TEST BANK FOR MEDICALSURGICAL NURSING, 10TH EDITION, DONNA D. IGNATAVICIUS, LINDA WORKMAN, CHERIE R. REBAR, NICOLE M. HEIMGARTNER

TEST BANK FOR MEDICALSURGICAL NURSING, 10TH EDITION, DONNA D. IGNATAVICIUS, LINDA WORKMAN, CHERIE R. REBAR, NICOLE M. HEIMGARTNER TABLE OF CONTENTS Section I: Concepts of Medical-Surgical Nursing 1. Overview of Professional Nursing Concepts for Medical-Surgical Nursing 2. From Clinical Judgment to Systems Thinking NEW! 3. Overview of Health Concepts for Medical-Surgical Nursing 4. Common Health Problems of Older Adults 5. Assessment and Concepts of Care for Patients with Pain 6. Concepts of Genetics and Genomics 7. Concepts of Rehabilitation for Chronic and Disabling Health Problems 8. Care of Patients at End-of-Life 9. Care of Perioperative Patients Section II: Concepts of Emergency Care and Disaster Preparedness 10. Concepts of Emergency and Trauma Nursing 11. Care of Patients with Common Environmental Emergencies 12. Concepts of Disaster Preparedness Section III: Concepts of Patients with Problems of Fluid, Electrolyte, and Acid-Base Balance 13. Concepts of Fluid and Electrolyte Balance 14. Concepts of Acid-Base Balance 15. Concepts of Infusion Therapy Section V: Interprofessional Collaboration for Patients with Problems of Immunity 16. Concepts of Inflammation and Immunity 17. Care of Patients with HIV Disease 18. Care of Patients with Hypersensitivity (Allergy) and Autoimmunity 19. Concepts of Cancer Development 20. Care of Patients with Cancer 21. Care of Patients with Infection Section VI: Interprofessional Collaboration for Patients with Problems of the Skin, Hair, and Nails 22. Assessment of the Skin, Hair, and Nails 23. Care of Patients with Skin Problems Section VII: Interprofessional Collaboration for Patients with Problems of the Respiratory System 24. Assessment of the Respiratory System 25. Care of Patients Requiring Oxygen Therapy or Tracheostomy 26. Care of Patients with Noninfectious Upper Respiratory Problems 27. Care of Patients with Noninfectious Lower Respiratory Problems 28. Care of Patients with Infectious Respiratory Problems 29. Critical Care of Patients with Respiratory Emergencies Section VIII: Interprofessional Collaboration for Patients with Problems of the Cardiovascular System 30. Assessment of the Cardiovascular System 31. Care of Patients with Dysrhythmias 32. Care of Patients with Cardiac Problems 33. Care of Patients with Vascular Problems 34. Critical Care of Patients with Shock 35. Critical Care of Patients with Acute Coronary Syndromes Section IX: Interprofessional Collaboration for Patients with Problems of the Hematologic System 36. Assessment of the Hematologic System 37. Care of Patients with Hematologic Problems Section X: Interprofessional Collaboration for Patients with Problems of the Nervous System 38. Assessment of the Nervous System 39. Care of Patients with Problems of the Central Nervous System: The Brain 40. Care of Patients with Problems of the Central Nervous System: The Spinal Cord 41. Critical Care of Patients with Neurologic Emergencies Section XI: Interprofessional Collaboration for Patients with Problems of the Sensory System 42. Assessment and Concepts of Care for Patients with Eye and Vision Problems 43. Assessment and Concepts of Care for Patients with Ear and Hearing Problems Section XII: Interprofessional Collaboration for Patients with Problems of the Musculoskeletal System 44. Assessment of the Musculoskeletal System 45. Care of Patients with Musculoskeletal Problems 46. Care of Patients with Arthritis and Total Joint Arthroplasty NEW! 47. Care of Patients with Musculoskeletal Trauma Section XIII: Interprofessional Collaboration for Patients with Problems of the Gastrointestinal System 48. Assessment of the Gastrointestinal System 49. Care of Patients with Oral Cavity and Esophageal Problems 50. Care of Patients with Stomach Disorders 51. Care of Patients with Noninflammatory Intestinal Disorders 52. Care of Patients with Inflammatory Intestinal Disorders 53. Care of Patients with Liver Problems 54. Care of Patients with Problems of the Biliary System and Pancreas 55. Care of Patients with Malnutrition: Undernutrition and Obesity Section XIV: Interprofessional Collaboration for Patients with Problems of the Endocrine System 56. Assessment of the Endocrine System 57. Care of Patients with Pituitary and Adrenal Gland Problems 58. Care of Patients with Problems of the Thyroid and Parathyroid Glands 59. Care of Patients with Diabetes Mellitus Section XV: Interprofessional Collaboration for Patients with Problems of the Renal/Urinary System 60. Assessment of the Renal/Urinary System 61. Care of Patients with Urinary Problems 62. Care of Patients with Kidney Disorders 63. Care of Patients with Acute Kidney Injury and Chronic Kidney Disease Section XVI: Interprofessional Collaboration for Patients with Problems of the Reproductive System 64. Assessment of the Reproductive System 65. Care of Patients with Breast Disorders 66. Care of Patients with Gynecologic Problems 67. Care of Patients with Male Reproductive Problems 68. Care of Transgender Patients 69. Care of Patients with Sexually Transmitted Infections Chapter 01: Overview of Professional Nursing Concepts for Medical-Surgical Nursing Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A new nurse is working with a preceptor on a medical-surgical unit. The preceptor advises the new nurse that which is the priority when working as a professional nurse? a. Attending to holistic client needs b. Ensuring client safety c. Not making medication errors d. Providing client-focused care ANS: B All actions are appropriate for the professional nurse. However, ensuring client safety is the priority. Health care errors have been widely reported for 25 years, many of which result in client injury, death, and increased health care costs. There are several national and international organizations that have either recommended or mandated safety initiatives. Every nurse has the responsibility to guard the client’s safety. The other actions are important for quality nursing, but they are not as vital as providing safety. Not making medication errors does provide safety, but is too narrow in scope to be the best answer. DIF: Understanding TOP: Integrated Process: Nursing Process: Intervention KEY: Client safety MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 2. A nurse is orienting a new client and family to the medical-surgical unit. What information does the nurse provide to best help the client promote his or her own safety? a. Encourage the client and family to be active partners. b. Have the client monitor hand hygiene in caregivers. c. Offer the family the opportunity to stay with the client. d. Tell the client to always wear his or her armband. ANS: A Each action could be important for the client or family to perform. However, encouraging the client to be active in his or her health care as a safety partner is the most critical. The other actions are very limited in scope and do not provide the broad protection that being active and involved does. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Client safety MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 3. A nurse is caring for a postoperative client on the surgical unit. The client’s blood pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action would the nurse take first? a. Call the Rapid Response Team. b. Document and continue to monitor. c. Notify the primary health care provider. d. Repeat the blood pressure in 15 minutes. ANS: A The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating before they suffer either respiratory or cardiac arrest. Since the client has manifested a significant change, the nurse would call the RRT. Changes in blood pressure, mental status, heart rate, temperature, oxygen saturation, and last 2 hours’ urine output are particularly significant and are part of the Modified Early Warning System guide. Documentation is vital, but the nurse must do more than document. The primary health care provider would be notified, but this is not more important than calling the RRT. The client’s blood pressure would be reassessed frequently, but the priority is getting the rapid care to the client. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Rapid Response Team (RRT), Clinical judgment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 4. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse best demonstrates this concept? a. Assesses for cultural influences affecting health care. b. Ensures that all the client’s basic needs are met. c. Tells the client and family about all upcoming tests. d. Thoroughly orients the client and family to the room. ANS: A Showing respect for the client and family’s preferences and needs is essential to ensure a holistic or “whole-person” approach to care. By assessing the effect of the client’s culture on health care, this nurse is practicing client-focused care. Providing for basic needs does not demonstrate this competence. Simply telling the client about all upcoming tests is not providing empowering education. Orienting the client and family to the room is an important safety measure, but not directly related to demonstrating client-centered care. DIF: Understanding TOP: Integrated Process: Culture and Spirituality KEY: Client-centered care, Culture MSC: Client Needs Category: Psychosocial Integrity 5. A client is going to be admitted for a scheduled surgical procedure. Which action does the nurse explain is the most important thing the client can do to protect against errors? a. Bring a list of all medications and what they are for. b. Keep the provider’s phone number by the telephone. c. Make sure that all providers wash hands before entering the room. d. Write down the name of each caregiver who comes in the room. ANS: A Medication reconciliation is a formal process in which the client’s actual current medications are compared to the prescribed medications at the time of admission, transfer, or discharge. This National client Safety Goal is important to reduce medication errors. The client would not have to be responsible for providers washing their hands, and even if the client does so, this is too narrow to be the most important action to prevent errors. Keeping the provider’s phone number nearby and documenting everyone who enters the room also do not guarantee safety. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Client safety, Informatics MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 6. Which action by the nurse working with a client best demonstrates respect for autonomy? a. Asks if the client has questions before signing a consent. b. Gives the client accurate information when questioned. c. Keeps the promises made to the client and family. d. Treats the client fairly compared to other clients. ANS: A Autonomy is self-determination. The client would make decisions regarding care. When the nurse obtains a signature on the consent form, assessing if the client still has questions is vital, because without full information the client cannot practice autonomy. Giving accurate information is practicing with veracity. Keeping promises is upholding fidelity. Treating the client fairly is providing social justice. DIF: Applying TOP: Integrated Process: Caring KEY: Ethics, Autonomy MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 7. A nurse asks a more seasoned colleague to explain best practices when communicating with a person from the lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) community. What answer by the faculty is most accurate? a. Avoid embarrassing the client by asking questions. b. Don’t make assumptions about his or her health needs. c. Most LGBTQ people do not want to share information. d. No differences exist in communicating with this population. ANS: B Many members of the LGBTQ community have faced discrimination from health care providers and may be reluctant to seek health care. The nurse would never make assumptions about the needs of members of this population. Rather, respectful questions are appropriate. If approached with sensitivity, the client with any health care need is more likely to answer honestly. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Health care disparities, LGBTQ MSC: Client Needs Category: Psychosocial Integrity 8. A nurse is calling the on-call health care provider about a client who had a hysterectomy 2 days ago and has pain that is unrelieved by the prescribed opioid pain medication. Which statement comprises the background portion of the SBAR format for communication? a. “I would like you to order a different pain medication.” b. “This client has allergies to morphine and codeine.” c. “Dr. Smith doesn’t like nonsteroidal anti-inflammatory meds.” d. “This client had a vaginal hysterectomy 2 days ago.” ANS: B SBAR is a recommended form of communication, and the acronym stands for Situation, Background, Assessment, and Recommendation. Appropriate background information includes allergies to medications the on-call health care provider might order. Situation describes what is happening right now that must be communicated; the client’s surgery 2 days ago would be considered background. Assessment would include an analysis of the client’s problem; none of the options has assessment information. Asking for a different pain medication is a recommendation. Recommendation is a statement of what is needed or what outcome is desired. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Teamwork and collaboration, SBAR MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 9. A nurse working on a cardiac unit delegated taking vital signs to an experienced assistive personnel (AP). Four hours later, the nurse notes that the client’s blood pressure taken by the AP was much higher than previous readings, and the client’s mental status has changed. What action by the nurse would most likely have prevented this negative outcome? a. Determining if the AP knew how to take blood pressure b. Double-checking the AP by taking another blood pressure c. Providing more appropriate supervision of the AP d. Taking the blood pressure instead of delegating the task ANS: C Supervision is one of the five rights of delegation and includes directing, evaluating, and following up on delegated tasks. The nurse would either have asked the AP about the vital signs or instructed the AP to report them right away. An experienced AP would know how to take vital signs and the nurse would not have to assess this at this point. Double-checking the work defeats the purpose of delegation. Vital signs are within the scope of practice for a AP and are permissible to delegate. The only appropriate answer is that the nurse did not provide adequate instruction to the AP. DIF: Analyzing TOP: Integrated Process: Communication and Documentation KEY: Teamwork and collaboration, Delegation MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 10. A newly graduated nurse in the hospital states that because of being so new, participation in quality improvement (QI) projects is not wise. What response by the precepting nurse is best? a. “All staff nurses are required to participate in quality improvement here.” b. “Even being new, you can implement activities designed to improve care.” c. “It’s easy to identify what indicators would be used to measure quality.” d. “You should ask to be assigned to the research and quality committee.” ANS: B The preceptor would try to reassure the nurse that implementing QI measures is not out of line for a newly licensed nurse. Simply stating that all nurses are required to participate does not help the nurse understand how that is possible and is dismissive. Identifying indicators of quality is not an easy, quick process and would not be the best place to suggest a new nurse to start. Asking to be assigned to the QI committee does not give the nurse information about how to implement QI in daily practice. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Systems thinking, Quality improvement MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 11. A nurse is talking with a co-worker who is moving to a new state and needs to find new employment there. What advice by the nurse is best? a. Ask the hospitals there about standard nurse–client ratios. b. Choose the hospital that has the newest technology. c. Find a hospital that has achieved Magnet status. d. Work in a facility affiliated with a medical or nursing school. ANS: C Client Magnet status is awarded by The Joint Commission (TJC) and certifies that nurses can demonstrate how best current evidence guides their practice. New technology doesn’t necessarily mean that the hospital is safe. Affiliation with a health profession school has several advantages, but safety is most important. DIF: Understanding TOP: Integrated Process: Communication and Documentation KEY: Evidence-based practice, Magnet status MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. A nurse manager wishes to ensure that the nurses on the unit are practicing at their highest levels of competency. Which areas would the manager assess to determine if the nursing staff demonstrate competency according to the Institute of Medicine (IOM) report Health Professions Education: A Bridge to Quality? (Select all that apply.) a. Collaborating with an interprofessional team b. Implementing evidence-based care c. Providing family-focused care d. Routinely using informatics in practice e. Using quality improvement in client care f. Formalizing systems thinking when implementing care ANS: A, B, D, E The IOM report lists five broad core competencies that all health care providers should practice. These include collaborating with the interprofessional team, implementing evidence-based practice, providing patient-focused care, using informatics in client care, and using quality improvement in client care. Systems thinking is required for quality improvement but is not a specified part of the IOM report. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Competencies, Institute of Medicine (IOM) MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 2. A nurse is interested in making interprofessional work a high priority. Which actions by the nurse best demonstrate this skill? (Select all that apply.) a. Consults with other disciplines on client care. b. Coordinates discharge planning for home safety. c. Participates in comprehensive client rounding. d. Routinely asks other disciplines about client progress. e. Shows the nursing care plans to other disciplines. f. Delegate tasks to unlicensed personnel appropriately. ANS: A, B, C, D, F Collaborating with the interprofessional team involves planning, implementing, and evaluating client care as a team with all other involved disciplines included. Simply showing other caregivers the nursing care plan is not actively involving them or collaborating with them. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Teamwork and collaboration, Interprofessional team MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 3. The nurse utilizing evidence-based practice (EBP) considers which factors when planning care? (Select all that apply.) a. Cost-saving measures b. Nurse’s expertise c. Client preferences d. Research findings e. Values of the client f. Plan-do-study-act model ANS: B, C, D, E EBP consists of utilizing current evidence, the client’s values and preferences, and the nurse’s expertise when planning care. It does not include cost-saving measures. The PDSA model is a systematic model for quality improvement, but is not a specific component of EBP. DIF: Remembering TOP: Integrated Process: Nursing Process: Planning KEY: Evidence-based practice (EBP) MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 4. A nurse manager wants to improve hand-off communication among the staff. What actions by the manager would best help achieve this goal? (Select all that apply.) a. Attend hand-off rounds to coach and mentor. b. Create a template of suggested topics to include in report. c. Encourage staff to ask questions during hand-off. d. Give raises based on compliance with reporting. e. Provide education on the SBAR method of communication ANS: A, B, C, E The SBAR method of communication has been identified as an excellent method of communication between health care professionals. It is a formalized structure consisting of Situation, Background, Assessment, and Recommendation/Request. Using a formalized mechanism for communication helps ensure successful hand-off and fewer client errors. When establishing this new format for report, the most helpful actions by the manager would be to provide initial education on the process, develop a template with suggested topics under each heading, attend rounds to coach and mentor, and encourage staff to ask questions to clarify information. Basing raises on compliance would not be the most helpful method because