◦ Timby'smIntroductory mMedical-SurgicalmNursingm13thmEditionmMorenomTestmBank
Chapterm 1 Conceptsm and m Trendsm in m Healthcare
◦ Amnewmnursemismworkingmwith mampreceptormon man minpatientmmedical-
surgicalmunit.mThempreceptormadvisesmthemstudentmthatmwhich mismthempriority mwhe
n mworkingmasmamprofessionalmnurse?
◦ Attendingm to m holisticm clientm needs
◦ Ensuringm clientm safety
◦ Notm makingm medication m errors
◦ Providingmclient-
mfocused mcare mA
NS:mB
◦ Allmactionsmaremappropriate mformthemprofessionalmnurse.mHowever,m ensur
ingm clientm safety m ism them priority.m Up m to m 98,000 m deathsm resultm each m yearm fromm errorsmin
mhospitalmcare, maccordingmto mthe m2000 mInstitute mof mMedicine mreport. mMany mmore mclientsm
havemsuffered minjuriesmand mlessmseriousmoutcomes.mEvery mnursemhasmthemresponsibility mt
o mguard mthemclientsmsafety.
◦ DIF:mUnderstanding/Comprehension mREF:m2
mKEY:mPatientmsafety mMSC:mIntegrated mProcess:mNursingmPr
ocess:mIntervention
◦ NOT:mClientmNeedsmCategory:mSafemand mEffective mCar
emEnvironment:mSafety mand mInfection mControl
◦ Amnursemismorientingmamnewmclientmand mfamily mto mtheminpatientmunit.mWhatminf
ormation mdoesmthemnursemprovide mto mhelp mthemclientmpromote mhismormhermown m
safety?
◦ Encourage m them clientm and m family m to m bem activem partners.
◦ Havem them clientm monitorm hand m hygienem in m caregivers.
◦ Offerm them family m them opportunity m to m stay m with m them client.
◦ Tellmthemclientmto malwaysmwearmhism
ormhermarmband.mANS:mA
◦ Each maction mcould mbemimportantmformthemclientmormfamily mto mperform.m
However,mencouragingmthemclientmto mbemactivemin mhismormhermhealth mcaremasmampartner
mismthe mmostmcritical. mThe mothermactions mare
◦
◦ very mlimited min mscopemand mdo mnotmprovide mthembroad mprotection mth
atmbeingmactivemand minvolved mdoes.
◦ DIF:mUnderstanding/Comprehension mREF:m3
mKEY:mPatientmsafety mMSC:mIntegrated mProcess:mTeaching/m
Learning
◦ NOT:m Clientm Needsm Category:m Safem and m Effective m Care
,Environment:m Safety m and m Infection m Control
◦ Amnursemismcaringmformampostoperative mclientmon mthemsurgicalmunit.mThemclientsmblo
od mpressure mwasm142/76 mmmmHgm30 mminutesmago,mand mnowmism88/50mmmmHg.mWh
atmaction mby mthemnurse mismbest?
◦ Callm them Rapid m Response m Team.
◦ Documentm and m continue m to m monitor.
◦ Notify m them primary m carem provider.
◦ Repeatmblood mpressure mmeasurement
min m15 mminutes. mANS:mA
◦ Thempurpose mof mthemRapid mResponsemTeamm(RRT)mismto mintervene mwhen m
clientsmaremdeterioratingmbefore mthey msuffermeithermrespiratory mormcardiacmarrest.mSincemth
emclientmhasmmanifested mamsignificantmchange,mthemnursemshould mcallmthemRRT.mChangesmi
n mblood mpressure,mmentalmstatus,mheartmrate,mand mpain maremparticularly msignificant.mDocu
mentation mismvital,mbutmthemnursemmustmdo mmore mthan mdocument.mThemprimary mcaremprovi
dermshould mbemnotified,mbutmthismismnotmthempriority movermcallingm themRRT.mThem clientsm
blood mpressure mshould mbemreassessed mfrequently, mbutmthempriority mismgetting
themrapid mcaremto mthemclient.
◦ DIF:mApplying/Application m REF:m 3
◦ KEY:mRapid mResponse mTeamm(RRT)
|mmedicalmemergenciesmMSC:mIntegrated mProcess:
Communication m and m Documentation
◦ NOT:m Clientm Needsm Category:m Physiologicalm Integrity:m PhysiologicalmAdaptation
◦
◦ Amnursemwishesmto mprovide mclient-
centered mcaremin mallminteractions.mWhich maction mby mthemnursembestmdemon
stratesmthismconcept?
◦ Assessesm form culturalm influencesm affectingm health m care
◦ Ensuresmthatmallm themclientsm basicmneedsm arem met
◦ Tellsmthem clientm and m family m aboutm allm upcomingm tests
◦ Thoroughly morientsmthemclientman
d mfamily mto mthemroommANS:mA
◦ Competency min mclient-
focused mcaremismdemonstrated mwhen mthemnursemfocusesmonmcommunication, mculture,
mrespect, mcompassion, mclientmeducation, mandmempowerment. mBy massessingmthe meffec
tmof mthe
◦
◦ clientsmculturemon mhealth mcare,mthismnurse mismpracticingmclient-
focused mcare.mProvidingmformbasicm needsmdoesmnotmdemonstrate mthismcompetence.mSimp
ly mtellingmthemclientmaboutmallmupcomingmtestsmismnotmprovidingmempoweringmeducation.
mOrientingmthe mclientmand mfamily mto mthe mroom misman mimportantmsafety mmeasure, mbutmnotm
directly m related mto mdemonstratingmclient-centered m care.
◦ DIF:m Understanding/Comprehension m REF:m 3
, ◦ KEY:mPatient-
centered mcare|mculturemMSC:mIntegrated mProcess:mCaringm
NOT:mClientmNeedsmCategory:
Psychosocialm Integrity
◦ Amclientmismgoing mto mbemadmitted mformamscheduled msurgicalmprocedure.mWhic
h maction mdoesmthemnursemexplain mismthemmostmimportantmthingmthemclientmcan
mdo m to mprotectmagainstmerrors?
◦ Bringmam listmof m allmmedicationsm and m whatmthey m arem for.
◦ Keep m them doctorsm phonem numberm by m them telephone.
◦ Makem surem allm providersm wash m handsm before m enteringm them room.
◦ Writemdown mthemnamemof meach mcaregivermwh
o mcomesmin mthemroom.mANS:mA
◦ Medication merrorsmaremthemmostmcommon mtypemof mhealth mcaremmistake.m
ThemJointmCommissionsmSpeak mUp mcampaign mencouragesmclientsmto mhelp mensure mtheirm
safety.mOnemrecommendationmismformclientsmto mknowmallmtheirmmedicationsmand mwhy mthe
y mtakemthem.mThismwillmhelp mpreventmmedication merrors.
◦ DIF:mApplying/Application m REF:m 4
◦ KEY:mSpeak mUp mcampaign|mpatientmsafety mMSC:mIntegrated mPr
ocess:mTeaching/LearningmNOT:mClientmNeedsmCategory:mSafemand mEffective m
CaremEnvironment:mSafety mand mInfection mControl
◦ Which maction mby mthemnurse mworkingmwith mamclientmbestmdemonstratesmrespectmfor
m autonomy?
◦ Asksm if m them clientm hasm questionsm beforem signingm am consent
◦ Givesm them clientm accurate m information m when m questioned
◦ Keepsm them promisesm madem to m them clientm and m family
◦ Treatsmthemclientmfairly mc
ompared mto mothermclientsm
ANS:mA
◦ Autonomy mismself-
determination. mThemclientmshould mmake mdecisionsmregardingmcare.mWhen mthemnurse mobta
insmamsignature mon mthemconsentmform,massessingmif m themclientmstillmhasmquestionsmismvital
,mbecause mwithoutmfullminformation mthemclientmcannotmpractice mautonomy.mGivingmaccur
ateminformation mismpracticingmwith mveracity.mKeepingmpromisesmismupholdingmfidelity.mT
reatingmthe
◦
◦ clientm fairly m ism providingm socialm justice.
◦
◦ DIF:mApplying/Application m REF:m 4
◦ KEY:mAutonomy|m ethicalm principlesm MSC:m Integrated m Process:m Caring
◦ NOT:m Clientm Needsm Category:m Safem and m Effective m Carem Environment:m Management
of mCare
, ◦
◦ Amstudentmnursemasksmthemfaculty mto mexplain mbestmpracticesmwhenmcommunicatin
gmwith mamperson mfrommthemlesbian,mgay,mbisexual,mtransgender, mand mqueer/mquest
ioningm(LGBTQ)mcommunity.mWhatmanswermby mthemfaculty mismmostm accurate?
◦ Avoid m embarrassingm them clientm by m askingm questions.
◦ Dontm makem assumptionsm aboutm theirm health m needs.
◦ Mostm LGBTQm peoplem do m notm wantm to m share m information.
◦ No mdifferencesmexistmin mcommunicatingmwit
h mthismpopulation. mANS:mB
◦ Many mmembersmof mthemLGBTQmcommunity mhave mfaced mdiscrimination m
frommhealth mcaremprovidersmand mmaymbemreluctantmto mseekmhealth mcare.mThemnursemshoul
d mnevermmakemassumptionsmaboutmthemneedsmofmmembersmof mthismpopulation.mRather,mre
spectfulmquestionsmaremappropriate.mIf mapproached mwith msensitivity,mthemclientmwith many m
health mcaremneed mismmoremlikely mto manswermhonestly.
◦ DIF:mUnderstanding/Comprehension mREF:m4
mKEY:mLGBTQ|mdiversity mMSC:mIntegrated mProcess:mTeachi
ng/Learning
◦ NOT:m Clientm Needsm Category:m Psychosocialm Integrity
◦
◦ Amnursemismcallingmthemon-
callmphysician maboutmamclientmwho mhad mamhysterectomym2 mdaysmago mandmhasmpain m
thatmismunrelieved mby mthemprescribed mnarcotic mpain mmedication.mWhich mstatementm
ismpartmof mthemSBARmformatmformcommunication?
◦ A:mImwould mlikem you mto morderm amdifferentmpain m medication.
◦ B:mThism clientm hasm allergiesm to m morphine m and m codeine.
◦ R:m Dr.m Smith m doesntm likem nonsteroidalm anti-inflammatory m meds.
◦ S:mThismclientmhad mamvaginalmhyst
erectomy m2 mdaysmago.mANS:mB
◦ SBARmismamrecommended mformmof mcommunication, mandmthemacronym ms
tandsmformSituation,mBackground, mAssessment,mand mRecommendation. mAppropriate mbac
kground minformation mincludesmallergiesmto mmedicationsmthemon-
callmphysician mmightmorder.mSituation mdescribesmwhatmismhappeningmrightmnowmthatmmus
tmbemcommunicated;m themclientsmsurgery m2 mdaysmago mwould mbemconsidered mbackground
.mAssessmentmwould mincludeman manalysismof mthemclientsmproblem;maskingmformamdifferent
mpain mmedication misma mrecommendation. mRecommendation misma mstatementmof mwhatmismn
eeded mormwhat
◦
◦ outcome mismdesired;mthisminformation maboutmthemsurgeonsmpreferenc
emmightmbembettermplaced min mbackground.
◦ DIF:mApplying/
mApplication mREF:m5 mKEY:mS
BAR|mcommunication
Chapterm 1 Conceptsm and m Trendsm in m Healthcare
◦ Amnewmnursemismworkingmwith mampreceptormon man minpatientmmedical-
surgicalmunit.mThempreceptormadvisesmthemstudentmthatmwhich mismthempriority mwhe
n mworkingmasmamprofessionalmnurse?
◦ Attendingm to m holisticm clientm needs
◦ Ensuringm clientm safety
◦ Notm makingm medication m errors
◦ Providingmclient-
mfocused mcare mA
NS:mB
◦ Allmactionsmaremappropriate mformthemprofessionalmnurse.mHowever,m ensur
ingm clientm safety m ism them priority.m Up m to m 98,000 m deathsm resultm each m yearm fromm errorsmin
mhospitalmcare, maccordingmto mthe m2000 mInstitute mof mMedicine mreport. mMany mmore mclientsm
havemsuffered minjuriesmand mlessmseriousmoutcomes.mEvery mnursemhasmthemresponsibility mt
o mguard mthemclientsmsafety.
◦ DIF:mUnderstanding/Comprehension mREF:m2
mKEY:mPatientmsafety mMSC:mIntegrated mProcess:mNursingmPr
ocess:mIntervention
◦ NOT:mClientmNeedsmCategory:mSafemand mEffective mCar
emEnvironment:mSafety mand mInfection mControl
◦ Amnursemismorientingmamnewmclientmand mfamily mto mtheminpatientmunit.mWhatminf
ormation mdoesmthemnursemprovide mto mhelp mthemclientmpromote mhismormhermown m
safety?
◦ Encourage m them clientm and m family m to m bem activem partners.
◦ Havem them clientm monitorm hand m hygienem in m caregivers.
◦ Offerm them family m them opportunity m to m stay m with m them client.
◦ Tellmthemclientmto malwaysmwearmhism
ormhermarmband.mANS:mA
◦ Each maction mcould mbemimportantmformthemclientmormfamily mto mperform.m
However,mencouragingmthemclientmto mbemactivemin mhismormhermhealth mcaremasmampartner
mismthe mmostmcritical. mThe mothermactions mare
◦
◦ very mlimited min mscopemand mdo mnotmprovide mthembroad mprotection mth
atmbeingmactivemand minvolved mdoes.
◦ DIF:mUnderstanding/Comprehension mREF:m3
mKEY:mPatientmsafety mMSC:mIntegrated mProcess:mTeaching/m
Learning
◦ NOT:m Clientm Needsm Category:m Safem and m Effective m Care
,Environment:m Safety m and m Infection m Control
◦ Amnursemismcaringmformampostoperative mclientmon mthemsurgicalmunit.mThemclientsmblo
od mpressure mwasm142/76 mmmmHgm30 mminutesmago,mand mnowmism88/50mmmmHg.mWh
atmaction mby mthemnurse mismbest?
◦ Callm them Rapid m Response m Team.
◦ Documentm and m continue m to m monitor.
◦ Notify m them primary m carem provider.
◦ Repeatmblood mpressure mmeasurement
min m15 mminutes. mANS:mA
◦ Thempurpose mof mthemRapid mResponsemTeamm(RRT)mismto mintervene mwhen m
clientsmaremdeterioratingmbefore mthey msuffermeithermrespiratory mormcardiacmarrest.mSincemth
emclientmhasmmanifested mamsignificantmchange,mthemnursemshould mcallmthemRRT.mChangesmi
n mblood mpressure,mmentalmstatus,mheartmrate,mand mpain maremparticularly msignificant.mDocu
mentation mismvital,mbutmthemnursemmustmdo mmore mthan mdocument.mThemprimary mcaremprovi
dermshould mbemnotified,mbutmthismismnotmthempriority movermcallingm themRRT.mThem clientsm
blood mpressure mshould mbemreassessed mfrequently, mbutmthempriority mismgetting
themrapid mcaremto mthemclient.
◦ DIF:mApplying/Application m REF:m 3
◦ KEY:mRapid mResponse mTeamm(RRT)
|mmedicalmemergenciesmMSC:mIntegrated mProcess:
Communication m and m Documentation
◦ NOT:m Clientm Needsm Category:m Physiologicalm Integrity:m PhysiologicalmAdaptation
◦
◦ Amnursemwishesmto mprovide mclient-
centered mcaremin mallminteractions.mWhich maction mby mthemnursembestmdemon
stratesmthismconcept?
◦ Assessesm form culturalm influencesm affectingm health m care
◦ Ensuresmthatmallm themclientsm basicmneedsm arem met
◦ Tellsmthem clientm and m family m aboutm allm upcomingm tests
◦ Thoroughly morientsmthemclientman
d mfamily mto mthemroommANS:mA
◦ Competency min mclient-
focused mcaremismdemonstrated mwhen mthemnursemfocusesmonmcommunication, mculture,
mrespect, mcompassion, mclientmeducation, mandmempowerment. mBy massessingmthe meffec
tmof mthe
◦
◦ clientsmculturemon mhealth mcare,mthismnurse mismpracticingmclient-
focused mcare.mProvidingmformbasicm needsmdoesmnotmdemonstrate mthismcompetence.mSimp
ly mtellingmthemclientmaboutmallmupcomingmtestsmismnotmprovidingmempoweringmeducation.
mOrientingmthe mclientmand mfamily mto mthe mroom misman mimportantmsafety mmeasure, mbutmnotm
directly m related mto mdemonstratingmclient-centered m care.
◦ DIF:m Understanding/Comprehension m REF:m 3
, ◦ KEY:mPatient-
centered mcare|mculturemMSC:mIntegrated mProcess:mCaringm
NOT:mClientmNeedsmCategory:
Psychosocialm Integrity
◦ Amclientmismgoing mto mbemadmitted mformamscheduled msurgicalmprocedure.mWhic
h maction mdoesmthemnursemexplain mismthemmostmimportantmthingmthemclientmcan
mdo m to mprotectmagainstmerrors?
◦ Bringmam listmof m allmmedicationsm and m whatmthey m arem for.
◦ Keep m them doctorsm phonem numberm by m them telephone.
◦ Makem surem allm providersm wash m handsm before m enteringm them room.
◦ Writemdown mthemnamemof meach mcaregivermwh
o mcomesmin mthemroom.mANS:mA
◦ Medication merrorsmaremthemmostmcommon mtypemof mhealth mcaremmistake.m
ThemJointmCommissionsmSpeak mUp mcampaign mencouragesmclientsmto mhelp mensure mtheirm
safety.mOnemrecommendationmismformclientsmto mknowmallmtheirmmedicationsmand mwhy mthe
y mtakemthem.mThismwillmhelp mpreventmmedication merrors.
◦ DIF:mApplying/Application m REF:m 4
◦ KEY:mSpeak mUp mcampaign|mpatientmsafety mMSC:mIntegrated mPr
ocess:mTeaching/LearningmNOT:mClientmNeedsmCategory:mSafemand mEffective m
CaremEnvironment:mSafety mand mInfection mControl
◦ Which maction mby mthemnurse mworkingmwith mamclientmbestmdemonstratesmrespectmfor
m autonomy?
◦ Asksm if m them clientm hasm questionsm beforem signingm am consent
◦ Givesm them clientm accurate m information m when m questioned
◦ Keepsm them promisesm madem to m them clientm and m family
◦ Treatsmthemclientmfairly mc
ompared mto mothermclientsm
ANS:mA
◦ Autonomy mismself-
determination. mThemclientmshould mmake mdecisionsmregardingmcare.mWhen mthemnurse mobta
insmamsignature mon mthemconsentmform,massessingmif m themclientmstillmhasmquestionsmismvital
,mbecause mwithoutmfullminformation mthemclientmcannotmpractice mautonomy.mGivingmaccur
ateminformation mismpracticingmwith mveracity.mKeepingmpromisesmismupholdingmfidelity.mT
reatingmthe
◦
◦ clientm fairly m ism providingm socialm justice.
◦
◦ DIF:mApplying/Application m REF:m 4
◦ KEY:mAutonomy|m ethicalm principlesm MSC:m Integrated m Process:m Caring
◦ NOT:m Clientm Needsm Category:m Safem and m Effective m Carem Environment:m Management
of mCare
, ◦
◦ Amstudentmnursemasksmthemfaculty mto mexplain mbestmpracticesmwhenmcommunicatin
gmwith mamperson mfrommthemlesbian,mgay,mbisexual,mtransgender, mand mqueer/mquest
ioningm(LGBTQ)mcommunity.mWhatmanswermby mthemfaculty mismmostm accurate?
◦ Avoid m embarrassingm them clientm by m askingm questions.
◦ Dontm makem assumptionsm aboutm theirm health m needs.
◦ Mostm LGBTQm peoplem do m notm wantm to m share m information.
◦ No mdifferencesmexistmin mcommunicatingmwit
h mthismpopulation. mANS:mB
◦ Many mmembersmof mthemLGBTQmcommunity mhave mfaced mdiscrimination m
frommhealth mcaremprovidersmand mmaymbemreluctantmto mseekmhealth mcare.mThemnursemshoul
d mnevermmakemassumptionsmaboutmthemneedsmofmmembersmof mthismpopulation.mRather,mre
spectfulmquestionsmaremappropriate.mIf mapproached mwith msensitivity,mthemclientmwith many m
health mcaremneed mismmoremlikely mto manswermhonestly.
◦ DIF:mUnderstanding/Comprehension mREF:m4
mKEY:mLGBTQ|mdiversity mMSC:mIntegrated mProcess:mTeachi
ng/Learning
◦ NOT:m Clientm Needsm Category:m Psychosocialm Integrity
◦
◦ Amnursemismcallingmthemon-
callmphysician maboutmamclientmwho mhad mamhysterectomym2 mdaysmago mandmhasmpain m
thatmismunrelieved mby mthemprescribed mnarcotic mpain mmedication.mWhich mstatementm
ismpartmof mthemSBARmformatmformcommunication?
◦ A:mImwould mlikem you mto morderm amdifferentmpain m medication.
◦ B:mThism clientm hasm allergiesm to m morphine m and m codeine.
◦ R:m Dr.m Smith m doesntm likem nonsteroidalm anti-inflammatory m meds.
◦ S:mThismclientmhad mamvaginalmhyst
erectomy m2 mdaysmago.mANS:mB
◦ SBARmismamrecommended mformmof mcommunication, mandmthemacronym ms
tandsmformSituation,mBackground, mAssessment,mand mRecommendation. mAppropriate mbac
kground minformation mincludesmallergiesmto mmedicationsmthemon-
callmphysician mmightmorder.mSituation mdescribesmwhatmismhappeningmrightmnowmthatmmus
tmbemcommunicated;m themclientsmsurgery m2 mdaysmago mwould mbemconsidered mbackground
.mAssessmentmwould mincludeman manalysismof mthemclientsmproblem;maskingmformamdifferent
mpain mmedication misma mrecommendation. mRecommendation misma mstatementmof mwhatmismn
eeded mormwhat
◦
◦ outcome mismdesired;mthisminformation maboutmthemsurgeonsmpreferenc
emmightmbembettermplaced min mbackground.
◦ DIF:mApplying/
mApplication mREF:m5 mKEY:mS
BAR|mcommunication
