Medical-Surgical Nursing:
Concepts for Clinical Judgment and Collaborative Care 11th
Edition by Ignatavicius
Chapters 1-69
,Concepts for Medical-Surgical NursingIgnatavicius: Medical-
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Surgical Nursing, 11th Edition
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MULTIPLE CHOICE hd
1. A new nurse is working with a preceptor on a medical-
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surgical unit. The preceptor advises thenew nurse that which is the priority when wor
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king as a professional nurse?
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a. Attending to holistic client needs hd hd hd hd
b. Ensuring client safety hd hd
c. Not making medication errors hd hd hd
d. Providing client-focused care hd hd
ACCURATE ANSWER: hd hd
B
Rationale:All actions are appropriate for the professional nurse. However, ensuring c
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lient safety is thepriority. Health care errors have been widely reported for 25 years,
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many of which result inclient injury, death, and increased health care costs. There a
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re several national and international organizations that have either recommended or
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mandated safety initiatives.
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Every nurse has the responsibility to guard the client’s safety. The other actions are im
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portantfor quality nursing, but they are not as vital as providing safety. Not making me
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dication errorsdoes provide safety, but is too narrow in scope to be the best accurate a
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nswerwer.
DIF: Understanding
TOP: Integrated Process: Nursing Process: InterventionKEY: Client safety
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MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
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2. A nurse is orienting a new client and family to the medical-
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surgical unit. What informationdoes the nurse provide to best help the client promo
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te his or her own safety?
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a. Encourage the client and family to be active partners. hd hd hd hd hd hd hd hd
b. Have the client monitor hand hygiene in caregivers.
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c. Offer the family the opportunity to stay with the client.
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d. Tell the client to always wear his or her armband.
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ACCURATE ANSWER: hd hd
A
Rationale:Each action could be important for the client or family to perform. However,
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encouraging theclient to be active in his or her health care as a safety partner is the m
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ost critical. The other actions are very limited in scope and do not provide the broad p
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rotection that being active andinvolved does. hd hd hd hd h
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DIF: Understanding
TOP: Integrated Process: Teaching/LearningKEY: Client safety
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MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
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3. A nurse is caring for a postoperative client on the surgical unit. The client’s blood pr
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essure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action
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, would the nursetake first? hd hd h
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a. Call the Rapid Response Team. hd hd hd hd
b. Document and continue to monitor. hd hd hd hd
c. Notify the primary health care provider. hd hd hd hd hd
d. Repeat the blood pressure in 15 minutes. hd hd hd hd hd hd
ACCURATE ANSWER: A hd hd
Rationale:The purpose of the Rapid Response Team (RRT) is to intervene when clients
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are deterioratingbefore they suffer either respiratory or cardiac arrest. Since the client
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has manifested a significant change, the nurse would call the RRT. Changes in blood p
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ressure, mental status, heart rate, temperature, oxygen saturation, and last 2 hours’ uri
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ne output are particularly significant and are part of the Modified Early Warning Syste
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m guide. Documentation is vital, but the nurse must do more than document. The prim
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ary health care provider would be notified, but this is not more important than calling
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the RRT. The client’s blood pressure would be reassessed frequently, but the priority is
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getting the rapid care to the client.
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DIF: Applying
TOP: Integrated Process: Communication and DocumentationKEY: Rapi
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d Response Team (RRT), Clinical judgment
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MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
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4. A nurse wishes to provide client-
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centered care in all interactions. Which action by the nurse
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best demonstrates this concept?
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a. Assesses for cultural influences affecting health care. hd hd hd hd hd hd
b. Ensures that all the client’s basic needs are met. hd hd hd hd hd hd hd hd
c. Tells the client and family about all upcoming tests.
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d. Thoroughly orients the client and family to the room. hd hd hd hd hd hd hd hd
ACCURATE ANSWER: A hd hd
Rationale:Showing respect for the client and family’s preferences and needs is essenti hd hd hd hd hd hd hd hd hd hd hd
al to ensure a holistic or “whole-
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person” approach to care. By assessing the effect of the client’s culture onhealth care,
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this nurse is practicing client-
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focused care. Providing for basic needs does not demonstrate this competence. Simpl
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y telling the client about all upcoming tests is not providing empowering education. O
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rienting the client and family to the room is an importantsafety measure, but not direc
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tly related to demonstrating client-centered care.
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DIF: Understanding
TOP: Integrated Process: Culture and Spirituality KEY: Client-
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centered care, Culture hd hd
MSC: Client Needs Category: Psychosocial Integrity h d hd hd hd hd
5. A client is going to be admitted for a scheduled surgical procedure. Which action d
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oes thenurse explain is the most important thing the client can do to protect agains
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t errors?
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a. Bring a list of all medications and what they are for.
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b. Keep the provider’s phone number by the telephone.
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c. Make sure that all providers wash hands before entering the room.
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d. Write down the name of each caregiver who comes in the room.
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ACCURATE ANSWER: A hd hd
Rationale:Medication reconciliation is a formal process in which the client’s actual curr hd hd hd hd hd hd hd hd hd hd hd
, ent medicationsare compared to the prescribed medications at the time of admission, t
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raccurate answerfer, or discharge. This National client Safety Goal is important to redu
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ce medication errors. The client would not have to be responsible for providers washi
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ng their hands, and even if the client does so, this is too narrow to be the most import
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ant action to prevent errors. Keeping the provider’s phone number nearby and docum
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enting everyone who enters the room also do not guarantee safety.
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DIF: Applying
TOP: Integrated Process: Teaching/LearningKEY: Clien h d hd hd h
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t safety, Informatics
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MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
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6. Which action by the nurse working with a client best demonstrates respect for autonom
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y?
a. Asks if the client has questions before signing a consent.
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b. Gives the client accurate information when questioned.
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c. Keeps the promises made to the client and family.
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d. Treats the client fairly compared to other clients.
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ACCURATE ANSWER: A hd hd
Rationale:Autonomy is self- hd hd
determination. The client would make decisions regarding care. When the nurse obtain hd hd hd hd hd hd hd hd hd hd hd
s a signature on the consent form, assessing if the client still has questions is vital,beca
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use without full information the client cannot practice autonomy. Giving accurate infor
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mation is practicing with veracity. Keeping promises is upholding fidelity. Treating the
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client fairly is providing social justice.
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DIF: Applying TOP: Integrated Process: Caring h d hd hd
KEY: Ethics, AutonomyMSC: Client Needs Category: Safe and Effective Care E
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nvironment: Management of Care hd hd hd
7. A nurse asks a more seasoned colleague to explain best practices when communicating
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with aperson from the lesbian, gay, bisexual, traccurate answergender, and questionin
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g/queer (LGBTQ) community. What accurate answerwer by the faculty is most accurat
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e?
a. Avoid embarrassing the client by asking questions. hd hd hd hd hd hd
b. Don’t make assumptions about his or her health needs.
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c. Most LGBTQ people do not want to share information.
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d. No differences exist in communicating with this population.
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ACCURATE ANSWER: B hd hd
Rationale:Many members of the LGBTQ community have faced discrimination from hea hd hd hd hd hd hd hd hd hd hd
lth care providers and may be reluctant to seek health care. The nurse would never m
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ake assumptions about the needs of members of this population. Rather, respectful que
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stions are appropriate. Ifapproached with sensitivity, the client with any health care ne
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ed is more likely to accurate answerwer honestly.
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DIF: Understanding TOP: Integrated Process: Teaching/Learning
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KEY: Health care disparities, LGBTQ
h d hd hd hd MSC: Client Needs Category: Psychosocial Integrity
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8. A nurse is calling the on-
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call health care provider about a client who had a hysterectomy 2days ago and has
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pain that is unrelieved by the prescribed opioid pain medication. Which statement
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comprises the background portion of the SBAR format for communication?
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a. “I would like you to order a different pain medication.”
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,b. “This client has allergies to morphine and codeine.”
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c. “Dr. Smith doesn’t like nonsteroidal anti-inflammatory meds.”
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d. “This client had a vaginal hysterectomy 2 days ago.”
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ACCURATE ANSWER: B
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, Rationale:SBAR is a recommended form of communication, and the acronym stands for hd hd hd hd hd hd hd hd hd hd hd
Situation, Background, Assessment, and Recommendation. Appropriate background in
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formation includes allergies to medications the on- hd hd hd hd hd hd
call health care provider might order. Situation describes what is happening right now
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that must be communicated; the client’s surgery 2 daysago would be considered backg
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round. Assessment would include an analysis of the client’s problem; none of the optio
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ns has assessment information. Asking for a different pain medication is a recommend
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ation. Recommendation is a statement of what is needed or what outcome is desired.
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DIF: Applying
TOP: Integrated Process: Communication and DocumentationKEY: Tea
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mwork and collaboration, SBAR hd hd hd
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
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9. A nurse working on a cardiac unit delegated taking vital signs to an experienced assist
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ive personnel (AP). Four hours later, the nurse notes that the client’s blood pressure t
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aken by the AP was much higher than previous readings, and the client’s mental status
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has changed. Whataction by the nurse would most likely have prevented this negative
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doutcome?
a. Determining if the AP knew how to take blood pressure hd hd hd hd hd hd hd hd hd
b. Double-checking the AP by taking another blood pressure hd hd hd hd hd hd hd
c. Providing more appropriate supervision of the AP hd hd hd hd hd hd
d. Taking the blood pressure instead of delegating the task hd hd hd hd hd hd hd hd
ACCURATE ANSWER: C hd hd
Rationale:Supervision is one of the five rights of delegation and includes directing, eva hd hd hd hd hd hd hd hd hd hd hd hd
luating, and following up on delegated tasks. The nurse would either have asked the A
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P about the vital signs or instructed the AP to report them right away. An experienced
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dAP would know how totake vital signs and the nurse would not have to assess this at
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this point. Double- hd hd
checking thework defeats the purpose of delegation. Vital signs are within the scope o
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f practice for a AP and are permissible to delegate. The only appropriate accurate ans
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werwer is that the nurse did not provideadequate instruction to the AP.
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DIF: Analyzing
TOP: Integrated Process: Communication and DocumentationKEY: Tea
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mwork and collaboration, Delegation hd hd hd
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
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10. A newly graduated nurse in the hospital states that because of being so new, participat
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ion in quality improvement (QI) projects is not wise. What response by the precepting
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nurse is best? hd hd
a. “All staff nurses are required to participate in quality improvement here.”
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b. “Even being new, you can implement activities designed to improve care.”
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c. “It’s easy to identify what indicators would be used to measure quality.”
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d. “You should ask to be assigned to the research and quality committee.”
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ACCURATE ANSWER: B hd hd
Rationale:The preceptor would try to reassure the nurse that implementing QI measure
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s is not out of linefor a newly licensed nurse. Simply stating that all nurses are require
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d to participate does not help the nurse understand how that is possible and is dismiss
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ive. Identifying indicators of quality is not an easy, quick process and would not be the
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best place to suggest a new nurse tostart. Asking to be assigned to the QI committee do
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es not give the nurse information about how to implement QI in daily practice.
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,DIF: Applying TOP: Integrated Process: Communication and Documentation
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, KEY: Systems thinking, Quality improvement
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MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
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11. A nurse is talking with a co-
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worker who is moving to a new state and needs to find newemployment there.
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What advice by the nurse is best?
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a. Ask the hospitals there about standard nurse–client ratios.
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b. Choose the hospital that has the newest technology. hd hd hd hd hd hd hd
c. Find a hospital that has achieved Magnet status.
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d. Work in a facility affiliated with a medical or nursing school.
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ACCURATE ANSWER: C hd hd
Rationale:Client Magnet status is awarded by The Joint Commission (TJC) and certifies hd hd hd hd hd hd hd hd hd hd hd
that nurses candemonstrate how best current evidence guides their practice. New tec
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hnology doesn’t necessarily mean that the hospital is safe. Affiliation with a health pro
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fession school has several advantages, but safety is most important.
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DIF: Understanding
TOP: Integrated Process: Communication and Documentation
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d
KEY: Evidence-based practice, Magnet status
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MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
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MULTIPLE RESPONSE hd
1. A nurse manager wishes to ensure that the nurses on the unit are practicing at their h
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ighest levels of competency. Which areas would the manager assess to determine if th
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e nursing staffdemonstrate competency according to the Institute of Medicine (IOM) r
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eport Health Professions Education: A Bridge to Quality? (Select all that apply.)
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a. Collaborating with an interprofessional team hd hd hd hd
b. Implementing evidence-based care hd hd
c. Providing family-focused care hd hd
d. Routinely using informatics in practice hd hd hd hd
e. Using quality improvement in client care hd hd hd hd hd
f. Formalizing systems thinking when implementing care hd hd hd hd hd
ACCURATE ANSWER: A, B, D, E hd hd hd hd hd
Rationale:The IOM report lists five broad core competencies that all health care provi
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ders should practice. These include collaborating with the interprofessional team, im
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plementing evidence-based practice, providing patient- hd hd hd hd
focused care, using informatics in client care, andusing quality improvement in client
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care. Systems thinking is required for quality improvement but is not a specified part
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of the IOM report.
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DIF: Remembering
TOP: Integrated Process: Nursing Process: AssessmentKEY: Competencies, Institute o
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f Medicine (IOM)
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MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
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2. A nurse is interested in making interprofessional work a high priority. Which action
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s by thenurse best demonstrate this skill? (Select all that apply.)
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a. Consults with other disciplines on client care. hd hd hd hd hd hd
b. Coordinates discharge planning for home safety. hd hd hd hd hd
c. Participates in comprehensive client rounding. hd hd hd hd
d. Routinely asks other disciplines about client progress. hd hd hd hd hd hd
, e. Shows the nursing care placcurate answer to other disciplines.
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f. Delegate tasks to unlicensed personnel appropriately. hd hd hd hd hd
ACCURATE ANSWER: A, B, C, D, F hd hd hd hd hd hd
Rationale:Collaborating with the interprofessional team involves planning, implement hd hd hd hd hd hd hd
ing, and evaluating client care as a team with all other involved disciplines included. S
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imply showingother caregivers the nursing care plan is not actively involving them or
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collaborating with them.
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DIF: Applying
TOP: Integrated Process: Communication and DocumentationKEY: Tea
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d hd
mwork and collaboration, Interprofessional team
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MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
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3. The nurse utilizing evidence-
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based practice (EBP) considers which factors when planningcare? (Select all that a
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pply.)
a. Cost-saving measures hd
b. Nurse’s expertise hd
c. Client preferences hd
d. Research findings hd
e. Values of the client hd hd hd
f. Plan-do-study-act model hd
ACCURATE ANSWER: B, C, D, E hd hd hd hd hd
Rationale:EBP consists of utilizing current evidence, the client’s values and preferences
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, and the nurse’sexpertise when planning care. It does not include cost-
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saving measures. The PDSA model is asystematic model for quality improvement, but i
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s not a specific component of EBP.
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DIF: Remembering
TOP: Integrated Process: Nursing Process: PlanningKEY: Evidence-
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based practice (EBP) hd hd
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
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4. A nurse manager wants to improve hand-
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off communication among the staff. What actions bythe manager would best help achie
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ve this goal? (Select all that apply.)
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a. Attend hand-off rounds to coach and mentor. hd hd hd hd hd hd
b. Create a template of suggested topics to include in report.
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c. Encourage staff to ask questions during hand-off. hd hd hd hd hd hd
d. Give raises based on compliance with reporting.
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e. Provide education on the SBAR method of communication hd hd hd hd hd hd hd
ACCURATE ANSWER: A, B, C, E hd hd hd hd hd
Rationale:The SBAR method of communication has been identified as an excellent meth
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od of communication between health care professionals. It is a formalized structure co
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nsisting of Situation, Background, Assessment, and Recommendation/Request. Using a f
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ormalized mechanism for communication helps ensure successful hand-
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off and fewer client errors. Whenestablishing this new format for report, the most help
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ful actions by the manager would be to provide initial education on the process, develo
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p a template with suggested topics under each heading, attend rounds to coach and me
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ntor, and encourage staff to ask questions to clarify information. Basing raises on comp
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liance would not be the most helpful method because raises are often determined only
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once a year and are based on multiple criteria.
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, DIF: Applying
TOP: Integrated Process: Communication and DocumentationKEY: Tea
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mwork and collaboration, Communication
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