TEST BANK FOR Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care 11th edition by Donna D. Ignatavicius ISBN: 978-0323878265 COMPLETE GUIDE WITH RATIONALES 100% VERIFIED

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, Overview of Professional Nursing Concepts for Medical- $@ $@ $@ $@ $@ $@




Surgical Nursing
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MULTIPLE CHOICE $@




1. A nurse wishes to provide client-
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centered care in all interactions. Which action by the nurse best demonstrates this concept?
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a. Assesses for cultural influences affecting health care
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b. Ensures that all the clients basic needs are met
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c. Tells the client and family about all upcoming tests
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d. Thoroughly orients the client and family to the room
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ANS: A $@


Rationale
Competency in client- $@ $@


focused care is demonstrated when the nurse focuses on communication, culture, respect compassion,
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@client ed ucation, and empowerment. By assessing the effect of the clients culture on health care,
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@ this nurse is practici ng client-
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focused care. Providing for basic needs does not demonstrate this competence.
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Simply telling the client about all upcoming tests is not providing empowering education. Orienting
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the client and family to the room is an important safety measure, but not directly related to demon
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strating client- centered care.
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DIF: Understanding/Comprehension REF: 3
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KEY: Patient-
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centered care| culture MSC: Integrated Process: Caring NOT: Client
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@N eeds Category: Psychosocial Integrity
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2. A nurse is caring for a postoperative client on the surgical unit. The clients blood pressure was
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@142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is best?
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a. Call the Rapid Response Team.
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b. Document and continue to monitor. $@ $@ $@ $@


c. Notify the primary care provider.
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d. Repeat blood pressure measurement in 15 minutes.
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ANS: A $@


Rationale
The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteri
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orating before they suffer either respiratory or cardiac arrest. Since the client has manifested a sign
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ificant change, the nurse s hould call the RRT. Changes in blood pressure, mental status, heart rat
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e, and pain are particularly significant. Documentation is vital, but the nurse must do more than do
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cument. The primary care provider should be no tified, but this is not the priority over calling the
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RRT. The clients blood pressure should be reassessed freq uently, but the priority is getting the rapi
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d care to the client.
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DIF: Applying/Application REF: 3
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KEY: Rapid Response Team (RRT)| medical emergencies
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MS C: Integrated Process: Communication and Documentati
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on
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
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3. A nurse is orienting a new client and family to the inpatient unit. What information does the nurse p
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rovide to h elp the client promote his or her own safety?
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a. Encourage the client and family to be active partners.
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b. Have the client monitor hand hygiene in caregivers.
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c. Offer the family the opportunity to stay with the client.
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d. Tell the client to always wear his or her armband.
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ANS: A $@


Rationale