Davis Advantage for Medical-
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
Question 6 (MCQ)
Clinical Scenario
,A nurse is caring for a patient admitted with acute pancreatitis.
During morning assessment, the nurse notes increasing
abdominal pain, restlessness, and a respiratory rate of 30
breaths/min.
Question Stem
Which action best demonstrates clinical judgment?
Answer Options
A. Administer the scheduled analgesic and reassess at the end
of the shift
B. Recognize the change in condition, assess further, and notify
the provider
C. Document the findings and continue routine care
D. Encourage the patient to ambulate to relieve discomfort
Correct Answer
B. Recognize the change in condition, assess further, and
notify the provider
Detailed Rationale
Clinical judgment involves recognizing cues, analyzing their
significance, and taking appropriate action. Worsening pain,
restlessness, and tachypnea may indicate deterioration,
complications, or worsening inflammation. The nurse must
,perform additional assessment and communicate concerns
promptly.
Incorrect Option Analysis
A
Why Incorrect: Treating symptoms alone ignores potential
deterioration.
Common Misconception: Pain medication solves the problem.
Safety Risk: Delayed recognition of complications.
C
Why Incorrect: Documentation alone is not an intervention.
Common Misconception: Recording findings fulfills nursing
responsibility.
Safety Risk: Failure to intervene.
D
Why Incorrect: Ambulation may worsen pain and does not
address the underlying issue.
Common Misconception: Activity is always beneficial.
Safety Risk: Increased patient distress.
Nursing Process Linkage
, Assessment
NCJMM Competencies
• Recognize Cues
• Analyze Cues
• Take Action
Difficulty Level
Moderate
Bloom's Level
Analyze
NCLEX Client Needs Category
Physiological Adaptation
Key Learning Objective
Apply clinical judgment when identifying patient deterioration.
Question 7 (SATA)
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
Question 6 (MCQ)
Clinical Scenario
,A nurse is caring for a patient admitted with acute pancreatitis.
During morning assessment, the nurse notes increasing
abdominal pain, restlessness, and a respiratory rate of 30
breaths/min.
Question Stem
Which action best demonstrates clinical judgment?
Answer Options
A. Administer the scheduled analgesic and reassess at the end
of the shift
B. Recognize the change in condition, assess further, and notify
the provider
C. Document the findings and continue routine care
D. Encourage the patient to ambulate to relieve discomfort
Correct Answer
B. Recognize the change in condition, assess further, and
notify the provider
Detailed Rationale
Clinical judgment involves recognizing cues, analyzing their
significance, and taking appropriate action. Worsening pain,
restlessness, and tachypnea may indicate deterioration,
complications, or worsening inflammation. The nurse must
,perform additional assessment and communicate concerns
promptly.
Incorrect Option Analysis
A
Why Incorrect: Treating symptoms alone ignores potential
deterioration.
Common Misconception: Pain medication solves the problem.
Safety Risk: Delayed recognition of complications.
C
Why Incorrect: Documentation alone is not an intervention.
Common Misconception: Recording findings fulfills nursing
responsibility.
Safety Risk: Failure to intervene.
D
Why Incorrect: Ambulation may worsen pain and does not
address the underlying issue.
Common Misconception: Activity is always beneficial.
Safety Risk: Increased patient distress.
Nursing Process Linkage
, Assessment
NCJMM Competencies
• Recognize Cues
• Analyze Cues
• Take Action
Difficulty Level
Moderate
Bloom's Level
Analyze
NCLEX Client Needs Category
Physiological Adaptation
Key Learning Objective
Apply clinical judgment when identifying patient deterioration.
Question 7 (SATA)
