, ◦ Timby's Introductory Medical-Surgical Nursing 13th Edition Moreno Test Bank
7i 7i 7i 7i 7i 7i 7i 7i
Chapter 1 7i Concepts and Trends in Healthcare 7i 7i 7i 7i
◦ A new nurse is working with a preceptor on an inpatient medical-
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
surgical unit. The preceptor advises the student that which is the priority when
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
working as a professional nurse? 7i 7i 7i 7i
◦ Attending to holistic client needs 7i 7i 7i 7i
◦ Ensuring client safety 7i 7i
◦ Not making medication errors
7i 7i 7i
◦
Providing client- 7i
focused care A 7i 7i 7i
NS: B 7i
◦ All actions are appropriate for the professional nurse. However, ensuri
7i 7i 7i 7i 7i 7i 7i 7i 7 i
ng client safety is the priority. Up to 98,000 deaths result each year from errors in
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7
hospital care, according to the 2000 Institute of Medicine report. Many more clients ha
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ve suffered injuries and less serious outcomes. Every nurse has the responsibility to gu
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ard the clients safety.
7i 7i 7i
◦ DIF: Understanding/Comprehension REF: 2 7i 7i 7i 7i
KEY: Patient safety MSC: Integrated Process: Nursing Proc
7i 7i 7i 7i 7i 7i 7i
ess: Intervention
7i
◦ NOT: Client Needs Category: Safe and Effective Care 7i 7i 7i 7i 7i 7i 7i 7i
Environment: Safety and Infection Control 7i 7i 7i 7i
◦ A nurse is orienting a new client and family to the inpatient unit. What infor
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
mation does the nurse provide to help the client promote his or her own safet
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
y?
◦ Encourage the client and family to be active partners.
7i 7i 7i 7i 7i 7i 7i 7i
◦ Have the client monitor hand hygiene in caregivers.
7i 7i 7i 7i 7i 7i 7i
◦ Offer the family the opportunity to stay with the client.
7i 7i 7i 7i 7i 7i 7i 7i 7i
◦
Tell the client to always wear his or
7i 7i 7i 7i 7i 7i 7i
her armband. ANS: A 7i 7i 7i 7i
◦ Each action could be important for the client or family to perform. H 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
owever, encouraging the client to be active in his or her health care as a partner is th
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
e most critical. The other actions are
7i 7i 7i 7i 7i 7i
◦
◦ very limited in scope and do not provide the broad protection that 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
being active and involved does.
7i 7i 7i 7i
◦ DIF: Understanding/Comprehension REF: 3 7i 7i 7i 7i
KEY: Patient safety MSC: Integrated Process: Teaching/ Le
7i 7i 7i 7i 7i 7i 7i
arning
◦ NOT: Client Needs Category: Safe and Effective Care 7i 7i 7i 7i 7i 7i 7i
,Environment: Safety and Infection Control 7i 7i 7i 7i
◦ A nurse is caring for a postoperative client on the surgical unit. The clients blood
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What act
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ion by the nurse is best?
7i 7i 7i 7i 7i
◦ Call the Rapid Response Team.
7i 7i 7i 7i
◦ Document and continue to monitor. 7i 7i 7i 7i
◦ Notify the primary care provider. 7i 7i 7i 7i
◦
Repeat blood pressure measurement 7i 7i 7i 7i
in 15 minutes. ANS: A 7i 7i 7i 7i
◦ The purpose of the Rapid Response Team (RRT) is to intervene when cl 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ients are deteriorating before they suffer either respiratory or cardiac arrest. Since the cl
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ient has manifested a significant change, the nurse should call the RRT. Changes in blo
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
od pressure, mental status, heart rate, and pain are particularly significant. Documentati
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
on is vital, but the nurse must do more than document. The primary care provider shoul
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
d be notified, but this is not the priority over calling the RRT. The clients blood pres
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7 i 7i 7i 7 i 7i 7i
sure should be reassessed frequently, but the priority is getting
7i 7i 7i 7i 7i 7i 7i 7i 7i
the rapid care to the client. 7i 7i 7i 7i 7i
◦ DIF: Applying/Application REF: 3
7i 7i 7i
◦ KEY: Rapid Response Team (RRT)| 7i 7i 7i 7i 7
medical emergencies MSC: Integrated Process:
i 7i 7i 7i 7i
Communication and Documentation 7i 7i
◦ NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 7i 7i 7i 7i 7i 7i 7i
◦
◦ A nurse wishes to provide client- 7i 7i 7i 7i 7i
centered care in all interactions. Which action by the nurse best demonst
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
rates this concept? 7i 7i
◦ Assesses for cultural influences affecting health care 7i 7i 7i 7i 7i 7i
◦ Ensures that all the clients basic needs are met
7i 7i 7i 7i 7i 7i 7i 7i
◦ Tells the client and family about all upcoming tests
7i 7i 7i 7i 7i 7i 7i 7i
◦
Thoroughly orients the client and 7i 7i 7i 7i 7
family to the room ANS: A
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◦ Competency in client- 7i 7i
focused care is demonstrated when the nurse focuses on communication, culture, r
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
espect, compassion, client education, and empowerment. By assessing the effect of
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the
7i
◦
◦ clients culture on health care, this nurse is practicing client- 7i 7i 7i 7i 7i 7i 7i 7i 7i
focused care. Providing for basic needs does not demonstrate this competence. Simpl
7i 7i 7i 7i 7 i 7i 7i 7i 7i 7i 7i
y telling the client about all upcoming tests is not providing empowering education. O
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
rienting the client and family to the room is an important safety measure, but not direc
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
tly related to demonstrating client-centered care.
7 i 7i 7i 7i 7 i
◦ DIF: Understanding/Comprehension REF: 3
7i 7i 7i
, ◦ KEY: Patient- 7i
centered care| culture MSC: Integrated Process: Caring N
7i 7i 7i 7i 7i 7i 7i
OT: Client Needs Category:
7i 7i 7i
Psychosocial Integrity 7i
◦ A client is going to be admitted for a scheduled surgical procedure. Which
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
action does the nurse explain is the most important thing the client can do
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7 i
to protect against errors?
7i 7i 7i
◦ Bring a list of all medications and what they are for.
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
◦ Keep the doctors phone number by the telephone.
7i 7i 7i 7i 7i 7i 7i
◦ Make sure all providers wash hands before entering the room.
7i 7i 7i 7i 7i 7i 7i 7i 7 i
◦
Write down the name of each caregiver who 7i 7i 7i 7i 7i 7i 7i 7
comes in the room. ANS: A
i 7i 7i 7i 7i 7i
◦ Medication errors are the most common type of health care mistake. T 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
he Joint Commissions Speak Up campaign encourages clients to help ensure their safe
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ty. One recommendation is for clients to know all their medications and why they take
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
them. This will help prevent medication errors.
7i 7i 7i 7i 7i 7i 7i
◦ DIF: Applying/Application REF: 4
7i 7i 7i
◦ KEY: Speak Up campaign| patient safety MSC: Integrated Pro 7i 7i 7i 7i 7i 7i 7i 7i
cess: Teaching/Learning NOT: Client Needs Category: Safe and Effective Car
7i 7i 7i 7i 7i 7i 7i 7i 7i
e Environment: Safety and Infection Control
7i 7i 7i 7i 7i
◦ Which action by the nurse working with a client best demonstrates respect for
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7 i
autonomy?
◦ Asks if the client has questions before signing a consent
7i 7i 7i 7i 7i 7i 7i 7i 7i
◦ Gives the client accurate information when questioned
7i 7i 7i 7i 7i 7i
◦ Keeps the promises made to the client and family
7i 7i 7i 7i 7i 7i 7i 7i
Treats the client fairly co◦ 7i 7i 7i 7i
mpared to other clients A 7i 7i 7i 7i
NS: A 7i
◦ Autonomy is self- 7i 7i
determination. The client should make decisions regarding care. When the nurse obtain
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
s a signature on the consent form, assessing if the client still has questions is vital, be
7i 7i 7i 7i 7i 7i 7i 7i 7 i 7i 7i 7i 7i 7i 7i 7i
cause without full information the client cannot practice autonomy. Giving accurate inf
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ormation is practicing with veracity. Keeping promises is upholding fidelity. Treating t
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
he
◦
◦ client fairly is providing social justice.
7i 7i 7i 7i 7i
◦
◦ DIF: Applying/Application REF: 4
7i 7i 7i
◦ KEY: Autonomy| ethical principles MSC: Integrated Process: Caring
7i 7i 7i 7i 7i 7i 7i
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
7i 7i 7i 7i 7i 7i 7i 7i 7i
of Care 7i
7i 7i 7i 7i 7i 7i 7i 7i
Chapter 1 7i Concepts and Trends in Healthcare 7i 7i 7i 7i
◦ A new nurse is working with a preceptor on an inpatient medical-
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
surgical unit. The preceptor advises the student that which is the priority when
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
working as a professional nurse? 7i 7i 7i 7i
◦ Attending to holistic client needs 7i 7i 7i 7i
◦ Ensuring client safety 7i 7i
◦ Not making medication errors
7i 7i 7i
◦
Providing client- 7i
focused care A 7i 7i 7i
NS: B 7i
◦ All actions are appropriate for the professional nurse. However, ensuri
7i 7i 7i 7i 7i 7i 7i 7i 7 i
ng client safety is the priority. Up to 98,000 deaths result each year from errors in
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7
hospital care, according to the 2000 Institute of Medicine report. Many more clients ha
i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ve suffered injuries and less serious outcomes. Every nurse has the responsibility to gu
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ard the clients safety.
7i 7i 7i
◦ DIF: Understanding/Comprehension REF: 2 7i 7i 7i 7i
KEY: Patient safety MSC: Integrated Process: Nursing Proc
7i 7i 7i 7i 7i 7i 7i
ess: Intervention
7i
◦ NOT: Client Needs Category: Safe and Effective Care 7i 7i 7i 7i 7i 7i 7i 7i
Environment: Safety and Infection Control 7i 7i 7i 7i
◦ A nurse is orienting a new client and family to the inpatient unit. What infor
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
mation does the nurse provide to help the client promote his or her own safet
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
y?
◦ Encourage the client and family to be active partners.
7i 7i 7i 7i 7i 7i 7i 7i
◦ Have the client monitor hand hygiene in caregivers.
7i 7i 7i 7i 7i 7i 7i
◦ Offer the family the opportunity to stay with the client.
7i 7i 7i 7i 7i 7i 7i 7i 7i
◦
Tell the client to always wear his or
7i 7i 7i 7i 7i 7i 7i
her armband. ANS: A 7i 7i 7i 7i
◦ Each action could be important for the client or family to perform. H 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
owever, encouraging the client to be active in his or her health care as a partner is th
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
e most critical. The other actions are
7i 7i 7i 7i 7i 7i
◦
◦ very limited in scope and do not provide the broad protection that 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
being active and involved does.
7i 7i 7i 7i
◦ DIF: Understanding/Comprehension REF: 3 7i 7i 7i 7i
KEY: Patient safety MSC: Integrated Process: Teaching/ Le
7i 7i 7i 7i 7i 7i 7i
arning
◦ NOT: Client Needs Category: Safe and Effective Care 7i 7i 7i 7i 7i 7i 7i
,Environment: Safety and Infection Control 7i 7i 7i 7i
◦ A nurse is caring for a postoperative client on the surgical unit. The clients blood
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What act
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ion by the nurse is best?
7i 7i 7i 7i 7i
◦ Call the Rapid Response Team.
7i 7i 7i 7i
◦ Document and continue to monitor. 7i 7i 7i 7i
◦ Notify the primary care provider. 7i 7i 7i 7i
◦
Repeat blood pressure measurement 7i 7i 7i 7i
in 15 minutes. ANS: A 7i 7i 7i 7i
◦ The purpose of the Rapid Response Team (RRT) is to intervene when cl 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ients are deteriorating before they suffer either respiratory or cardiac arrest. Since the cl
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ient has manifested a significant change, the nurse should call the RRT. Changes in blo
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
od pressure, mental status, heart rate, and pain are particularly significant. Documentati
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
on is vital, but the nurse must do more than document. The primary care provider shoul
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
d be notified, but this is not the priority over calling the RRT. The clients blood pres
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7 i 7i 7i 7 i 7i 7i
sure should be reassessed frequently, but the priority is getting
7i 7i 7i 7i 7i 7i 7i 7i 7i
the rapid care to the client. 7i 7i 7i 7i 7i
◦ DIF: Applying/Application REF: 3
7i 7i 7i
◦ KEY: Rapid Response Team (RRT)| 7i 7i 7i 7i 7
medical emergencies MSC: Integrated Process:
i 7i 7i 7i 7i
Communication and Documentation 7i 7i
◦ NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 7i 7i 7i 7i 7i 7i 7i
◦
◦ A nurse wishes to provide client- 7i 7i 7i 7i 7i
centered care in all interactions. Which action by the nurse best demonst
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
rates this concept? 7i 7i
◦ Assesses for cultural influences affecting health care 7i 7i 7i 7i 7i 7i
◦ Ensures that all the clients basic needs are met
7i 7i 7i 7i 7i 7i 7i 7i
◦ Tells the client and family about all upcoming tests
7i 7i 7i 7i 7i 7i 7i 7i
◦
Thoroughly orients the client and 7i 7i 7i 7i 7
family to the room ANS: A
i 7i 7i 7i 7i 7i
◦ Competency in client- 7i 7i
focused care is demonstrated when the nurse focuses on communication, culture, r
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
espect, compassion, client education, and empowerment. By assessing the effect of
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
the
7i
◦
◦ clients culture on health care, this nurse is practicing client- 7i 7i 7i 7i 7i 7i 7i 7i 7i
focused care. Providing for basic needs does not demonstrate this competence. Simpl
7i 7i 7i 7i 7 i 7i 7i 7i 7i 7i 7i
y telling the client about all upcoming tests is not providing empowering education. O
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
rienting the client and family to the room is an important safety measure, but not direc
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
tly related to demonstrating client-centered care.
7 i 7i 7i 7i 7 i
◦ DIF: Understanding/Comprehension REF: 3
7i 7i 7i
, ◦ KEY: Patient- 7i
centered care| culture MSC: Integrated Process: Caring N
7i 7i 7i 7i 7i 7i 7i
OT: Client Needs Category:
7i 7i 7i
Psychosocial Integrity 7i
◦ A client is going to be admitted for a scheduled surgical procedure. Which
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
action does the nurse explain is the most important thing the client can do
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7 i
to protect against errors?
7i 7i 7i
◦ Bring a list of all medications and what they are for.
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
◦ Keep the doctors phone number by the telephone.
7i 7i 7i 7i 7i 7i 7i
◦ Make sure all providers wash hands before entering the room.
7i 7i 7i 7i 7i 7i 7i 7i 7 i
◦
Write down the name of each caregiver who 7i 7i 7i 7i 7i 7i 7i 7
comes in the room. ANS: A
i 7i 7i 7i 7i 7i
◦ Medication errors are the most common type of health care mistake. T 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
he Joint Commissions Speak Up campaign encourages clients to help ensure their safe
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ty. One recommendation is for clients to know all their medications and why they take
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
them. This will help prevent medication errors.
7i 7i 7i 7i 7i 7i 7i
◦ DIF: Applying/Application REF: 4
7i 7i 7i
◦ KEY: Speak Up campaign| patient safety MSC: Integrated Pro 7i 7i 7i 7i 7i 7i 7i 7i
cess: Teaching/Learning NOT: Client Needs Category: Safe and Effective Car
7i 7i 7i 7i 7i 7i 7i 7i 7i
e Environment: Safety and Infection Control
7i 7i 7i 7i 7i
◦ Which action by the nurse working with a client best demonstrates respect for
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7 i
autonomy?
◦ Asks if the client has questions before signing a consent
7i 7i 7i 7i 7i 7i 7i 7i 7i
◦ Gives the client accurate information when questioned
7i 7i 7i 7i 7i 7i
◦ Keeps the promises made to the client and family
7i 7i 7i 7i 7i 7i 7i 7i
Treats the client fairly co◦ 7i 7i 7i 7i
mpared to other clients A 7i 7i 7i 7i
NS: A 7i
◦ Autonomy is self- 7i 7i
determination. The client should make decisions regarding care. When the nurse obtain
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
s a signature on the consent form, assessing if the client still has questions is vital, be
7i 7i 7i 7i 7i 7i 7i 7i 7 i 7i 7i 7i 7i 7i 7i 7i
cause without full information the client cannot practice autonomy. Giving accurate inf
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
ormation is practicing with veracity. Keeping promises is upholding fidelity. Treating t
7i 7i 7i 7i 7i 7i 7i 7i 7i 7i 7i
he
◦
◦ client fairly is providing social justice.
7i 7i 7i 7i 7i
◦
◦ DIF: Applying/Application REF: 4
7i 7i 7i
◦ KEY: Autonomy| ethical principles MSC: Integrated Process: Caring
7i 7i 7i 7i 7i 7i 7i
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
7i 7i 7i 7i 7i 7i 7i 7i 7i
of Care 7i
