, ◦ Timby's Introductory Medical-Surgical Nursing 13th Edition Moreno Test Bank
vi vi vi vi vi vi vi vi
Chapter 1 vi Concepts and Trends in Healthcare vi vi vi vi
◦ A new nurse is working with a preceptor on an inpatient medical-
vi vi vi vi vi vi vi vi vi vi vi
surgical unit. The preceptor advises the student that which is the priority when
vi vi vi vi vi vi vi vi vi vi vi vi vi
working as a professional nurse? vi vi vi vi
◦ Attending to holistic client needs vi vi vi vi
◦ Ensuring client safety vi vi
◦ Not making medication errors
vi vi vi
◦
Providing client- vi
focused care A vi vi vi
NS: B vi
◦ All actions are appropriate for the professional nurse. However, ensuri
vi vi vi vi vi vi vi vi v i
ng client safety is the priority. Up to 98,000 deaths result each year from errors in
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi v
hospital care, according to the 2000 Institute of Medicine report. Many more clients ha
i vi vi vi vi vi vi vi vi vi vi vi vi vi
ve suffered injuries and less serious outcomes. Every nurse has the responsibility to gu
vi vi vi vi vi vi vi vi vi vi vi vi vi
ard the clients safety.
vi vi vi
◦ DIF: Understanding/Comprehension REF: 2 vi vi vi vi
KEY: Patient safety MSC: Integrated Process: Nursing Proc
vi vi vi vi vi vi vi
ess: Intervention
vi
◦ NOT: Client Needs Category: Safe and Effective Care vi vi vi vi vi vi vi vi
Environment: Safety and Infection Control vi vi vi vi
◦ A nurse is orienting a new client and family to the inpatient unit. What infor
vi vi vi vi vi vi vi vi vi vi vi vi vi vi
mation does the nurse provide to help the client promote his or her own safet
vi vi vi vi vi vi vi vi vi vi vi vi vi vi
y?
◦ Encourage the client and family to be active partners.
vi vi vi vi vi vi vi vi
◦ Have the client monitor hand hygiene in caregivers.
vi vi vi vi vi vi vi
◦ Offer the family the opportunity to stay with the client.
vi vi vi vi vi vi vi vi vi
◦
Tell the client to always wear his or
vi vi vi vi vi vi vi
her armband. ANS: A vi vi vi vi
◦ Each action could be important for the client or family to perform. H vi vi vi vi vi vi vi vi vi vi vi vi
owever, encouraging the client to be active in his or her health care as a partner is th
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
e most critical. The other actions are
vi vi vi vi vi vi
◦
◦ very limited in scope and do not provide the broad protection that vi vi vi vi vi vi vi vi vi vi vi vi
being active and involved does.
vi vi vi vi
◦ DIF: Understanding/Comprehension REF: 3 vi vi vi vi
KEY: Patient safety MSC: Integrated Process: Teaching/ Le
vi vi vi vi vi vi vi
arning
◦ NOT: Client Needs Category: Safe and Effective Care vi vi vi vi vi vi vi
,Environment: Safety and Infection Control vi vi vi vi
◦ A nurse is caring for a postoperative client on the surgical unit. The clients blood
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What act
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
ion by the nurse is best?
vi vi vi vi vi
◦ Call the Rapid Response Team.
vi vi vi vi
◦ Document and continue to monitor. vi vi vi vi
◦ Notify the primary care provider. vi vi vi vi
◦
Repeat blood pressure measurement vi vi vi vi
in 15 minutes. ANS: A vi vi vi vi
◦ The purpose of the Rapid Response Team (RRT) is to intervene when cl vi vi vi vi vi vi vi vi vi vi vi vi
ients are deteriorating before they suffer either respiratory or cardiac arrest. Since the cl
vi vi vi vi vi vi vi vi vi vi vi vi vi
ient has manifested a significant change, the nurse should call the RRT. Changes in blo
vi vi vi vi vi vi vi vi vi vi vi vi vi vi
od pressure, mental status, heart rate, and pain are particularly significant. Documentati
vi vi vi vi vi vi vi vi vi vi vi
on is vital, but the nurse must do more than document. The primary care provider shoul
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
d be notified, but this is not the priority over calling the RRT. The clients blood pres
vi vi vi vi vi vi vi vi vi vi v i vi vi v i vi vi
sure should be reassessed frequently, but the priority is getting
vi vi vi vi vi vi vi vi vi
the rapid care to the client. vi vi vi vi vi
◦ DIF: Applying/Application REF: 3
vi vi vi
◦ KEY: Rapid Response Team (RRT)| vi vi vi vi v
medical emergencies MSC: Integrated Process:
i vi vi vi vi
Communication and Documentation vi vi
◦ NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation vi vi vi vi vi vi vi
◦
◦ A nurse wishes to provide client- vi vi vi vi vi
centered care in all interactions. Which action by the nurse best demonst
vi vi vi vi vi vi vi vi vi vi vi
rates this concept? vi vi
◦ Assesses for cultural influences affecting health care vi vi vi vi vi vi
◦ Ensures that all the clients basic needs are met
vi vi vi vi vi vi vi vi
◦ Tells the client and family about all upcoming tests
vi vi vi vi vi vi vi vi
◦
Thoroughly orients the client and vi vi vi vi v
family to the room ANS: A
i vi vi vi vi vi
◦ Competency in client- vi vi
focused care is demonstrated when the nurse focuses on communication, culture, r
vi vi vi vi vi vi vi vi vi vi vi
espect, compassion, client education, and empowerment. By assessing the effect of
vi vi vi vi vi vi vi vi vi vi
the
vi
◦
◦ clients culture on health care, this nurse is practicing client- vi vi vi vi vi vi vi vi vi
focused care. Providing for basic needs does not demonstrate this competence. Simpl
vi vi vi vi v i vi vi vi vi vi vi
y telling the client about all upcoming tests is not providing empowering education. O
vi vi vi vi vi vi vi vi vi vi vi vi vi
rienting the client and family to the room is an important safety measure, but not direc
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
tly related to demonstrating client-centered care.
v i vi vi vi v i
◦ DIF: Understanding/Comprehension REF: 3
vi vi vi
, ◦ KEY: Patient- vi
centered care| culture MSC: Integrated Process: Caring N
vi vi vi vi vi vi vi
OT: Client Needs Category:
vi vi vi
Psychosocial Integrity vi
◦ A client is going to be admitted for a scheduled surgical procedure. Which
vi vi vi vi vi vi vi vi vi vi vi vi vi
action does the nurse explain is the most important thing the client can do
vi vi vi vi vi vi vi vi vi vi vi vi vi v i
to protect against errors?
vi vi vi
◦ Bring a list of all medications and what they are for.
vi vi vi vi vi vi vi vi vi vi
◦ Keep the doctors phone number by the telephone.
vi vi vi vi vi vi vi
◦ Make sure all providers wash hands before entering the room.
vi vi vi vi vi vi vi vi v i
◦
Write down the name of each caregiver who vi vi vi vi vi vi vi v
comes in the room. ANS: A i vi vi vi vi vi
◦ Medication errors are the most common type of health care mistake. T vi vi vi vi vi vi vi vi vi vi vi
he Joint Commissions Speak Up campaign encourages clients to help ensure their safe
vi vi vi vi vi vi vi vi vi vi vi vi
ty. One recommendation is for clients to know all their medications and why they take
vi vi vi vi vi vi vi vi vi vi vi vi vi vi
them. This will help prevent medication errors.
vi vi vi vi vi vi vi
◦ DIF: Applying/Application REF: 4
vi vi vi
◦ KEY: Speak Up campaign| patient safety MSC: Integrated Pro vi vi vi vi vi vi vi vi
cess: Teaching/Learning NOT: Client Needs Category: Safe and Effective Car
vi vi vi vi vi vi vi vi vi
e Environment: Safety and Infection Control
vi vi vi vi vi
◦ Which action by the nurse working with a client best demonstrates respect for
vi vi vi vi vi vi vi vi vi vi vi vi v i
autonomy?
◦ Asks if the client has questions before signing a consent
vi vi vi vi vi vi vi vi vi
◦ Gives the client accurate information when questioned
vi vi vi vi vi vi
◦ Keeps the promises made to the client and family
vi vi vi vi vi vi vi vi
Treats the client fairly co ◦ vi vi vi vi
mpared to other clients A vi vi vi vi
NS: A vi
◦ Autonomy is self- vi vi
determination. The client should make decisions regarding care. When the nurse obtain
vi vi vi vi vi vi vi vi vi vi vi
s a signature on the consent form, assessing if the client still has questions is vital, be
vi vi vi vi vi vi vi vi v i vi vi vi vi vi vi vi
cause without full information the client cannot practice autonomy. Giving accurate inf
vi vi vi vi vi vi vi vi vi vi vi
ormation is practicing with veracity. Keeping promises is upholding fidelity. Treating t
vi vi vi vi vi vi vi vi vi vi vi
he
◦
◦ client fairly is providing social justice.
vi vi vi vi vi
◦
◦ DIF: Applying/Application REF: 4
vi vi vi
◦ KEY: Autonomy| ethical principles MSC: Integrated Process: Caring
vi vi vi vi vi vi vi
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
vi vi vi vi vi vi vi vi vi
of Care vi
vi vi vi vi vi vi vi vi
Chapter 1 vi Concepts and Trends in Healthcare vi vi vi vi
◦ A new nurse is working with a preceptor on an inpatient medical-
vi vi vi vi vi vi vi vi vi vi vi
surgical unit. The preceptor advises the student that which is the priority when
vi vi vi vi vi vi vi vi vi vi vi vi vi
working as a professional nurse? vi vi vi vi
◦ Attending to holistic client needs vi vi vi vi
◦ Ensuring client safety vi vi
◦ Not making medication errors
vi vi vi
◦
Providing client- vi
focused care A vi vi vi
NS: B vi
◦ All actions are appropriate for the professional nurse. However, ensuri
vi vi vi vi vi vi vi vi v i
ng client safety is the priority. Up to 98,000 deaths result each year from errors in
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi v
hospital care, according to the 2000 Institute of Medicine report. Many more clients ha
i vi vi vi vi vi vi vi vi vi vi vi vi vi
ve suffered injuries and less serious outcomes. Every nurse has the responsibility to gu
vi vi vi vi vi vi vi vi vi vi vi vi vi
ard the clients safety.
vi vi vi
◦ DIF: Understanding/Comprehension REF: 2 vi vi vi vi
KEY: Patient safety MSC: Integrated Process: Nursing Proc
vi vi vi vi vi vi vi
ess: Intervention
vi
◦ NOT: Client Needs Category: Safe and Effective Care vi vi vi vi vi vi vi vi
Environment: Safety and Infection Control vi vi vi vi
◦ A nurse is orienting a new client and family to the inpatient unit. What infor
vi vi vi vi vi vi vi vi vi vi vi vi vi vi
mation does the nurse provide to help the client promote his or her own safet
vi vi vi vi vi vi vi vi vi vi vi vi vi vi
y?
◦ Encourage the client and family to be active partners.
vi vi vi vi vi vi vi vi
◦ Have the client monitor hand hygiene in caregivers.
vi vi vi vi vi vi vi
◦ Offer the family the opportunity to stay with the client.
vi vi vi vi vi vi vi vi vi
◦
Tell the client to always wear his or
vi vi vi vi vi vi vi
her armband. ANS: A vi vi vi vi
◦ Each action could be important for the client or family to perform. H vi vi vi vi vi vi vi vi vi vi vi vi
owever, encouraging the client to be active in his or her health care as a partner is th
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
e most critical. The other actions are
vi vi vi vi vi vi
◦
◦ very limited in scope and do not provide the broad protection that vi vi vi vi vi vi vi vi vi vi vi vi
being active and involved does.
vi vi vi vi
◦ DIF: Understanding/Comprehension REF: 3 vi vi vi vi
KEY: Patient safety MSC: Integrated Process: Teaching/ Le
vi vi vi vi vi vi vi
arning
◦ NOT: Client Needs Category: Safe and Effective Care vi vi vi vi vi vi vi
,Environment: Safety and Infection Control vi vi vi vi
◦ A nurse is caring for a postoperative client on the surgical unit. The clients blood
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What act
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
ion by the nurse is best?
vi vi vi vi vi
◦ Call the Rapid Response Team.
vi vi vi vi
◦ Document and continue to monitor. vi vi vi vi
◦ Notify the primary care provider. vi vi vi vi
◦
Repeat blood pressure measurement vi vi vi vi
in 15 minutes. ANS: A vi vi vi vi
◦ The purpose of the Rapid Response Team (RRT) is to intervene when cl vi vi vi vi vi vi vi vi vi vi vi vi
ients are deteriorating before they suffer either respiratory or cardiac arrest. Since the cl
vi vi vi vi vi vi vi vi vi vi vi vi vi
ient has manifested a significant change, the nurse should call the RRT. Changes in blo
vi vi vi vi vi vi vi vi vi vi vi vi vi vi
od pressure, mental status, heart rate, and pain are particularly significant. Documentati
vi vi vi vi vi vi vi vi vi vi vi
on is vital, but the nurse must do more than document. The primary care provider shoul
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
d be notified, but this is not the priority over calling the RRT. The clients blood pres
vi vi vi vi vi vi vi vi vi vi v i vi vi v i vi vi
sure should be reassessed frequently, but the priority is getting
vi vi vi vi vi vi vi vi vi
the rapid care to the client. vi vi vi vi vi
◦ DIF: Applying/Application REF: 3
vi vi vi
◦ KEY: Rapid Response Team (RRT)| vi vi vi vi v
medical emergencies MSC: Integrated Process:
i vi vi vi vi
Communication and Documentation vi vi
◦ NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation vi vi vi vi vi vi vi
◦
◦ A nurse wishes to provide client- vi vi vi vi vi
centered care in all interactions. Which action by the nurse best demonst
vi vi vi vi vi vi vi vi vi vi vi
rates this concept? vi vi
◦ Assesses for cultural influences affecting health care vi vi vi vi vi vi
◦ Ensures that all the clients basic needs are met
vi vi vi vi vi vi vi vi
◦ Tells the client and family about all upcoming tests
vi vi vi vi vi vi vi vi
◦
Thoroughly orients the client and vi vi vi vi v
family to the room ANS: A
i vi vi vi vi vi
◦ Competency in client- vi vi
focused care is demonstrated when the nurse focuses on communication, culture, r
vi vi vi vi vi vi vi vi vi vi vi
espect, compassion, client education, and empowerment. By assessing the effect of
vi vi vi vi vi vi vi vi vi vi
the
vi
◦
◦ clients culture on health care, this nurse is practicing client- vi vi vi vi vi vi vi vi vi
focused care. Providing for basic needs does not demonstrate this competence. Simpl
vi vi vi vi v i vi vi vi vi vi vi
y telling the client about all upcoming tests is not providing empowering education. O
vi vi vi vi vi vi vi vi vi vi vi vi vi
rienting the client and family to the room is an important safety measure, but not direc
vi vi vi vi vi vi vi vi vi vi vi vi vi vi vi
tly related to demonstrating client-centered care.
v i vi vi vi v i
◦ DIF: Understanding/Comprehension REF: 3
vi vi vi
, ◦ KEY: Patient- vi
centered care| culture MSC: Integrated Process: Caring N
vi vi vi vi vi vi vi
OT: Client Needs Category:
vi vi vi
Psychosocial Integrity vi
◦ A client is going to be admitted for a scheduled surgical procedure. Which
vi vi vi vi vi vi vi vi vi vi vi vi vi
action does the nurse explain is the most important thing the client can do
vi vi vi vi vi vi vi vi vi vi vi vi vi v i
to protect against errors?
vi vi vi
◦ Bring a list of all medications and what they are for.
vi vi vi vi vi vi vi vi vi vi
◦ Keep the doctors phone number by the telephone.
vi vi vi vi vi vi vi
◦ Make sure all providers wash hands before entering the room.
vi vi vi vi vi vi vi vi v i
◦
Write down the name of each caregiver who vi vi vi vi vi vi vi v
comes in the room. ANS: A i vi vi vi vi vi
◦ Medication errors are the most common type of health care mistake. T vi vi vi vi vi vi vi vi vi vi vi
he Joint Commissions Speak Up campaign encourages clients to help ensure their safe
vi vi vi vi vi vi vi vi vi vi vi vi
ty. One recommendation is for clients to know all their medications and why they take
vi vi vi vi vi vi vi vi vi vi vi vi vi vi
them. This will help prevent medication errors.
vi vi vi vi vi vi vi
◦ DIF: Applying/Application REF: 4
vi vi vi
◦ KEY: Speak Up campaign| patient safety MSC: Integrated Pro vi vi vi vi vi vi vi vi
cess: Teaching/Learning NOT: Client Needs Category: Safe and Effective Car
vi vi vi vi vi vi vi vi vi
e Environment: Safety and Infection Control
vi vi vi vi vi
◦ Which action by the nurse working with a client best demonstrates respect for
vi vi vi vi vi vi vi vi vi vi vi vi v i
autonomy?
◦ Asks if the client has questions before signing a consent
vi vi vi vi vi vi vi vi vi
◦ Gives the client accurate information when questioned
vi vi vi vi vi vi
◦ Keeps the promises made to the client and family
vi vi vi vi vi vi vi vi
Treats the client fairly co ◦ vi vi vi vi
mpared to other clients A vi vi vi vi
NS: A vi
◦ Autonomy is self- vi vi
determination. The client should make decisions regarding care. When the nurse obtain
vi vi vi vi vi vi vi vi vi vi vi
s a signature on the consent form, assessing if the client still has questions is vital, be
vi vi vi vi vi vi vi vi v i vi vi vi vi vi vi vi
cause without full information the client cannot practice autonomy. Giving accurate inf
vi vi vi vi vi vi vi vi vi vi vi
ormation is practicing with veracity. Keeping promises is upholding fidelity. Treating t
vi vi vi vi vi vi vi vi vi vi vi
he
◦
◦ client fairly is providing social justice.
vi vi vi vi vi
◦
◦ DIF: Applying/Application REF: 4
vi vi vi
◦ KEY: Autonomy| ethical principles MSC: Integrated Process: Caring
vi vi vi vi vi vi vi
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
vi vi vi vi vi vi vi vi vi
of Care vi
