresultsarewithinacceptablerange;therefore,theresult s
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should not be called in to thephysician.
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Cognitive Level: Application k k
Hospital client Needs: Physio
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logic Integrity Nursing Proces
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s:
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Assessment
4. The caregiver is orienting a new graduate. The caregiver is reinforcing the impo
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rtance of standard precautions. Which of the following observations bythe caregiv er
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would require further education regardingstandard precautions?
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1. Thegraduatecaregiverunderstandstowashhandswhenenteringa nd
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exiting the Hospital client‘s room.
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2. Thegraduatecaregiverwearsgloveswhenservingbreakfasttraystova
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rious Hospital clients.
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3. Thegraduatecaregiverwearsagown,gloves,andgoggleswhen suctioning
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a Hospitalclient. k d k
4. Thegraduatecaregiverleavesallsupplies intheroomofaHospitalcl
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ient who is in contact isolation.
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ACCURATEANSWER:-2 k
, Reasoning:-
>>>The caregiver must have an understanding of standard precautions. Preventio n is k k k k k k k k k k k
the most important measure to prevent nosocomial infections. Standard preca
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utions were published in 1996 that provide guidelines
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for the handling of blood and other body fluids. These guidelines are used with all H
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ospital clients, regardless ofwhether theyhave a known infectious disease. Standar
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dprecautions are used
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by all healthcare workers who have direct contact with Hospital clients or with thei r
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body fluids. It is not necessary for the caregiver to wear gloves while delivering fo
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odtrays tothe Hospital client, because there is not contact withthe Hospital client.
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CognitiveLevel:Application k k
Hospital clientNeeds:Safe,EffectiveCareEnvironme
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nt Nursing Process: Evaluation
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5. Theadmittingdepartmentalertsthecaregivero namedical–
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surgicalunit thata Hospital client with active tuberculosis (TB) is being admitted to the uni
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t. Which type of isolation is appropriate based on the Hospital client‘s diagnosis?
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1. Standard precautions d
2. Airborneprecautions
3. Dropletprecautions
4. Contactprecautions k d
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Reasoning:-
>>>Inadditiontohandwashingandstandard precautions,thenatureandspreadofsomeinf
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ectiousdiseasesrequirethat specialtechniquesbeusedtoprotectuninfectedHospitalclient s
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andworkers.TheHospitalclientwithpulmonarytuberculosiswillbeplacedinairbornepr
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ecautions.TheHospital client should beplaced in aprivateroom with special ventilationth at
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doesnot allowairto circulateto generalhealthcenterventilation;amaskorspecialfilterr
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espirators will be used for everyone entering the room.
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CognitiveLevel:Application k k
Hospital clientNeeds:Safe,EffectiveCareEnvironme
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nt Nursing Process: Assessment
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6. A Hospital client is receiving IV vancomycin for the treatment of Clostridium dif
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ficile.The caregiver understands that the Hospital client who develops flushing, tac
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hycardia, and hypotension during the infusion of vancomycin indicates:
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1. Ototoxicityeffect.
2. Superinfection.
3. Red mansyndrome. d