Page 1 of 29
Medical-Surgical Nursing, 7th Edition by
Adrianne Dill Linton and Mary Ann
Matteson
1. A nurse is caring for a postoperative patient who reports
pain of 8 on a 0–10 scale. Which action should the nurse take
first?
A) Reposition the patient
B) Administer prescribed analgesic
C) Apply a cold pack
D) Notify the provider
Answer: B
Rationale: Pain management is a priority. The nurse should first
administer the prescribed analgesic to relieve pain, then implement
nonpharmacologic measures.
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2. Which patient is at highest risk for developing a pressure
injury?
A) A 45-year-old with a hip fracture who is ambulatory with a
walker
B) A 30-year-old with a fractured wrist in a cast
C) A 75-year-old who is bedbound and incontinent
D) A 60-year-old who uses a wheelchair but can reposition
independently
Answer: C
Rationale: Immobility, incontinence, advanced age, and inability to
reposition are major risk factors for pressure injury development.
3. The nurse uses the SBAR tool when communicating with a
physician. “S” stands for:
A) Summary
B) Situation
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C) Symptoms
D) Safety
Answer: B
Rationale: SBAR: Situation, Background, Assessment,
Recommendation. It improves communication and reduces errors.
4. Scenario: A patient is to receive a blood transfusion. After 15
minutes, the patient reports chills and low back pain. What is the
nurse’s priority action?
A) Slow the transfusion rate
B) Stop the transfusion and start normal saline
C) Give acetaminophen as ordered
D) Notify the provider
Answer: B
Rationale: Chills and back pain suggest an acute hemolytic
reaction. The transfusion must be stopped immediately, and the IV
line kept open with saline.
Medical-Surgical Nursing, 7th Edition by
Adrianne Dill Linton and Mary Ann
Matteson
1. A nurse is caring for a postoperative patient who reports
pain of 8 on a 0–10 scale. Which action should the nurse take
first?
A) Reposition the patient
B) Administer prescribed analgesic
C) Apply a cold pack
D) Notify the provider
Answer: B
Rationale: Pain management is a priority. The nurse should first
administer the prescribed analgesic to relieve pain, then implement
nonpharmacologic measures.
,Page 2 of 29
2. Which patient is at highest risk for developing a pressure
injury?
A) A 45-year-old with a hip fracture who is ambulatory with a
walker
B) A 30-year-old with a fractured wrist in a cast
C) A 75-year-old who is bedbound and incontinent
D) A 60-year-old who uses a wheelchair but can reposition
independently
Answer: C
Rationale: Immobility, incontinence, advanced age, and inability to
reposition are major risk factors for pressure injury development.
3. The nurse uses the SBAR tool when communicating with a
physician. “S” stands for:
A) Summary
B) Situation
, Page 3 of 29
C) Symptoms
D) Safety
Answer: B
Rationale: SBAR: Situation, Background, Assessment,
Recommendation. It improves communication and reduces errors.
4. Scenario: A patient is to receive a blood transfusion. After 15
minutes, the patient reports chills and low back pain. What is the
nurse’s priority action?
A) Slow the transfusion rate
B) Stop the transfusion and start normal saline
C) Give acetaminophen as ordered
D) Notify the provider
Answer: B
Rationale: Chills and back pain suggest an acute hemolytic
reaction. The transfusion must be stopped immediately, and the IV
line kept open with saline.
