NUR 303/NUR303 MEDICAL –SURGICAL NURSING EXAM 2022
Chapter 1: Overview of Professional Nursing Concepts for Medical- Surgical
Nursing
1. A nurse wishes to provide client-centered care in all interactions. Which
action by the nurse bestdemonstrates this concept?
a. Assesses for cultural influ...
NUR 303 /NUR303 MEDICAL –SURGICAL NURSING EXAM 2022 Chapter 1: Overview of Professional Nursing Concepts for Medical - Surgical Nursing 1. A nurse wishes to provide client -centered care in all interactions. Which action by the nurse best demonstrates this concept? a. Assesses for cultural influences affecting health care b. Ensures that all the clients basic needs are met c. Tells the client & family about all upcoming tests d. Thoroughly orients the client & family to the room ANS: A - Competency in client -focused care is demonstrated when the nurse focuses on communication, culture, respect, compassion, client education & empowerment. By assessing the effect of the client’s culture on health care, this nurse is practicing client -
focused care. Providing for basic needs does not demonstrate this competence. Simply telling the client about all upcoming tests is not providing empowering education. Orienting the client & family to the room is an important safety measure, but not directly related to demonstrating client -centered care. 2. A nurse is caring for a postoperative client on the surgical unit. The client’s blood pressure was 142/76 mm Hg 30 minutes ago & now is 88/50 mm Hg. What action by the nurse is best? a. Call the Rapid Response Team. b. Document & continue to monitor. c. Notify the primary care provider. d. Repeat blood pressure measurement in 15 minutes. ANS: A – The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating before they suffer either respiratory or cardiac arrest. Since the client has manifested a significant change, the nurse should call the RRT. Changes in blood pressure, mental status, heart rate & pain are particularly significant. Documentation is vital, but the nurse must do more than document. The primary care provider should be notified, but this is not the priority over calling the RRT. The client’s blood pressure should be reassessed frequently, but the priority is getting the rapid care to the client. 3. A nurse is orienting a new client & family to the inpatient unit. What info does the nurse give to help the client promote his or her own safety? a. Encourage the client & family to be active partners. b. Have the client monitor hand hygiene in caregivers. c. Offer the family the opportunity to stay with the client. d. Tell the client to always wear his or her armband. ANS: A - Each action could be important for the client or family to perform. However, encouraging the client to be active in his or her health care as a partner is the most critical. The other actions are very limited in scope & do not provide the broad protection being active & involved does. 4. A new nurse is working with a preceptor on an inpatient medical -surgical unit. The preceptor advises the student that which is the priority when working as a professional nurse? a. Attending to holistic client needsb. Ensuring client safety c. Not making medication errors d. Providing client -focused care ANS: B – All actions are appropriate for the professional nurse. However, ensuring client safety is the priority. Up to 98,000 deaths result each year from errors in hospital care, according to the 2000 Institute of Medicine report. Many more clients have suffered injuries & less serious outcomes. Every nurse has the responsibility to guard the client’s safety. 5. A client is going to be admitted for a scheduled surgical procedure. Which action does the nurse explain is the most important thing the client can do to protect against errors? a. Bring a list of all medications & what they are for. b. Keep the doctors phone number by the telephone. c. Make sure all providers wash hands before entering the room. d. Write down the name of each caregiver who comes in the room. ANS: A – Medication errors are the most common type of health care mistake. The Joint Commissions Speak Up campaign encourages clients to help ensure their safety. One recommendation is for clients to know all their medications & why they take them. This will help prevent med errors. 6. Which action by the nurse working with a client best demonstrates respect for autonomy? a. Asks if the client has questions before signing a consent b. Gives the client accurate information when questioned c. Keeps the promises made to the client & family d. Treats the client fairly compared to other clients ANS: A – Autonomy is self-determination. The client should make decisions regarding care. When the nurse obtains a signature on the consent form, assessing if the client still has questions is vital, because without full information the client cannot practice autonomy. Giving accurate information is practicing with veracity. Keeping promises is upholding fidelity. Treating the client fairly is providing social justice. 7. A student nurse asks the faculty to explain best practices when communicating with a person from the lesbian, gay, bisexual, transgender & queer/questioning (LGBTQ) community. What answer by the faculty is most accurate? a. Avoid embarrassing the client by asking questions. b. Don’t make assumptions about their health needs. c. Most LGBTQ people do not want to share information. d. No differences exist in communicating with this population. ANS: B - Many members of the LGBTQ community have faced discrimination from health care providers & may be reluctant to seek health care. The nurse should never make assumptions about the needs of members of this population. Rather, respectful questions are appropriate. If approached with sensitivity, the client with any health care need is more likely to answer honestly. 8. A nurse is calling the on-call physician about a client who had a hysterectomy 2 days ago & has pain that is unrelieved by the prescribed narcotic pain medication. Which statement is part of the SBAR format for communication? a. A: I would like you to order a different pain medication. b. B: This client has allergies to morphine & codeine. c. R: Dr. Smith doesn’t like nonsteroidal anti-inflammatory meds. d. S: This client had a vaginal hysterectomy 2 days ago. ANS: B – SBAR is a recommended form of communication & the acronym stands for Situation, Background, Assessment & Recommendation. Appropriate background information includes allergies to medications the on- call physician might order. Situation describes what is happening right now that must be communicated; the client’s surgery 2 days ago would be considered background. Assessment would include an analysis of the client’s problem; asking for a different pain medication is a recommendation. Recommendation is a statement of what is needed or what outcome is desired; this information about the surgeon’s preference might be better placed in background. 9. A nurse working on a cardiac unit delegated taking vital signs to an experienced unlicensed assistive personnel (UAP). Four hours later, the nurse notes the client’s blood pressure is much higher than previous readings & the client’s mental status has changed. What action by the nurse would most likely have prevented this negative outcome? a. Determining if the UAP knew how to take blood pressure b. Double -checking the UAP by taking another blood pressure c. Providing more appropriate supervision of the UAP d. Taking the blood pressure instead of delegating the task ANS: C – Supervision is one of the five rights of delegation & includes directing, evaluating & following up on delegated tasks. The nurse should either have asked the UAP about the vital signs or instructed the UAP to report them right away. An experienced UAP should know how to take vital signs & the nurse should not have to assess this at this point. Double -checking the work defeats the purpose of delegation. Vital signs are within the scope of practice for a UAP & are permissible to delegate. The only appropriate answer is that the nurse did not provide adequate instruction to the UAP. 10. A nurse is talking with a client who is moving to a new state & needs to find a new doctor & hospital there. What advice by the nurse is best? a. Ask the hospitals there about standard nurse -client ratios. b. Choose the hospital that has the newest technology. c. Find a hospital that is accredited by The Joint Commission. d. Use a facility affiliated with a medical or nursing school. ANS: C – Accreditation by The Joint Commission (TJC) or other accrediting body gives assurance that the facility has a focus on safety. Nurse -client ratios differ by unit type & change over time. New technology doesnt necessarily mean the hospital is safe. Affiliation with a health professions school has several advantages, but safety is most important. 11. A newly graduated nurse in the hospital states that, since she is so new, she cannot participate in quality improvement (QI) projects. What response by the precepting nurse is best? a. All staff nurses are required to participate in quality improvement. b. Even being new you can implement activities designed to improve care. c. It’s easy to identify what indicators should be used to measure quality d. You should ask to be assigned to the research & quality committee. ANS: B – The preceptor should try to reassure the nurse that implementing QI measures is not out of line for a newly licensed nurse. Simply stating that all nurses are required to participate does not help the nurse understand how that is possible & is dismissive. Identifying indicators of quality is not an easy, quick process &
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