Davis Advantage for Medical-Surgical Nursing,
3rd Edition
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy Sullivan
Chapter 1: Foundations for Medical-Surgical Nursing
Question 1
A newly licensed registered nurse is orienting to a medical-surgical unit. Which action best
demonstrates the competency of clinical judgment?
A. Completing all assigned tasks according to the unit routine
B. Comparing the patient's current findings with the patient's baseline and determining
whether a change requires intervention
C. Asking the charge nurse to make all decisions involving changes in patient condition
D. Following a previous nurse's plan of care without modification
Correct Answer: B
Rationale:
Clinical judgment requires the nurse to notice relevant clinical information, interpret its
significance, determine priorities, and make an appropriate decision. Comparing current
findings with a patient's baseline helps the nurse recognize meaningful changes and
determine whether additional assessment or intervention is needed. Clinical judgment is
more than completing routine tasks; it requires active interpretation and decision-making.
Why the other options are incorrect:
• A: Completing routine tasks is necessary, but task completion alone does not
demonstrate clinical judgment.
1
, • B: Correct. Comparing current findings with baseline data is an important part of
recognizing and analyzing cues.
• C: The RN remains accountable for exercising independent nursing judgment within
the nurse's scope of practice.
• D: Plans of care must be individualized and updated as patient needs change.
Cognitive Level: Application
NCLEX Client-Needs Category: Management of Care
Nursing Process: Assessment
CJMM Focus: Recognize Cues
Question 2
Which statement best describes the primary focus of patient-centered care in the
medical-surgical setting?
A. Making decisions according to standardized routines whenever possible
B. Ensuring that the health care team determines the treatment plan without patient
involvement
C. Adapting care to the patient's preferences, values, needs, and goals while maintaining
safety
D. Giving each patient identical interventions to promote fairness
Correct Answer: C
Rationale:
Patient-centered care recognizes the patient as an active participant in health care
decisions. The nurse incorporates the patient's preferences, values, cultural
considerations, goals, and individual needs into the plan of care while maintaining
evidence-based and safe practice. Individualization is essential because patients with the
same diagnosis may have different priorities and responses to treatment.
Why the other options are incorrect:
• A: Standardized procedures promote consistency and safety but should not replace
individualized care.
• B: Patients should be included in decisions whenever they are able and willing to
participate.
• C: Correct. This reflects the central principles of patient-centered care.
2
, • D: Identical interventions do not account for individual differences in health status
or preferences.
Cognitive Level: Recall
NCLEX Client-Needs Category: Psychosocial Integrity
Nursing Process: Planning
Question 3
The nurse is reviewing the concept of evidence-based nursing care with a group of nursing
students. Which combination best represents evidence-based practice?
A. Clinical experience, physician preference, and unit tradition
B. Research evidence, clinical expertise, and patient preferences and values
C. Textbook recommendations, patient age, and nurse preference
D. Hospital policy, routine practice, and patient diagnosis
Correct Answer: B
Rationale:
Evidence-based nursing integrates the best available research evidence with professional
clinical expertise and the patient's preferences, values, and circumstances. This approach
supports informed, individualized, and scientifically supported nursing decisions.
Evidence-based care is not simply following tradition or choosing an intervention because
it has been used for a long time.
Why the other options are incorrect:
• A: Clinical experience can contribute to decision-making, but physician preference
and tradition alone do not constitute evidence-based practice.
• B: Correct. These are the major components of evidence-based practice.
• C: Patient age and diagnosis are clinically relevant, but textbook recommendations
and nurse preference alone do not constitute evidence-based practice.
• D: Policies and routines may guide practice but are not, by themselves, sufficient to
establish that care is evidence based.
Cognitive Level: Recall
NCLEX Client-Needs Category: Management of Care
Nursing Process: Planning
Question 4
3
, A medical-surgical nurse receives report on four patients. Which patient should the nurse
assess first?
A. A patient with chronic osteoarthritis reporting pain of 6/10 who requests PRN analgesia
B. A patient with newly diagnosed diabetes who is asking questions about dietary choices
C. A postoperative patient who is restless, has a respiratory rate of 30/min, and has an
oxygen saturation of 88% on the prescribed oxygen
D. A patient awaiting discharge who needs instructions about a follow-up appointment
Correct Answer: C
Rationale:
The postoperative patient has an acute change in respiratory status indicated by
tachypnea, hypoxemia, and restlessness. Restlessness may be an early sign of inadequate
oxygenation. This patient is potentially unstable and requires immediate assessment and
intervention. The other patients have needs that are important but do not currently indicate
an immediate threat to physiologic stability.
Why the other options are incorrect:
• A: Pain requires assessment and treatment, but the reported chronic pain does not
indicate the same immediate threat to life as acute hypoxemia.
• B: Diabetes education is important but can safely wait until the unstable patient is
assessed.
• C: Correct. The patient's respiratory compromise requires immediate attention.
• D: Discharge teaching is important but is not the priority over acute respiratory
deterioration.
Cognitive Level: Analysis
NCLEX Client-Needs Category: Physiological Adaptation
Nursing Process: Assessment
CJMM Focus: Prioritize Hypotheses
Question 5
The nurse is caring for an older adult who has multiple chronic conditions. Which action
best demonstrates effective interprofessional collaboration?
A. Asking another nurse to independently choose the patient's treatment goals
B. Communicating relevant assessment findings to the health care team and incorporating
recommendations into the patient's plan of care
4
3rd Edition
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy Sullivan
Chapter 1: Foundations for Medical-Surgical Nursing
Question 1
A newly licensed registered nurse is orienting to a medical-surgical unit. Which action best
demonstrates the competency of clinical judgment?
A. Completing all assigned tasks according to the unit routine
B. Comparing the patient's current findings with the patient's baseline and determining
whether a change requires intervention
C. Asking the charge nurse to make all decisions involving changes in patient condition
D. Following a previous nurse's plan of care without modification
Correct Answer: B
Rationale:
Clinical judgment requires the nurse to notice relevant clinical information, interpret its
significance, determine priorities, and make an appropriate decision. Comparing current
findings with a patient's baseline helps the nurse recognize meaningful changes and
determine whether additional assessment or intervention is needed. Clinical judgment is
more than completing routine tasks; it requires active interpretation and decision-making.
Why the other options are incorrect:
• A: Completing routine tasks is necessary, but task completion alone does not
demonstrate clinical judgment.
1
, • B: Correct. Comparing current findings with baseline data is an important part of
recognizing and analyzing cues.
• C: The RN remains accountable for exercising independent nursing judgment within
the nurse's scope of practice.
• D: Plans of care must be individualized and updated as patient needs change.
Cognitive Level: Application
NCLEX Client-Needs Category: Management of Care
Nursing Process: Assessment
CJMM Focus: Recognize Cues
Question 2
Which statement best describes the primary focus of patient-centered care in the
medical-surgical setting?
A. Making decisions according to standardized routines whenever possible
B. Ensuring that the health care team determines the treatment plan without patient
involvement
C. Adapting care to the patient's preferences, values, needs, and goals while maintaining
safety
D. Giving each patient identical interventions to promote fairness
Correct Answer: C
Rationale:
Patient-centered care recognizes the patient as an active participant in health care
decisions. The nurse incorporates the patient's preferences, values, cultural
considerations, goals, and individual needs into the plan of care while maintaining
evidence-based and safe practice. Individualization is essential because patients with the
same diagnosis may have different priorities and responses to treatment.
Why the other options are incorrect:
• A: Standardized procedures promote consistency and safety but should not replace
individualized care.
• B: Patients should be included in decisions whenever they are able and willing to
participate.
• C: Correct. This reflects the central principles of patient-centered care.
2
, • D: Identical interventions do not account for individual differences in health status
or preferences.
Cognitive Level: Recall
NCLEX Client-Needs Category: Psychosocial Integrity
Nursing Process: Planning
Question 3
The nurse is reviewing the concept of evidence-based nursing care with a group of nursing
students. Which combination best represents evidence-based practice?
A. Clinical experience, physician preference, and unit tradition
B. Research evidence, clinical expertise, and patient preferences and values
C. Textbook recommendations, patient age, and nurse preference
D. Hospital policy, routine practice, and patient diagnosis
Correct Answer: B
Rationale:
Evidence-based nursing integrates the best available research evidence with professional
clinical expertise and the patient's preferences, values, and circumstances. This approach
supports informed, individualized, and scientifically supported nursing decisions.
Evidence-based care is not simply following tradition or choosing an intervention because
it has been used for a long time.
Why the other options are incorrect:
• A: Clinical experience can contribute to decision-making, but physician preference
and tradition alone do not constitute evidence-based practice.
• B: Correct. These are the major components of evidence-based practice.
• C: Patient age and diagnosis are clinically relevant, but textbook recommendations
and nurse preference alone do not constitute evidence-based practice.
• D: Policies and routines may guide practice but are not, by themselves, sufficient to
establish that care is evidence based.
Cognitive Level: Recall
NCLEX Client-Needs Category: Management of Care
Nursing Process: Planning
Question 4
3
, A medical-surgical nurse receives report on four patients. Which patient should the nurse
assess first?
A. A patient with chronic osteoarthritis reporting pain of 6/10 who requests PRN analgesia
B. A patient with newly diagnosed diabetes who is asking questions about dietary choices
C. A postoperative patient who is restless, has a respiratory rate of 30/min, and has an
oxygen saturation of 88% on the prescribed oxygen
D. A patient awaiting discharge who needs instructions about a follow-up appointment
Correct Answer: C
Rationale:
The postoperative patient has an acute change in respiratory status indicated by
tachypnea, hypoxemia, and restlessness. Restlessness may be an early sign of inadequate
oxygenation. This patient is potentially unstable and requires immediate assessment and
intervention. The other patients have needs that are important but do not currently indicate
an immediate threat to physiologic stability.
Why the other options are incorrect:
• A: Pain requires assessment and treatment, but the reported chronic pain does not
indicate the same immediate threat to life as acute hypoxemia.
• B: Diabetes education is important but can safely wait until the unstable patient is
assessed.
• C: Correct. The patient's respiratory compromise requires immediate attention.
• D: Discharge teaching is important but is not the priority over acute respiratory
deterioration.
Cognitive Level: Analysis
NCLEX Client-Needs Category: Physiological Adaptation
Nursing Process: Assessment
CJMM Focus: Prioritize Hypotheses
Question 5
The nurse is caring for an older adult who has multiple chronic conditions. Which action
best demonstrates effective interprofessional collaboration?
A. Asking another nurse to independently choose the patient's treatment goals
B. Communicating relevant assessment findings to the health care team and incorporating
recommendations into the patient's plan of care
4
