TEST BANK for Medical-Surgical Nursing Concepts for Clinical Judgment and Collaborative Care 11th Edition by Donna D. Ignatavicius, All chapters 1 - 74 Complete A+ Guide.

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Chapter01:OverviewofProfessionalNursing ConceptsforMedical-SurgicalNursing
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Ignatavicius: Medical-Surgical Nursing,
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MULTIPLE CHOICE 6t



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1. A new nurse is working with a preceptor on a medical-surgical unit. The preceptor advises the new
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nurse that which is the priority when working as a professional nurse?
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a. Attendingto holistic client needs 6t 6t 6t 6t




b. Ensuring client safety 6t 6t




c. Not making medication errors 6t 6t 6t




d. Providing client-focusedcare 6t 6t




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ANS: B 6 t




All actions are appropriate for the professional nurse. However, ensuring client safety is the
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priority. Health care errors have been widely reported for 25 years, many of which result in
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client injury, death, and increased health care costs. There are several national and
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international organizations that have either recommended or mandated safety initiatives. Every 6t 6t 6t 6t 6t 6t 6t 6t 6t 6t




nurse has the responsibility to guard the client’s safety. The other actions are important for quality
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nursing, but they are not as vital asproviding safety.Not making medication errors does provide
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safety, but is too narrow in scope to be the best answer.
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DIF: Understanding
KEY: Client safety
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T O P : In teg rated Process: Nursing Process: Intervention
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MSC: ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfection Control
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2. Anurseisorientinganewclient and family tot h e m e d i c a l - surgicalunit.Whatinformationdoes
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the nurse provide to best help the client promote his or her own safety?
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a. Encouragethe client and family to beactive partners. 6t 6t 6t 6t 6t 6t 6t 6t




b. Have the client monitor hand hygiene in caregivers.
c. Offer the familythe opportunity to stay with the client.
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d. Tell the client to always wear his or her armband. 6t 6t 6t 6t 6t 6t 6t 6t 6t




ANS: abirb.com/test
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Eachactioncould be importantfor the client or familyto perform. However, encouraging the client to
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be active in his or her health care as a safety partner is the most critical. The other
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actionsare very limited in scope and do not provide the broadprotectionthat being active and
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involved does. 6t

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DIF: Understanding TOP: Integrated Process:Teaching/Learning 6 t 6t 6t




KEY: Client 6 t
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safety
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MSC: ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfection Control
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3. A nurse is caring for a postoperative client on the surgical unit. The client’s blood pressure was
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142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action would the nurse
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take first? 6t
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a. Call the Rapid Response Team. 6t 6t 6t 6t




b. Document and continue to monitor. 6t 6t 6t 6t




c. Notify the primary health care provider. 6t 6t 6t 6t abirb.com/test 6t




d. Repeat the blood pressure in 15 minutes. 6t 6t 6t 6t 6t 6t




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ANS:
6A purposeoftheRapidResponse Team (RRT) is t o intervene whenclientsaredeteriorating
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before they suffer either respiratory or cardiac arrest. Since the client has manifested a significant
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change, the nurse would call the RRT. Changes in blood pressure, mental status, heart rate,
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temperature, oxygen saturation, and last 2 hours’ urine output are particularly significant and are
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part of the Modified Early Warning System guide. Documentation is vital, but the nurse must do
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more than document. The primary health care provider would be notified, but this is not more
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important than calling the 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 andDocumentation 6 t 6t 6t 6t 6t




KEY: Rapid Response Team (RRT), Clinical judgment
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MSC: ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation
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4. A nurse wishes to provide client-centeredcare in all interactions. Which action by the nurse
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best demonstrates this concep t?
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a. Assesses for cultural influences affecting health care. 6t 6t
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b. Ensures that all the client’s basic needs are met. 6t 6t 6t 6t 6t 6t 6t 6t




c. Tellsthe client and family about all upcoming tests.
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d. Thoroughly orients the client and family to the room. 6t 6t 6t 6t 6t 6t 6t 6t




ANS: 6 t A
Showing respect for the client and family’s preferences and needs is essential to ensure a holistic or
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“whole-person” approach to care. By assessing the effect of the client’s cultureon health care, this
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nurse is practicing client-focused care. Providing for basic needs does not demonstrate this
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competence. Simply telling the client about all upcoming tests is not
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providingempoweringeducation. Orienting the client andfamilytotheroomisanimportant safety 6t 6t


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measure, but not directly related to demonstrating client-centered care.
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DIF: Understanding T OP : In tegrated Process: Culture and Spirituality
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stCategory:PsychosocialIntegrity
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KEY: Client-centered care,Culture 6 t 6t 6t MSC: Client 6 t 6t 6t 6t 6t




5. A client is going to be admitted for a scheduled surgical procedure. Which action does the nurse
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explain is the most important thing the 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. 6t 6t 6t 6t 6t 6t 6t




c. Make sure that all providers wash hands before entering the room. 6t 6t 6t 6t 6t 6t 6t 6t 6t 6t




d. Writedown the name of eachcaregiver who comes in the room. 6t 6t 6t 6t 6t abirb.com/test 6t 6t 6t 6t 6t 6t




ANS: 6 t A
Medicationreconciliation isa formal process inwhich the client’s actual current medications are
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compared to the prescribed medications at the time of admission, transfer, or discharge. This
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National client Safety Goal is important to reduce medication errors. The client would not have to
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be responsible for providers washing their hands, and even if the client does so, this is too narrow to
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be the most important action to prevent errors. Keeping the provider’s phone number nearby and
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documenting everyone who enters the room also do not guarantee safety.
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DIF: Applying TOP:
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Int eg rat e d Pro ce ss: Te ac h in g/ L earning KEY: Client safety, 6t 6 t 6t




Informatics
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MSC: ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfection Control
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