Complete Test Bank . .
Medical-
Surgical Nursing: Concepts for Clinical Judgment and Collaborative
. . . . . . . .
Care 11th Edition
. .
by Donna D. Ignatavicius
. . .
,Chapter 01: Overview of Professional Nursing Concepts for Medical-
. . . . . . . .
Surgical Nursing Ignatavicius: Medical-Surgical Nursing, 11th Edition
. . . . . .
MULTIPLE.CHOICE
1. A.new.nurse.is.working.with.a.preceptor.on.a.medical-
surgical.unit..The.preceptor.advises.the.new.nurse.that.which.is.the.priority.when.working.as.a.pro
fessional.nurse?
a. Attending. to. holistic. client. needs
b. Ensuring.client.safety
c. Not. making. medication. errors
d. Providing.client-focused. care
ANS:. B
All.actions.are.appropriate.for.the.professional.nurse..However,.ensuring.client.safety.is.the.prior
ity..Health.care.errors.have.been.widely.reported.for.25.years,.many.of.which.result.in.client.injur
y,.death,.and.increased.health.care.costs..There.are.several.national.and.international.organizati
ons.that.have.either.recommended.or.mandated.safety.initiatives.
Every.nurse.has.the.responsibility.to.guard.the.client‘s.safety..The.other.actions.are.important.for.q
uality.nursing,.but.they.are.not.as.vital.as.providing.safety..Not.making.medication.errors.does.prov
ide.safety,.but.is.too.narrow.in.scope.to.be.the.best.answer.
DIF: Understanding
TOP:.Integrated.Process:.Nursing.Process:.Intervention.KEY:.Client.safety
MSC:. Client. Needs.Category:.Safe.and.Effective.Care.Environment:. Safety.and.Infection.Control
2. A.nurse.is.orienting.a.new.client.and.family.to.the.medical-
surgical.unit..What.information.does.the.nurse.provide.to.best.help.the.client.promote.his.or.her.
own.safety?
a. Encourage.the. client. and. family.to. be.active. partners.
b. Have.the.client.monitor.hand.hygiene.in.caregivers.
c. Offer.the. family. the. opportunity.to. stay.with. the. client.
d. Tell.the.client.to.always.wear.his.or.her.armband.
ANS:. A
Each.action.could.be.important.for.the.client.or.family.to.perform..However,.encouraging.the.client.
to.be.active.in.his.or.her.health.care.as.a.safety.partner.is.the.most.critical..The.other.actions.are.very.l
imited.in.scope.and.do.not.provide.the.broad.protection.that.being.active.and.involved.does.
DIF: Understanding
TOP:.Integrated.Process:.Teaching/Learning.KEY:.Client.safety
MSC:. Client. Needs.Category:.Safe.and.Effective.Care.Environment:. Safety.and.Infection.Control
3. A.nurse.is.caring.for.a.postoperative.client.on.the.surgical.unit..The.client‘s.blood.pressure.was.1
42/76.mm.Hg.30.minutes.ago,.and.now.is.88/50.mm.Hg..What.action.would.the.nurse.take.first?
a. Call. the.Rapid. Response.Team.
b. Document. and. continue.to. monitor.
,c. Notify.the. primary. health. care. provider.
, d. Repeat.the.blood.pressure.in.15.minutes.
ANS:. A
The.purpose.of.the.Rapid.Response.Team.(RRT).is.to.intervene.when.clients.are.deteriorating.befor
e.they.suffer.either.respiratory.or.cardiac.arrest..Since.the.client.has.manifested.a.significant.chang
e,.the.nurse.would.call.the.RRT..Changes.in.blood.pressure,.mental.status,.heart.rate,.temperature,.
oxygen.saturation,.and.last.2.hours.‘urine.output.are.particularly.significant.and.are.part.of.the.Mod
ified.Early.Warning.System.guide..Documentation.is.vital,.but.the.nurse.must.do.more.than.docum
ent..The.primary.health.care.provider.would.be.notified,.but.this.is.not.more.important.than.calling.
the.RRT..The.client.‘s.blood.pressure.would.be.reassessed.frequently,.but.the.priority.is.getting.the.
rapid.care.to.the
client.
DIF: Applying
TOP:.Integrated.Process:.Communication.and.Documentation.KEY:.Rapid.Res
ponse.Team.(RRT),.Clinical.judgment
MSC:. Client.Needs.Category:.Physiological.Integrity:.Physiological.Adaptation
4. A.nurse.wishes.to.provide.client-centered.care.in.all.interactions.. Which.action.by.the.nurse
best.demonstrates. this. concept?
a. Assesses. for. cultural. influences. affecting. health. care.
b. Ensures.that. all. the. client‘s. basic. needs. are. met.
c. Tells.the.client. and. family.about. all. upcoming. tests.
d. Thoroughly.orients.the.client.and.family.to.the.room.
ANS:. A
Showing.respect.for.the.client.and.family‘s.preferences.and.needs.is.essential.to.ensure.a.holistic.or.
―whole-
person‖.approach.to.care..By.assessing.the.effect.of.the.client‘s.culture.on.health.care,.this.nurse.is.pr
acticing.client-
focused.care..Providing.for.basic.needs.does.not.demonstrate.this.competence..Simply.telling.the.
client.about.all.upcoming.tests.is.not.providing.empowering.education..Orienting.the.client.and.fa
mily.to.the.room.is.an.important.safety.measure,.but.not.directly.related.to.demonstrating.client-
centered.care.
DIF: Understanding
TOP:.Integrated.Process:.Culture.and.Spirituality.KEY:. Client-centered.care,.Culture
MSC:. Client.Needs.Category:.Psychosocial.Integrity
5. A.client.is.going.to.be.admitted.for.a.scheduled.surgical.procedure..Which.action.does.the.nurse
.explain.is.the.most.important.thing.the. client.can. do.to.protect.against . errors?
a. Bring.a.list.of.all.medications.and.what.they.are.for.
b. Keep. the. provider‘s. phone. number. by.the. telephone.
c. Make.sure.that. all. providers. wash. hands. before. entering. the. room.
d. Write.down.the.name.of.each.caregiver.who.comes.in.the.room.
ANS:. A
Medication.reconciliation.is.a.formal.process.in.which.the.client‘s.actual.current.medications.are.co
mpared.to.the.prescribed.medications.at.the.time.of.admission,.transfer,.or.discharge..This.Nationa
l.client.Safety.Goal.is.important.to.reduce.medication.errors..The.client.would.not.have.to.be.respo
nsible.for.providers.washing.their.hands,.and.even.if.the.client.does.so,.this.is.too.narrow.to.be.the.m
ost.important.action.to.prevent.errors..Keeping.the.provider‘s.phone.number.nearby.and.document
Medical-
Surgical Nursing: Concepts for Clinical Judgment and Collaborative
. . . . . . . .
Care 11th Edition
. .
by Donna D. Ignatavicius
. . .
,Chapter 01: Overview of Professional Nursing Concepts for Medical-
. . . . . . . .
Surgical Nursing Ignatavicius: Medical-Surgical Nursing, 11th Edition
. . . . . .
MULTIPLE.CHOICE
1. A.new.nurse.is.working.with.a.preceptor.on.a.medical-
surgical.unit..The.preceptor.advises.the.new.nurse.that.which.is.the.priority.when.working.as.a.pro
fessional.nurse?
a. Attending. to. holistic. client. needs
b. Ensuring.client.safety
c. Not. making. medication. errors
d. Providing.client-focused. care
ANS:. B
All.actions.are.appropriate.for.the.professional.nurse..However,.ensuring.client.safety.is.the.prior
ity..Health.care.errors.have.been.widely.reported.for.25.years,.many.of.which.result.in.client.injur
y,.death,.and.increased.health.care.costs..There.are.several.national.and.international.organizati
ons.that.have.either.recommended.or.mandated.safety.initiatives.
Every.nurse.has.the.responsibility.to.guard.the.client‘s.safety..The.other.actions.are.important.for.q
uality.nursing,.but.they.are.not.as.vital.as.providing.safety..Not.making.medication.errors.does.prov
ide.safety,.but.is.too.narrow.in.scope.to.be.the.best.answer.
DIF: Understanding
TOP:.Integrated.Process:.Nursing.Process:.Intervention.KEY:.Client.safety
MSC:. Client. Needs.Category:.Safe.and.Effective.Care.Environment:. Safety.and.Infection.Control
2. A.nurse.is.orienting.a.new.client.and.family.to.the.medical-
surgical.unit..What.information.does.the.nurse.provide.to.best.help.the.client.promote.his.or.her.
own.safety?
a. Encourage.the. client. and. family.to. be.active. partners.
b. Have.the.client.monitor.hand.hygiene.in.caregivers.
c. Offer.the. family. the. opportunity.to. stay.with. the. client.
d. Tell.the.client.to.always.wear.his.or.her.armband.
ANS:. A
Each.action.could.be.important.for.the.client.or.family.to.perform..However,.encouraging.the.client.
to.be.active.in.his.or.her.health.care.as.a.safety.partner.is.the.most.critical..The.other.actions.are.very.l
imited.in.scope.and.do.not.provide.the.broad.protection.that.being.active.and.involved.does.
DIF: Understanding
TOP:.Integrated.Process:.Teaching/Learning.KEY:.Client.safety
MSC:. Client. Needs.Category:.Safe.and.Effective.Care.Environment:. Safety.and.Infection.Control
3. A.nurse.is.caring.for.a.postoperative.client.on.the.surgical.unit..The.client‘s.blood.pressure.was.1
42/76.mm.Hg.30.minutes.ago,.and.now.is.88/50.mm.Hg..What.action.would.the.nurse.take.first?
a. Call. the.Rapid. Response.Team.
b. Document. and. continue.to. monitor.
,c. Notify.the. primary. health. care. provider.
, d. Repeat.the.blood.pressure.in.15.minutes.
ANS:. A
The.purpose.of.the.Rapid.Response.Team.(RRT).is.to.intervene.when.clients.are.deteriorating.befor
e.they.suffer.either.respiratory.or.cardiac.arrest..Since.the.client.has.manifested.a.significant.chang
e,.the.nurse.would.call.the.RRT..Changes.in.blood.pressure,.mental.status,.heart.rate,.temperature,.
oxygen.saturation,.and.last.2.hours.‘urine.output.are.particularly.significant.and.are.part.of.the.Mod
ified.Early.Warning.System.guide..Documentation.is.vital,.but.the.nurse.must.do.more.than.docum
ent..The.primary.health.care.provider.would.be.notified,.but.this.is.not.more.important.than.calling.
the.RRT..The.client.‘s.blood.pressure.would.be.reassessed.frequently,.but.the.priority.is.getting.the.
rapid.care.to.the
client.
DIF: Applying
TOP:.Integrated.Process:.Communication.and.Documentation.KEY:.Rapid.Res
ponse.Team.(RRT),.Clinical.judgment
MSC:. Client.Needs.Category:.Physiological.Integrity:.Physiological.Adaptation
4. A.nurse.wishes.to.provide.client-centered.care.in.all.interactions.. Which.action.by.the.nurse
best.demonstrates. this. concept?
a. Assesses. for. cultural. influences. affecting. health. care.
b. Ensures.that. all. the. client‘s. basic. needs. are. met.
c. Tells.the.client. and. family.about. all. upcoming. tests.
d. Thoroughly.orients.the.client.and.family.to.the.room.
ANS:. A
Showing.respect.for.the.client.and.family‘s.preferences.and.needs.is.essential.to.ensure.a.holistic.or.
―whole-
person‖.approach.to.care..By.assessing.the.effect.of.the.client‘s.culture.on.health.care,.this.nurse.is.pr
acticing.client-
focused.care..Providing.for.basic.needs.does.not.demonstrate.this.competence..Simply.telling.the.
client.about.all.upcoming.tests.is.not.providing.empowering.education..Orienting.the.client.and.fa
mily.to.the.room.is.an.important.safety.measure,.but.not.directly.related.to.demonstrating.client-
centered.care.
DIF: Understanding
TOP:.Integrated.Process:.Culture.and.Spirituality.KEY:. Client-centered.care,.Culture
MSC:. Client.Needs.Category:.Psychosocial.Integrity
5. A.client.is.going.to.be.admitted.for.a.scheduled.surgical.procedure..Which.action.does.the.nurse
.explain.is.the.most.important.thing.the. client.can. do.to.protect.against . errors?
a. Bring.a.list.of.all.medications.and.what.they.are.for.
b. Keep. the. provider‘s. phone. number. by.the. telephone.
c. Make.sure.that. all. providers. wash. hands. before. entering. the. room.
d. Write.down.the.name.of.each.caregiver.who.comes.in.the.room.
ANS:. A
Medication.reconciliation.is.a.formal.process.in.which.the.client‘s.actual.current.medications.are.co
mpared.to.the.prescribed.medications.at.the.time.of.admission,.transfer,.or.discharge..This.Nationa
l.client.Safety.Goal.is.important.to.reduce.medication.errors..The.client.would.not.have.to.be.respo
nsible.for.providers.washing.their.hands,.and.even.if.the.client.does.so,.this.is.too.narrow.to.be.the.m
ost.important.action.to.prevent.errors..Keeping.the.provider‘s.phone.number.nearby.and.document
