Davis Advantage for Medical-
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
Clinical Scenario:
A 68-year-old patient is transferred from the post-anesthesia
care unit to the medical-surgical unit after abdominal surgery.
On arrival, the patient is drowsy and reports nausea.
Question Stem:
What is the nurse’s priority first action?
Answer Options:
A. Offer the patient ice chips
B. Assess airway patency and respiratory status
C. Document the transfer assessment
D. Administer the prescribed antiemetic
Correct Answer:
B. Assess airway patency and respiratory status
Detailed Rationale:
In clinical judgment, the nurse first addresses airway and
breathing because postoperative sedation and anesthesia can
depress respirations. Nausea is important, but it is not the
immediate priority if airway compromise is possible. This
reflects safe, systematic assessment before intervention.
Incorrect Option Analysis:
, • A. Offer the patient ice chips — Incorrect because oral
intake should not begin until the patient is fully assessed
and safe to swallow.
o Misconception: Treating nausea before assessing
physiologic stability.
o Safety risk: Aspiration if swallowing is impaired.
• C. Document the transfer assessment — Incorrect
because documentation follows assessment and action.
o Misconception: Paperwork is more urgent than
physiologic assessment.
o Safety risk: Delayed recognition of respiratory
compromise.
• D. Administer the prescribed antiemetic — Incorrect
because medication administration is not first priority
before airway assessment.
o Misconception: Symptom relief always comes before
assessment.
o Safety risk: Missing early postoperative respiratory
depression.
Nursing Process Linkage: Assessment
NCJMM Competency: Recognize Cues
Difficulty Level: Moderate
Bloom’s Level: Apply
NCLEX Client Needs: Physiological Adaptation
, Key Learning Objective: Prioritize immediate postoperative
assessment using airway-first clinical judgment.
2) MCQ
Clinical Scenario:
A nurse is completing an admission assessment for a patient
with type 2 diabetes and hypertension.
Question Stem:
Which finding is an objective assessment datum?
Answer Options:
A. The patient says, “I feel weak.”
B. The patient reports poor appetite for 3 days
C. Blood pressure is 168/94 mm Hg
D. The patient seems anxious about hospitalization
Correct Answer:
C. Blood pressure is 168/94 mm Hg
Detailed Rationale:
Objective data are measurable and observable findings
collected by the nurse. Blood pressure is a direct, measurable
clinical finding. Subjective data are symptoms and perceptions
reported by the patient.
Incorrect Option Analysis:
• A. The patient says, “I feel weak.” — Incorrect; this is
subjective report.
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
Clinical Scenario:
A 68-year-old patient is transferred from the post-anesthesia
care unit to the medical-surgical unit after abdominal surgery.
On arrival, the patient is drowsy and reports nausea.
Question Stem:
What is the nurse’s priority first action?
Answer Options:
A. Offer the patient ice chips
B. Assess airway patency and respiratory status
C. Document the transfer assessment
D. Administer the prescribed antiemetic
Correct Answer:
B. Assess airway patency and respiratory status
Detailed Rationale:
In clinical judgment, the nurse first addresses airway and
breathing because postoperative sedation and anesthesia can
depress respirations. Nausea is important, but it is not the
immediate priority if airway compromise is possible. This
reflects safe, systematic assessment before intervention.
Incorrect Option Analysis:
, • A. Offer the patient ice chips — Incorrect because oral
intake should not begin until the patient is fully assessed
and safe to swallow.
o Misconception: Treating nausea before assessing
physiologic stability.
o Safety risk: Aspiration if swallowing is impaired.
• C. Document the transfer assessment — Incorrect
because documentation follows assessment and action.
o Misconception: Paperwork is more urgent than
physiologic assessment.
o Safety risk: Delayed recognition of respiratory
compromise.
• D. Administer the prescribed antiemetic — Incorrect
because medication administration is not first priority
before airway assessment.
o Misconception: Symptom relief always comes before
assessment.
o Safety risk: Missing early postoperative respiratory
depression.
Nursing Process Linkage: Assessment
NCJMM Competency: Recognize Cues
Difficulty Level: Moderate
Bloom’s Level: Apply
NCLEX Client Needs: Physiological Adaptation
, Key Learning Objective: Prioritize immediate postoperative
assessment using airway-first clinical judgment.
2) MCQ
Clinical Scenario:
A nurse is completing an admission assessment for a patient
with type 2 diabetes and hypertension.
Question Stem:
Which finding is an objective assessment datum?
Answer Options:
A. The patient says, “I feel weak.”
B. The patient reports poor appetite for 3 days
C. Blood pressure is 168/94 mm Hg
D. The patient seems anxious about hospitalization
Correct Answer:
C. Blood pressure is 168/94 mm Hg
Detailed Rationale:
Objective data are measurable and observable findings
collected by the nurse. Blood pressure is a direct, measurable
clinical finding. Subjective data are symptoms and perceptions
reported by the patient.
Incorrect Option Analysis:
• A. The patient says, “I feel weak.” — Incorrect; this is
subjective report.
