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Medical-Surgical Nursing Assessment and Management of Clinical Problems 11th Edition TESTBANK

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Medical-Surgical Nursing Assessment and Management of Clinical Problems 11th Edition TESTBANK An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ pedal edema b. Heart rate of 56 beats/minute c. Blood pressure (BP) of 88/42 mm Hg d. Complaints of fatigue ANS: C The patients BP indicates that the dose of metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of -adrenergic blockade, but the rate of 56 is not unusual with -adrenergic blocker therapy. - Adrenergic blockade initially will worsen symptoms of heart failure in many patients, and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs. 24. A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Assess the IV insertion site for signs of extravasation. b. Teach the patient the reasons for remaining on bed rest. c. Monitor the patients blood pressure and heart rate every hour. d. Titrate the rate to keep the systolic blood pressure 90 mm Hg. ANS: C An experienced LPN/LVN would be able to monitor BP and heart rate and would know to report significant changes to the RN. Teaching patients, making adjustments to the drip rate for vasoactive medications, and monitoring for serious complications such as extravasation require RN level education and scope of practice. 25. After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58 b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L c. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache d. Patient who is taking captopril (Capoten) and has a frequent nonproductive cough

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Medical-Surgical Nursing: Assessment
and Management of Clinical Problems 11th
Edition TESTBANK
ALL CHAPTERS COVERED

,Chapter 1. Professional Nursing

MULTIPLE CHOICE

1. The nurse completes an admission database and explains that the plan of care and discharge
goals will be developed with the patients input. The patient states, How is this different from what the
doctor does? Which response would be most appropriate for the nurse to make?




a. The role of the nurse is to administer medications and other treatments prescribed by your
doctor.

b. The nurses job is to help the doctor by collecting information and communicating any problems
that occur.

c. Nurses perform many of the same procedures as the doctor, but nurses are with the patients for
a longer time than the doctor.

d. In addition to caring for you while you are sick, the nurses will assist you to develop an
individualized plan to maintain your health.




ANS: D




This response is consistent with the American Nurses Association (ANA) definition of nursing, which
describes the role of nurses in promoting health. The other responses describe some of the dependent
and collaborative functions of the nursing role but do not accurately describe the nurses role in the
health care system.




DIF: Cognitive Level: Understand (comprehension) REF: 3




TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

,2. The nurse describes to a student nurse how to use evidence-based practice guidelines when
caring for patients. Which statement, if made by the nurse, would be the most accurate?




a. Inferences from clinical research studies are used as a guide.



b. Patient care is based on clinical judgment, experience, and traditions.

c. Data are evaluated to show that the patient outcomes are consistently met.

d. Recommendations are based on research, clinical expertise, and patient preferences.




ANS: D




Evidence-based practice (EBP) is the use of the best research-based evidence combined with clinician
expertise. Clinical judgment based on the nurses clinical experience is part of EBP, but clinical decision
making should also incorporate current research and research-based guidelines. Evaluation of patient
outcomes is important, but interventions should be based on research from randomized control studies
with a large number of subjects.




DIF: Cognitive Level: Remember (knowledge) REF: 11




TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment




3. The nurse teaches a student nurse about how to apply the nursing process when providing
patient care. Which statement, if made by the student nurse, indicates that teaching was successful?

, a. The nursing process is a scientific-based method of diagnosing the patients health care
problems.

b. The nursing process is a problem-solving tool used to identify and treat patients health care
needs.

c. The nursing process is based on nursing theory that incorporates the biopsychosocial nature of
humans.




d. The nursing process is used primarily to explain nursing interventions to other health care
professionals.




ANS: B



The nursing process is a problem-solving approach to the identification and treatment of patients
problems. Diagnosis is only one phase of the nursing process. The primary use of the nursing process is
in patient care, not to establish nursing theory or explain nursing interventions to other health care
professionals.




DIF: Cognitive Level: Understand (comprehension) REF: 7




TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment




4. A patient has been admitted to the hospital for surgery and tells the nurse, I do not feel
comfortable leaving my children with my parents. Which action should the nurse take next?




a. Reassure the patient that these feelings are common for parents.

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