Davis Advantage for Medical-
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
Clinical scenario: A nurse receives report on four adult medical-
surgical patients. One patient is 6 hours post-op and suddenly
becomes restless, has shallow respirations, and a pulse
oximetry reading of 89%.
Question stem: What is the nurse’s priority action?
Answer options:
A. Document the findings and reassess in 15 minutes
B. Apply oxygen and perform a focused respiratory assessment
C. Administer the prescribed pain medication
D. Notify the family member immediately
Correct answer: B
Detailed rationale:
This patient shows cues of possible hypoxemia and early
deterioration. The priority is to support oxygenation and assess
breathing status immediately. Applying oxygen and performing
a focused respiratory assessment addresses airway/breathing
first and helps the nurse determine the next action.
Incorrect option analysis:
• A: Incorrect. Delaying care risks worsening hypoxia.
o Common misconception: Believing observation is
enough when a patient is unstable.
o Safety risk: Rapid deterioration, respiratory arrest.
, • C: Incorrect. Pain may be present, but respiratory
compromise is the priority.
o Common misconception: Treating the most obvious
complaint instead of the most urgent problem.
o Safety risk: Respiratory depression or missed
respiratory failure.
• D: Incorrect. Family notification is not the immediate
priority.
o Common misconception: Prioritizing communication
over intervention.
o Safety risk: Delayed treatment.
Nursing process linkage: Assessment
NCJMM competencies: Recognize Cues, Analyze Cues, Take
Action
Difficulty: Moderate
Bloom’s level: Apply
NCLEX client needs: Physiological Adaptation
Key learning objective: Prioritize immediate interventions for
respiratory deterioration.
2) SATA
Clinical scenario: A new graduate nurse is preparing to call the
provider using SBAR.
, Question stem: Which components should the nurse include in
an SBAR report? Select all that apply.
Answer options:
A. The patient’s current assessment findings
B. The nurse’s recommendation for next steps
C. The nurse’s personal opinion about the provider’s prior
decisions
D. Relevant background information such as recent surgery or
diagnoses
E. Unrelated social history from five years ago
F. A clear statement of the current situation
Correct answers: A, B, D, F
Detailed rationale:
SBAR is a structured communication tool that improves clarity
and reduces omissions. It should include the situation,
background, assessment, and recommendation. These
elements support efficient interprofessional communication
and patient safety.
Incorrect option analysis:
• C: Incorrect. Personal opinion is not objective
communication.
o Common misconception: Thinking frustration
strengthens advocacy.
o Safety risk: Miscommunication and reduced
credibility.
Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
Clinical scenario: A nurse receives report on four adult medical-
surgical patients. One patient is 6 hours post-op and suddenly
becomes restless, has shallow respirations, and a pulse
oximetry reading of 89%.
Question stem: What is the nurse’s priority action?
Answer options:
A. Document the findings and reassess in 15 minutes
B. Apply oxygen and perform a focused respiratory assessment
C. Administer the prescribed pain medication
D. Notify the family member immediately
Correct answer: B
Detailed rationale:
This patient shows cues of possible hypoxemia and early
deterioration. The priority is to support oxygenation and assess
breathing status immediately. Applying oxygen and performing
a focused respiratory assessment addresses airway/breathing
first and helps the nurse determine the next action.
Incorrect option analysis:
• A: Incorrect. Delaying care risks worsening hypoxia.
o Common misconception: Believing observation is
enough when a patient is unstable.
o Safety risk: Rapid deterioration, respiratory arrest.
, • C: Incorrect. Pain may be present, but respiratory
compromise is the priority.
o Common misconception: Treating the most obvious
complaint instead of the most urgent problem.
o Safety risk: Respiratory depression or missed
respiratory failure.
• D: Incorrect. Family notification is not the immediate
priority.
o Common misconception: Prioritizing communication
over intervention.
o Safety risk: Delayed treatment.
Nursing process linkage: Assessment
NCJMM competencies: Recognize Cues, Analyze Cues, Take
Action
Difficulty: Moderate
Bloom’s level: Apply
NCLEX client needs: Physiological Adaptation
Key learning objective: Prioritize immediate interventions for
respiratory deterioration.
2) SATA
Clinical scenario: A new graduate nurse is preparing to call the
provider using SBAR.
, Question stem: Which components should the nurse include in
an SBAR report? Select all that apply.
Answer options:
A. The patient’s current assessment findings
B. The nurse’s recommendation for next steps
C. The nurse’s personal opinion about the provider’s prior
decisions
D. Relevant background information such as recent surgery or
diagnoses
E. Unrelated social history from five years ago
F. A clear statement of the current situation
Correct answers: A, B, D, F
Detailed rationale:
SBAR is a structured communication tool that improves clarity
and reduces omissions. It should include the situation,
background, assessment, and recommendation. These
elements support efficient interprofessional communication
and patient safety.
Incorrect option analysis:
• C: Incorrect. Personal opinion is not objective
communication.
o Common misconception: Thinking frustration
strengthens advocacy.
o Safety risk: Miscommunication and reduced
credibility.
