,Chapter 1: Introduction to Medical-Surgical Nursing Practice
h h h h h h
Ignatavicius: Medical-Surgical Nursing,10th Edition
h h h h
MULTIPLE CHOICE h
1. A new nurse is working with a preceptor on an inpatient medical-surgical unit. The
h h h h h h h h h h h h h
preceptor advises the student that which is the priority when working as a professional
h h h h h h h h h h h h h h
nurse?
h
a. Attending to holistic client needs h h h h
b. Ensuring client safety h h
c. Not making medication errors h h h
d. Providing client-focused care h h
ANS: B h
All actions are appropriate for the professional nurse. However, ensuring client safety is the
h h h h h h h h h h h h h
priority. Up to 98,000 deaths result each year from errors in hospital care, according to the
h h h h h h h h h h h h h h h h
2000 Institute of Medicine report. Many more clients have suffered injuries and less serious
h h h h h h h h h h h h h h
outcomes. Every nurse has the responsibility to guard the client‘s safety.
h h h h h h h h h h h
DIF: Understanding/Comprehension REF: 2 KEY: Patient safety h h
MSC: Integrated Process: Nursing Process: Intervention
h h h h h h
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
h h h h h h h h h h h
Control
h
2. A nurse is orienting a new client and family to the inpatient unit. What information does the
h h h h h h h h h h h h h h h h
nurse provide to help the client promote his or her own safety?
h h h h h h h h h h h h
a. Encourage the client and family to be active partners. h h h h h h h h
b. Have the client monitor hand hygiene in caregivers.
h h h h h h h
c. Offer the family the opportunity to stay with the client.
h h h h h h h h h
d. Tell the client to always wear his or her armband.
h h h h h h h h h
ANS: A h
Each action could be important for the client or family to perform. However, encouraging
h h h h h h h h h h h h h
the client to be active in his or her health care as a partner is the most critical. The other
h h h h h h h h h h h h h h h h h h h h
actions are very limited in scope and do not provide the broad protection that being active
h h h h h h h h h h h h h h h h
and involved does.
h h h
DIF: Understanding/Comprehension REF: 3 KEY: Patient safety h h
MSC: Integrated Process: Teaching/Learning
h h h h
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
h h h h h h h h h h h
Control
h
3. A nurse is caring for a postoperative client on the surgical unit. The client‘s blood pressure
h h h h h h h h h h h h h h h
was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is
h h h h h h h h h h h h h h h h h h h
best?
h
a. Call the Rapid Response Team. h h h h
b. Document and continue to monitor. h h h h
c. Notify the primary care provider. h h h h
d. Repeat blood pressure measurement in 15 minutes. h h h h h h
, ANS: A h
The purpose of the Rapid Response Team (RRT) is to intervene when clients are
h h h h h h h h h h h h h
deteriorating before they suffer either respiratory or cardiac arrest. Since the client has
h h h h h h h h h h h h h
manifested a significant change, the nurse should call the RRT. Changes in blood pressure,
h h h h h h h h h h h h h h
mental status, heart rate, and pain are particularly significant. Documentation is vital, but the
h h h h h h h h h h h h h h
nurse must do more than document. The primary care provider should be notified, but this is
h h h h h h h h h h h h h h h h
not the priority over calling the RRT. The client‘s blood pressure should be reassessed
h h h h h h h h h h h h h h
frequently, but the priority is getting the rapid care to the client.
h h h h h h h h h h h h
DIF: Applying/Application REF: 3
KEY:
h h Rapid Response Team (RRT)| medical emergencies
h h h h h
MSC: h Integrated Process: Communication and Documentation h h h h
NOT: h Client Needs Category: Physiological Integrity: Physiological Adaptation
h h h h h h
4. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse
h h h h h h h h h h h h h h
best demonstrates this concept?
h h h h
a. Assesses for cultural influences affecting health care h h h h h h
b. Ensures that all the clients‘ basic needs are meth h h h h h h h
c. Tells the client and family about all upcoming tests
h h h h h h h h
d. Thoroughly orients the client and family to the room h h h h h h h h
ANS: A h
Competency in client-focused care is demonstrated when the nurse focuses on
h h h h h h h h h h
communication, culture, respect, compassion, client education, and empowerment. By
h h h h h h h h h
assessing the effect of the client‘s culture on health care, this nurse is practicing
h h h h h h h h h h h h h h
client-focused care. Providing for basic needs does not demonstrate this competence.
h h h h h h h h h h
Simply telling the client about all upcoming tests is not providing empowering education.
h h h h h h h h h h h h h
Orienting the client and family to the room is an important safety measure, but not directly
h h h h h h h h h h h h h h h h
related to demonstrating client-centered care.
h h h h h
DIF: Understanding/Comprehension REF: 3
KEY: Patient-centered care| culture
h MSC: Integrated Process: Caring h h h h h
NOT: Client Needs Category: Psychosocial Integrity
h h h h h h
5. A client is going to be admitted for a scheduled surgical procedure. Which action does the
h h h h h h h h h h h h h h h
nurse explain is the most important thing the client can do to protect against errors?
h h h h h h h h h h h h h h h
a. Bring a list of all medications and what they are for.
h h h h h h h h h h
b. Keep the doctor‘s phone number by the telephone.
h h h h h h h
c. Make sure all providers wash hands before entering the room.
h h h h h h h h h
d. Write down the name of each caregiver who comes in the room.
h h h h h h h h h h h
ANS: A h
Medication errors are the most common type of health care mistake. The Joint
h h h h h h h h h h h h
Commission‘s Speak Up campaign encourages clients to help ensure their safety. One
h h h h h h h h h h h h
recommendation is for clients to know all their medications and why they take them. This
h h h h h h h h h h h h h h h
will help prevent medication errors.
h h h h h
DIF: Applying/Application REF: 4
KEY: Speak Up campaign| patient safety MSC: Integrated Process: Teaching/Learning
h h h h h h h h
, NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
h h h h h h h h h h h
Control
h
6. Which action by the nurse working with a client best demonstrates respect for autonomy?
h h h h h h h h h h h h h
a. Asks if the client has questions before signing a consent
h h h h h h h h h
b. Gives the client accurate information when questioned
h h h h h h
c. Keeps the promises made to the client and family
h h h h h h h h
d. Treats the client fairly compared to other clients
h h h h h h h
ANS: A h
Autonomy is self-determination. The client should make decisions regarding care. When the
h h h h h h h h h h h
nurse obtains a signature on the consent form, assessing if the client still has questions is
h h h h h h h h h h h h h h h h
vital, because without full information the client cannot practice autonomy. Giving accurate
h h h h h h h h h h h h
information is practicing with veracity. Keeping promises is upholding fidelity. Treating the
h h h h h h h h h h h h
client fairly is providing social justice.
h h h h h h
DIF: Applying/Application REF: 4
KEY: Autonomy| ethical principles
h MSC: Integrated Process: Caring h h h h h
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
h h h h h h h h h h h
7. A student nurse asks the faculty to explain best practices when communicating with a
h h h h h h h h h h h h h
person from the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)
h h h h h h h h h h
community. What answer by the faculty is most accurate?
h h h h h h h h h
a. Avoid embarrassing the client by asking questions.
h h h h h h
b. Don‘t make assumptions about their health needs.
h h h h h h
c. Most LGBTQ people do not want to share information.
h h h h h h h h
d. No differences exist in communicating with this population.
h h h h h h h
ANS: B h
Many members of the LGBTQ community have faced discrimination from health care
h h h h h h h h h h h
providers and may be reluctant to seek health care. The nurse should never make
h h h h h h h h h h h h h h
assumptions about the needs of members of this population. Rather, respectful questions are
h h h h h h h h h h h h h
appropriate. If approached with sensitivity, the client with any health care need is more
h h h h h h h h h h h h h h
likely to answer honestly.
h h h h
DIF: Understanding/Comprehension REF: 4 KEY: LGBTQ| diversity h h
MSC: Integrated Process: Teaching/Learning
h h h h
NOT: Client Needs Category: Psychosocial Integrity
h h h h h
8. A nurse is calling the on-call physician about a client who had a hysterectomy 2 days ago
h h h h h h h h h h h h h h h h
and has pain that is unrelieved by the prescribed narcotic pain medication. Which statement
h h h h h h h h h h h h h h
is part of the SBAR format for communication?
h h h h h h h h
a. A: ―I would like you to order a different pain medication.‖
h h h h h h h h h h
b. B: ―This client has allergies to morphine and codeine.‖
h h h h h h h h
c. R: ―Dr. Smith doesn‘t like nonsteroidal anti-inflammatory meds.‖
h h h h h h h
d. S: ―This client had a vaginal hysterectomy 2 days ago.‖
h h h h h h h h h
h ANS: B h
h h h h h h
Ignatavicius: Medical-Surgical Nursing,10th Edition
h h h h
MULTIPLE CHOICE h
1. A new nurse is working with a preceptor on an inpatient medical-surgical unit. The
h h h h h h h h h h h h h
preceptor advises the student that which is the priority when working as a professional
h h h h h h h h h h h h h h
nurse?
h
a. Attending to holistic client needs h h h h
b. Ensuring client safety h h
c. Not making medication errors h h h
d. Providing client-focused care h h
ANS: B h
All actions are appropriate for the professional nurse. However, ensuring client safety is the
h h h h h h h h h h h h h
priority. Up to 98,000 deaths result each year from errors in hospital care, according to the
h h h h h h h h h h h h h h h h
2000 Institute of Medicine report. Many more clients have suffered injuries and less serious
h h h h h h h h h h h h h h
outcomes. Every nurse has the responsibility to guard the client‘s safety.
h h h h h h h h h h h
DIF: Understanding/Comprehension REF: 2 KEY: Patient safety h h
MSC: Integrated Process: Nursing Process: Intervention
h h h h h h
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
h h h h h h h h h h h
Control
h
2. A nurse is orienting a new client and family to the inpatient unit. What information does the
h h h h h h h h h h h h h h h h
nurse provide to help the client promote his or her own safety?
h h h h h h h h h h h h
a. Encourage the client and family to be active partners. h h h h h h h h
b. Have the client monitor hand hygiene in caregivers.
h h h h h h h
c. Offer the family the opportunity to stay with the client.
h h h h h h h h h
d. Tell the client to always wear his or her armband.
h h h h h h h h h
ANS: A h
Each action could be important for the client or family to perform. However, encouraging
h h h h h h h h h h h h h
the client to be active in his or her health care as a partner is the most critical. The other
h h h h h h h h h h h h h h h h h h h h
actions are very limited in scope and do not provide the broad protection that being active
h h h h h h h h h h h h h h h h
and involved does.
h h h
DIF: Understanding/Comprehension REF: 3 KEY: Patient safety h h
MSC: Integrated Process: Teaching/Learning
h h h h
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
h h h h h h h h h h h
Control
h
3. A nurse is caring for a postoperative client on the surgical unit. The client‘s blood pressure
h h h h h h h h h h h h h h h
was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is
h h h h h h h h h h h h h h h h h h h
best?
h
a. Call the Rapid Response Team. h h h h
b. Document and continue to monitor. h h h h
c. Notify the primary care provider. h h h h
d. Repeat blood pressure measurement in 15 minutes. h h h h h h
, ANS: A h
The purpose of the Rapid Response Team (RRT) is to intervene when clients are
h h h h h h h h h h h h h
deteriorating before they suffer either respiratory or cardiac arrest. Since the client has
h h h h h h h h h h h h h
manifested a significant change, the nurse should call the RRT. Changes in blood pressure,
h h h h h h h h h h h h h h
mental status, heart rate, and pain are particularly significant. Documentation is vital, but the
h h h h h h h h h h h h h h
nurse must do more than document. The primary care provider should be notified, but this is
h h h h h h h h h h h h h h h h
not the priority over calling the RRT. The client‘s blood pressure should be reassessed
h h h h h h h h h h h h h h
frequently, but the priority is getting the rapid care to the client.
h h h h h h h h h h h h
DIF: Applying/Application REF: 3
KEY:
h h Rapid Response Team (RRT)| medical emergencies
h h h h h
MSC: h Integrated Process: Communication and Documentation h h h h
NOT: h Client Needs Category: Physiological Integrity: Physiological Adaptation
h h h h h h
4. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse
h h h h h h h h h h h h h h
best demonstrates this concept?
h h h h
a. Assesses for cultural influences affecting health care h h h h h h
b. Ensures that all the clients‘ basic needs are meth h h h h h h h
c. Tells the client and family about all upcoming tests
h h h h h h h h
d. Thoroughly orients the client and family to the room h h h h h h h h
ANS: A h
Competency in client-focused care is demonstrated when the nurse focuses on
h h h h h h h h h h
communication, culture, respect, compassion, client education, and empowerment. By
h h h h h h h h h
assessing the effect of the client‘s culture on health care, this nurse is practicing
h h h h h h h h h h h h h h
client-focused care. Providing for basic needs does not demonstrate this competence.
h h h h h h h h h h
Simply telling the client about all upcoming tests is not providing empowering education.
h h h h h h h h h h h h h
Orienting the client and family to the room is an important safety measure, but not directly
h h h h h h h h h h h h h h h h
related to demonstrating client-centered care.
h h h h h
DIF: Understanding/Comprehension REF: 3
KEY: Patient-centered care| culture
h MSC: Integrated Process: Caring h h h h h
NOT: Client Needs Category: Psychosocial Integrity
h h h h h h
5. A client is going to be admitted for a scheduled surgical procedure. Which action does the
h h h h h h h h h h h h h h h
nurse explain is the most important thing the client can do to protect against errors?
h h h h h h h h h h h h h h h
a. Bring a list of all medications and what they are for.
h h h h h h h h h h
b. Keep the doctor‘s phone number by the telephone.
h h h h h h h
c. Make sure all providers wash hands before entering the room.
h h h h h h h h h
d. Write down the name of each caregiver who comes in the room.
h h h h h h h h h h h
ANS: A h
Medication errors are the most common type of health care mistake. The Joint
h h h h h h h h h h h h
Commission‘s Speak Up campaign encourages clients to help ensure their safety. One
h h h h h h h h h h h h
recommendation is for clients to know all their medications and why they take them. This
h h h h h h h h h h h h h h h
will help prevent medication errors.
h h h h h
DIF: Applying/Application REF: 4
KEY: Speak Up campaign| patient safety MSC: Integrated Process: Teaching/Learning
h h h h h h h h
, NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
h h h h h h h h h h h
Control
h
6. Which action by the nurse working with a client best demonstrates respect for autonomy?
h h h h h h h h h h h h h
a. Asks if the client has questions before signing a consent
h h h h h h h h h
b. Gives the client accurate information when questioned
h h h h h h
c. Keeps the promises made to the client and family
h h h h h h h h
d. Treats the client fairly compared to other clients
h h h h h h h
ANS: A h
Autonomy is self-determination. The client should make decisions regarding care. When the
h h h h h h h h h h h
nurse obtains a signature on the consent form, assessing if the client still has questions is
h h h h h h h h h h h h h h h h
vital, because without full information the client cannot practice autonomy. Giving accurate
h h h h h h h h h h h h
information is practicing with veracity. Keeping promises is upholding fidelity. Treating the
h h h h h h h h h h h h
client fairly is providing social justice.
h h h h h h
DIF: Applying/Application REF: 4
KEY: Autonomy| ethical principles
h MSC: Integrated Process: Caring h h h h h
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
h h h h h h h h h h h
7. A student nurse asks the faculty to explain best practices when communicating with a
h h h h h h h h h h h h h
person from the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)
h h h h h h h h h h
community. What answer by the faculty is most accurate?
h h h h h h h h h
a. Avoid embarrassing the client by asking questions.
h h h h h h
b. Don‘t make assumptions about their health needs.
h h h h h h
c. Most LGBTQ people do not want to share information.
h h h h h h h h
d. No differences exist in communicating with this population.
h h h h h h h
ANS: B h
Many members of the LGBTQ community have faced discrimination from health care
h h h h h h h h h h h
providers and may be reluctant to seek health care. The nurse should never make
h h h h h h h h h h h h h h
assumptions about the needs of members of this population. Rather, respectful questions are
h h h h h h h h h h h h h
appropriate. If approached with sensitivity, the client with any health care need is more
h h h h h h h h h h h h h h
likely to answer honestly.
h h h h
DIF: Understanding/Comprehension REF: 4 KEY: LGBTQ| diversity h h
MSC: Integrated Process: Teaching/Learning
h h h h
NOT: Client Needs Category: Psychosocial Integrity
h h h h h
8. A nurse is calling the on-call physician about a client who had a hysterectomy 2 days ago
h h h h h h h h h h h h h h h h
and has pain that is unrelieved by the prescribed narcotic pain medication. Which statement
h h h h h h h h h h h h h h
is part of the SBAR format for communication?
h h h h h h h h
a. A: ―I would like you to order a different pain medication.‖
h h h h h h h h h h
b. B: ―This client has allergies to morphine and codeine.‖
h h h h h h h h
c. R: ―Dr. Smith doesn‘t like nonsteroidal anti-inflammatory meds.‖
h h h h h h h
d. S: ―This client had a vaginal hysterectomy 2 days ago.‖
h h h h h h h h h
h ANS: B h
