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
Which competency best reflects the primary role of the medical-surgical nurse in
contemporary practice?
A. Completing routine tasks according to established schedules
B. Coordinating individualized care while applying clinical judgment
C. Delegating most direct-care responsibilities to assistive personnel
D. Following provider prescriptions without independent nursing analysis
Correct Answer: B
Rationale:
Medical-surgical nursing requires the nurse to integrate assessment findings, clinical
judgment, the nursing process, evidence-based practice, safety principles, and patient
preferences when coordinating care. The nurse does not merely complete tasks or follow
prescriptions; the nurse continuously evaluates patient needs and adapts care
accordingly.
Why the other options are incorrect:
• A: Task completion alone does not represent the broad clinical reasoning and
coordination expected of the medical-surgical nurse.
1
, • B: Correct. Coordinating individualized care while applying clinical judgment
reflects a central competency of medical-surgical nursing.
• C: Delegation is appropriate for selected activities, but the RN retains responsibility
for nursing judgment and appropriate supervision.
• D: Nurses independently assess patients and use professional judgment rather than
simply following medical prescriptions.
Cognitive Level: Recall
NCLEX Client-Needs Category: Management of Care
Nursing Process: Planning
Question 2
Which action is an example of evidence-based nursing care?
A. Using a long-standing unit practice because it is familiar
B. Selecting an intervention supported by current evidence, clinical expertise, and patient
preferences
C. Choosing the least expensive intervention regardless of effectiveness
D. Using an intervention primarily because a colleague recommends it
Correct Answer: B
Rationale:
Evidence-based nursing care integrates the best available evidence with clinical expertise
and the patient's values, preferences, and circumstances. Familiarity, cost, or informal
recommendations alone are insufficient foundations for evidence-based practice.
Why the other options are incorrect:
• A: A traditional practice may be appropriate, but tradition alone does not establish
effectiveness.
• B: Correct. This reflects the central elements of evidence-based nursing practice.
• C: Cost may be considered, but it should not replace evidence of safety and
effectiveness.
• D: A colleague's recommendation may be useful, but it is not a substitute for
critically evaluating evidence.
Cognitive Level: Recall
NCLEX Client-Needs Category: Management of Care
2
,Nursing Process: Planning
Question 3
Which nursing action best demonstrates patient-centered care in the medical-
surgical setting?
A. Selecting goals based primarily on the nurse's preferred outcomes
B. Providing the same teaching plan to every patient with the same diagnosis
C. Incorporating the patient's values and preferences into the plan of care
D. Asking family members to make decisions whenever the patient is hospitalized
Correct Answer: C
Rationale:
Patient-centered care recognizes the patient as an active partner in care. The nurse
incorporates the patient's values, preferences, concerns, goals, culture, and
circumstances into assessment, planning, implementation, and evaluation.
Why the other options are incorrect:
• A: The patient's goals and preferences must be incorporated rather than replaced by
the nurse's preferences.
• B: Patients with the same diagnosis may have different needs, abilities, beliefs, and
priorities.
• C: Correct. Shared involvement of the patient is central to patient-centered care.
• D: Family participation can be valuable, but the patient should remain involved in
decision-making when able.
Cognitive Level: Recall
NCLEX Client-Needs Category: Psychosocial Integrity
Nursing Process: Planning
Question 4
A 68-year-old patient is admitted with pneumonia. The patient has a temperature of 38.4°C
(101.1°F), respiratory rate of 28/min, oxygen saturation of 89% on room air, and new
confusion. Which action should the nurse take first?
A. Review the patient's home medication list
B. Encourage the patient to increase oral fluid intake
3
, C. Apply oxygen and immediately reassess respiratory status
D. Document the findings and continue the admission assessment
Correct Answer: C
Rationale:
The patient has evidence of impaired oxygenation with tachypnea, low oxygen saturation,
and acute mental-status change. Oxygenation is an immediate priority. The nurse should
initiate appropriate supportive care and promptly reassess the patient's response while
escalating care as indicated.
Why the other options are incorrect:
• A: Medication history is important but is not the immediate priority in a patient with
impaired oxygenation.
• B: Fluids may be appropriate later, but they do not address the immediate
oxygenation problem.
• C: Correct. Supporting oxygenation and reassessing the response addresses the
most urgent clinical problem.
• D: Documentation should not delay treatment of an unstable patient.
Cognitive Level: Application
NCLEX Client-Needs Category: Physiological Adaptation
Nursing Process: Implementation
CJMM Focus: Take Action
Question 5
A patient newly diagnosed with heart failure says, "I don't think I can follow all these
instructions when I go home." Which nursing response is most appropriate?
A. "You will need to follow the instructions exactly as written."
B. "Your family can make sure that you follow the plan."
C. "Which part of the plan seems most difficult for you?"
D. "The important thing is to avoid becoming stressed about it."
Correct Answer: C
Rationale:
The nurse should first explore the patient's concerns and barriers. Asking which part of the
4
3rd Edition
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy Sullivan
Chapter 1: Foundations for Medical-Surgical Nursing
Question 1
Which competency best reflects the primary role of the medical-surgical nurse in
contemporary practice?
A. Completing routine tasks according to established schedules
B. Coordinating individualized care while applying clinical judgment
C. Delegating most direct-care responsibilities to assistive personnel
D. Following provider prescriptions without independent nursing analysis
Correct Answer: B
Rationale:
Medical-surgical nursing requires the nurse to integrate assessment findings, clinical
judgment, the nursing process, evidence-based practice, safety principles, and patient
preferences when coordinating care. The nurse does not merely complete tasks or follow
prescriptions; the nurse continuously evaluates patient needs and adapts care
accordingly.
Why the other options are incorrect:
• A: Task completion alone does not represent the broad clinical reasoning and
coordination expected of the medical-surgical nurse.
1
, • B: Correct. Coordinating individualized care while applying clinical judgment
reflects a central competency of medical-surgical nursing.
• C: Delegation is appropriate for selected activities, but the RN retains responsibility
for nursing judgment and appropriate supervision.
• D: Nurses independently assess patients and use professional judgment rather than
simply following medical prescriptions.
Cognitive Level: Recall
NCLEX Client-Needs Category: Management of Care
Nursing Process: Planning
Question 2
Which action is an example of evidence-based nursing care?
A. Using a long-standing unit practice because it is familiar
B. Selecting an intervention supported by current evidence, clinical expertise, and patient
preferences
C. Choosing the least expensive intervention regardless of effectiveness
D. Using an intervention primarily because a colleague recommends it
Correct Answer: B
Rationale:
Evidence-based nursing care integrates the best available evidence with clinical expertise
and the patient's values, preferences, and circumstances. Familiarity, cost, or informal
recommendations alone are insufficient foundations for evidence-based practice.
Why the other options are incorrect:
• A: A traditional practice may be appropriate, but tradition alone does not establish
effectiveness.
• B: Correct. This reflects the central elements of evidence-based nursing practice.
• C: Cost may be considered, but it should not replace evidence of safety and
effectiveness.
• D: A colleague's recommendation may be useful, but it is not a substitute for
critically evaluating evidence.
Cognitive Level: Recall
NCLEX Client-Needs Category: Management of Care
2
,Nursing Process: Planning
Question 3
Which nursing action best demonstrates patient-centered care in the medical-
surgical setting?
A. Selecting goals based primarily on the nurse's preferred outcomes
B. Providing the same teaching plan to every patient with the same diagnosis
C. Incorporating the patient's values and preferences into the plan of care
D. Asking family members to make decisions whenever the patient is hospitalized
Correct Answer: C
Rationale:
Patient-centered care recognizes the patient as an active partner in care. The nurse
incorporates the patient's values, preferences, concerns, goals, culture, and
circumstances into assessment, planning, implementation, and evaluation.
Why the other options are incorrect:
• A: The patient's goals and preferences must be incorporated rather than replaced by
the nurse's preferences.
• B: Patients with the same diagnosis may have different needs, abilities, beliefs, and
priorities.
• C: Correct. Shared involvement of the patient is central to patient-centered care.
• D: Family participation can be valuable, but the patient should remain involved in
decision-making when able.
Cognitive Level: Recall
NCLEX Client-Needs Category: Psychosocial Integrity
Nursing Process: Planning
Question 4
A 68-year-old patient is admitted with pneumonia. The patient has a temperature of 38.4°C
(101.1°F), respiratory rate of 28/min, oxygen saturation of 89% on room air, and new
confusion. Which action should the nurse take first?
A. Review the patient's home medication list
B. Encourage the patient to increase oral fluid intake
3
, C. Apply oxygen and immediately reassess respiratory status
D. Document the findings and continue the admission assessment
Correct Answer: C
Rationale:
The patient has evidence of impaired oxygenation with tachypnea, low oxygen saturation,
and acute mental-status change. Oxygenation is an immediate priority. The nurse should
initiate appropriate supportive care and promptly reassess the patient's response while
escalating care as indicated.
Why the other options are incorrect:
• A: Medication history is important but is not the immediate priority in a patient with
impaired oxygenation.
• B: Fluids may be appropriate later, but they do not address the immediate
oxygenation problem.
• C: Correct. Supporting oxygenation and reassessing the response addresses the
most urgent clinical problem.
• D: Documentation should not delay treatment of an unstable patient.
Cognitive Level: Application
NCLEX Client-Needs Category: Physiological Adaptation
Nursing Process: Implementation
CJMM Focus: Take Action
Question 5
A patient newly diagnosed with heart failure says, "I don't think I can follow all these
instructions when I go home." Which nursing response is most appropriate?
A. "You will need to follow the instructions exactly as written."
B. "Your family can make sure that you follow the plan."
C. "Which part of the plan seems most difficult for you?"
D. "The important thing is to avoid becoming stressed about it."
Correct Answer: C
Rationale:
The nurse should first explore the patient's concerns and barriers. Asking which part of the
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