Med Surg Chapter 1 NCLEX examination questions and answers

The nurse has recently been assigned to a medical-surgical clinical rotation. According to the scope of medical-surgical nursing, what type of client assignments does the nurse expect to see? A. Hospitalized children with acute and chronic illnesses B. Hospitalized adults with acute and chronic illnesses C. Older adults in a nursing home D. Working adults in a corporate setting B. Hospitalized adults with acute and chronic illnesses The scope of medical-surgical nursing, sometimes called adult health nursing, is to promote health and prevent illness or injury in clients from 18 to 100 years of age or older. The most common practice setting is the acute care hospital. Hospitalized children with acute and chronic illnesses are commonly seen in pediatric nursing. Older adults in a nursing home are commonly seen in geriatric nursing. Working adults in a corporate setting are commonly seen by occupational health nurses. The nursing student has been assigned to the hospital's Rapid Response Team (RRT). Which statement by the student indicates a correct understanding of the RRT member's purpose? A. "I will be caring for clients in the hospital." B. "I will be riding along in the hospital's ambulance." C. "I will be admitting clients to the hospital." D. "I will be observing Code Blue resuscitations." A. "I will be caring for clients in the hospital." Members of the RRT are critical care experts who are on site in the hospital and are available at any time. The RRT does not ride along in the ambulance; it is hospital-based. RRT members do not admit clients to the hospital. They do not replace the code team—they often precede it. Brainpower Read More The nurse is working in the intensive care unit. When does the nurse call the Rapid Response Team (RRT)? A. An 87-year-old client awakens mildly confused, then reorients quickly. B. A newly admitted client requests pain medication. C. A postoperative client's dressing has mild bloody drainage. D. A postoperative client's blood pressure suddenly drops. D. A postoperative client's blood pressure suddenly drops. The RRT should be called whenever a client has a slow or sudden deterioration in clinical condition, such as a sudden drop in blood pressure. The older adult client awakening in a confused state and then reorienting can be a normal occurrence because of the client's age. Pain medication should be indicated in the health care provider's prescription. If it is not, the admitting health care provider should be called, not the RRT. Mild drainage on the dressing of the postoperative client is normal. Which role of the medical-surgical nurse is demonstrated when writing a plan of care for a client who is newly admitted to the hospital? A. Advocate B. Caregiver C. Communicator D. Educator B. Caregiver In the caregiver role, medical-surgical nurses assess clients, analyze collected information to determine their needs, develop nursing diagnoses and collaborative problems, plan care and carry out the plan with the health care team, and evaluate the care given. In the role of advocate, the medical-surgical nurse assists the client and family through caring interventions. "Communicator" is not a defined nursing role. In the role of educator, the nurse strives to improve health by facilitating client learning regarding health promotion, disease and illness, and specific treatment by teaching clients and family members or other caregivers. The nurse supports the client and family in deciding on a "Do Not Resuscitate" order. Which ethical principle that guides nursing clinical decision making is demonstrated in this situation? A. Beneficence B. Justice C. Legality D. Self-determination D. Self-determination Self-determination refers to the idea that clients are autonomous individuals capable of making informed decisions about their care. When the client is not capable of self-determination, the nurse is ethically obligated to protect the client as an advocate in the professional scope of practice. Beneficence emphasizes the importance of preventing harm and ensuring the client's well-being. Justice refers to equality (i.e., all clients should be treated equally and fairly). Legality is not one of the ethical principles. Which important aspect of coordinating care within the interdisciplinary team is facilitated by use of the "SBAR" and "PACE" procedures? A. Communication B. Implementation C. Policymaking D. Protocol development A. Communication SBAR and PACE are acronyms for "hand-off" methods of communication used by health care organizations to share information between shifts and between departments. SBAR and PACE are not types of implementation [of client care]. Implementation, the fourth step of the nursing process, is an action rather than a coordination of care. SBAR and PACE are not types of policymaking or protocol development. The nursing student asks the supervising nurse whether a certain fall protocol used on the nursing unit is effective. To demonstrate effectiveness, what does the supervising nurse identify? A. Information about how to implement a fall protocol and what nurses need to document B. Data about the number of falls after the protocol was introduced compared with previous fall rates C. The number of clients who currently have a fall protocol in place D. National statistics about the use of fall protocols to prevent serious injury from falls B. Data about the number of falls after the protocol was introduced compared with previous fall rates Medical-surgical nurses, as part of the Quality and Safety Education for Nurses (QSEN) quality improvement competency, are expected to be able to identify indicators to monitor quality and effectiveness of health care. Data that demonstrate evidence of improvement in falls after implementation of a protocol is a type of indicator of quality and effectiveness of care. Information about implementation and documentation of the protocol is part of a procedure and not an indicator of quality. The number of clients with a fall monitor in place is not an outcome measure. National statistics provide valuable information when implementing a new strategy, but do not yield outcome data for a particular protocol in that unit. Bedside computers are an example of informatics used in health care primarily for which purpose? A. Documenting interdisciplinary care B. Enhancing collaboration and coordination of care C. Offering clients access to e-mail and the Internet D. Retrieving data for evidence-based practice A. Documenting interdisciplinary care The largest application of health care informatics is the growing trend of the use of electronic medical records (EMRs) for documenting interdisciplinary care. Computers may be located at the client's bedside or in the treatment room for ease of access for documentation. Computers allow quick communication among health care professionals to enhance collaboration and coordination of care; however, this type of communication typically would not take place at the client's bedside. Bedside computers in the health care setting are not intended for client use. The Internet provides ways to search multiple sources of information and retrieve data efficiently; however, this would not be done at the client's bedside. Which nursing action demonstrates use of the principle of justice? A. A 32-year-old client is prevented from falling during the initial postoperative period following her hysterectomy. B. A 67-year-old client with dementia is shown the same respect as his 47-year-old roommate with prostate cancer. C. An 82-year-old client is provided access to the hospital Patient Advocate for processing of a complaint. D. The parents of a 13-year-old are included in discussions about the course of their teen's treatment and care. B. A 67-year-old client with dementia is shown the same respect as his 47-year-old roommate with prostate cancer. The principle of justice refers to equality—all clients should be treated equally and fairly, as demonstrated by the respect shown to the client with dementia. The 32-year-old's fall prevention relates to providing a safe care environment, which is an important nursing principle but is not categorized as justice. Providing the 82-year-old client access to the hospital Patient Advocate is an example of the principle of self-determination through facilitation of the client's autonomy. Including the parents of the 13-year-old in the discussion about care represents an example of dependent care, not the principle of justice. Teens may not legally be empowered as the final decision makers in their own care. When developing a standardized plan of care for clients with a diagnosis of pneumonia, how does the nurse find the best information about providing optimal nursing care? A. Access a website that reports on randomized controlled studies on nursing care for clients with pneumonia. B. Research the most recent articles in nursing magazines that discuss care for clients with pneumonia. C. Review the chart to determine what primary health care provider's prescriptions are frequently written for clients with pneumonia. D. Survey experienced RNs about which nursing actions are effective when caring for clients with pneumonia. A. Access a website that reports on randomized controlled studies on nursing care for clients with pneumonia. The best evidence-based nursing practice will be developed by using information from randomized controlled studies testing the impact of various nursing interventions on outcomes for clients with pneumonia. This type of data collection is the most scientifically based approach listed here. Articles in nursing magazines are likely to be researcher biased. They are also unlikely to be controlled. Chart review serves as a limited source of data and cannot be generalized for a standard. Also, regional practices may tend to skew the data. Data from nurses, although valuable, are likely to be biased; data collection would not be well controlled. Which of these hospital staff members will the nurse manager assign to coordinate the discharge of a client who will need community-based rehabilitation services after a traumatic injury? A. The nurse responsible for the client's case management B. The physical therapist who developed the client's exercise program C. The health care provider assigned as the client's medical resident D. The unit-based RN who has cared for the client during the hospital stay A. The nurse responsible for the client's case management The case manager role includes coordination of acute care and post-discharge community services for the client. The physical therapist, health care provider, and unit-based RN will have input into planning for rehabilitation for the client, but are not the best choice to coordinate a smooth transition from acute care to community rehabilitation services. Which nursing activity is best for the charge nurse on the medical-surgical unit to delegate to staff members who are unlicensed assistive personnel (UAPs)? A. Feeding a client whose hands are affected by rheumatoid arthritis B. Increasing the oxygen flow rate for a client who has wheezes C. Positioning a client who has just returned from hip surgery D. Taking vital signs for a client who is having acute chest pain A. Feeding a client whose hands are affected by rheumatoid arthritis Although all of these actions may sometimes be delegated to UAPs, the client with rheumatoid arthritis is the most stable of the clients described here. The client who needs an increase in oxygen, the client who just underwent hip surgery, and the client with chest pain have clinical manifestations that indicate a need for assessment or intervention by licensed nursing personnel, who have broader education and scope of practice than do UAPs.