,
,Chapter 01: Overview of Professional Nursing Concepts for Medical- Surgical Nursing
MULTIPLE CHOICE
, 1. 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 clients basic needs are met
c. Tells the client and family about all upcoming tests
d. Thoroughly orients the client and family to the room
CORRECT ANSWER: A
Rationale:Competency in client-focused care is demonstrated when the nurse focuses on
communication, culture, respect compassion, client education, and empowerment. By
assessing the effect of the clients culture on health care, this nurse is practicing 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 family to the room is an important safety measure,
but not directly related to demonstrating client-centered care.
DIF: Understanding/Comprehension REF: 3
KEY: Patient-centered care| culture MSC: Integrated
Process: Caring NOT: Client Needs Category:
Psychosocial Integrity
2. A nurse is caring for a postoperative client on the surgical unit. The clients blood
pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action
by the nurse is best?
a. Call the Rapid Response Team.
b. Document and continue to monitor.
c. Notify the primary care provider.
d. Repeat blood pressure measurement in 15 minutes.
CORRECT ANSWER: A
Rationale:The purpose of the Rapid Response Team (RRT) is to intervene when clients
are deteriorating before they suffer either respiratory or cardiac arrest. Since the client
has manifested a significant change, the nurse should call the RRT. Changes in blood
pressure, mental status, heart rate, and pain are particularly significant.
Documentation is vital, but the nurse must do more than document. The primary
care provider should be notified, but this is not the priority over calling the RRT. The
,Chapter 01: Overview of Professional Nursing Concepts for Medical- Surgical Nursing
MULTIPLE CHOICE
, 1. 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 clients basic needs are met
c. Tells the client and family about all upcoming tests
d. Thoroughly orients the client and family to the room
CORRECT ANSWER: A
Rationale:Competency in client-focused care is demonstrated when the nurse focuses on
communication, culture, respect compassion, client education, and empowerment. By
assessing the effect of the clients culture on health care, this nurse is practicing 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 family to the room is an important safety measure,
but not directly related to demonstrating client-centered care.
DIF: Understanding/Comprehension REF: 3
KEY: Patient-centered care| culture MSC: Integrated
Process: Caring NOT: Client Needs Category:
Psychosocial Integrity
2. A nurse is caring for a postoperative client on the surgical unit. The clients blood
pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action
by the nurse is best?
a. Call the Rapid Response Team.
b. Document and continue to monitor.
c. Notify the primary care provider.
d. Repeat blood pressure measurement in 15 minutes.
CORRECT ANSWER: A
Rationale:The purpose of the Rapid Response Team (RRT) is to intervene when clients
are deteriorating before they suffer either respiratory or cardiac arrest. Since the client
has manifested a significant change, the nurse should call the RRT. Changes in blood
pressure, mental status, heart rate, and pain are particularly significant.
Documentation is vital, but the nurse must do more than document. The primary
care provider should be notified, but this is not the priority over calling the RRT. The
