STUDY GUIDE
Davis Advantage for Understanding
Medical-Surgical Nursing 7th Edition
By Linda S. Hopper, Paula D.; Williams, All Chapter's 1 - 57
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,(Davis Advantage for Understanding Medical-Surgical Nursing, 7e Linda Williams, Paula Hopper)
Answers
CHAPTER 1 to collect appropriate data, identify a patient problem, and
determine the best possible plan of action. Clinicaljudgment
CRITICAL THINKING, is based on good critical thinking.
CLINICAL JUDGMENT, AND Cue
THE NURSING PROCESS Definition: Significant or relevant data. Not all data are
cues (relevant), but all cues are data.
AUDIO CASE STUDY Collaboration
Jane Practices Clinical Judgment Definition: Working together with the health team to
improve patient outcomes.
1. Identify and analyze cues; prioritize hypotheses; generate
solutions; take action; evaluate outcomes; repeat. Intervention
2. Jane was exhausted, failed a test, and was pulled in too many Definition: Taking action to carry out a plan.
directions. She was also crying in her car and hadpoor study
habits and not enough sleep. Evaluation
3. Jane’s resources included a good friend, sick time fromwork, Definition: Comparing the outcomes you expected withactual
and wasted time between classes that she could better utilize. outcomes. Did the plan work? Were expected outcomes
Your resources will be different, but theyexist! met?
4. Critical thinking—the why: Jane uses critical thinking to Vigilance
determine why her current plan isn’t working. She thinks
Definition: The act of being attentive, alert, and watchful.
honestly about her poor study habits, her time- management
problems, and the impact this is having onher and her family. CRITICAL THINKING AND CLINICALJUDGMENT
Clinical judgment—the do: Jane uses her thinking to develop
and carry out a plan that uses her resources and provides more Critical thinking and clinical judgment both follow a similar
productive study time and more quality time with her kids. format. Both follow steps from collecting data to determin- ing
problems and outcomes, developing and taking actions, and
VOCABULARY evaluating outcomes. However, critical thinking helps you think
about the problem: What is it? Why is it happen- ing? And
Sample sentences will vary for the Vocabulary problems. clinical judgment leads you to do something to manage the
Nursing process problem.
Definition: An organizing framework that links thinking with
nursing actions. Steps include assessment/data collection, CUE RECOGNITION
nursing diagnosis, planning, implementation,and evaluation. You will do many things for each individual, but the FIRST
Critical thinking thing is listed below.
Definition: The use of those cognitive (knowledge) skills or 1. Sit the patient upright.
strategies that increase the probability of a desirable outcome. 2. Call 911 while running across the street.
Also involves reflection, problem-solving, andrelated thinking 3. Elevate the feet off the bed by placing a pillow under thecalves
skills. and allowing the feet to hang off the edge of the pillow.
Clinical judgment 4. Check blood glucose and have a glucose source ready.
Definition: The observed outcome of critical thinking and 5. Turn the patient to the side to prevent aspiration.
decision making. A process that uses nursing knowledge
,2 Chapter 1 Answers
CRITICAL THINKING
This is just one possible way to complete a cognitive map.
Could it be low Am I diabetic? Frontal area "Sick" feeling Hard Tylenol helps Hunger makes
blood sugar? it worse
Patient's Where is it? Quality Aggravating and
perception alleviating factors
Food helps
Headache
Useful other Severity Timing
data
Sometimes feel Mother is 7–8 on 0–10 Lasts 1–2 hours Before meals Early in the
sick to stomach diabetic scale once starts morning
REVIEW QUESTIONS taking vital signs; data collection is the first step in the
nursing process. (2, 3, 4) are all steps in the nursing process,
The correct answers are in boldface.
for which the registered nurse is responsible; the LPN/LVN
1. (2) Critical thinking can lead to better outcomes for the may assist the registered nurse with these. Nitroglycerin
patient. (1, 3, 4) may be true but are not the best answer. should not be administered withoutfirst knowing the patient’s
2. (4) is correct. The nurse who can admit to not knowing blood pressure.
something is exhibiting intellectual humility. (1) shows 7. (2) indicates that the patient is concerned about freedom from
expertise but not necessarily intellectual humility; injury and harm. (1) relates to basic needs such as air, oxygen,
(2) reporting an error shows intellectual integrity; and water. (3) relates to feeling loved. (4) isrelated to having
(3) empathizing is positive but does is not evidence of positive self-esteem.
humility. 8. (3, 1, 2, 4) is the correct order according to Maslow.
3. (3, 4, 5, 1, 2) is the correct order. 9. (5, 2, 1, 4, 6, 3) is the correct order.
4. (1) is the best definition. (2, 3, 4) do not define critical 10. (3) shows the patient is actually taking action. (1, 2, 4) are
thinking but are examples of good thinking. all positive but do not show intent to take action.
5. (4) is correct. Evaluation determines whether goals are 11. (4) is the nurse’s analysis of the situation. (1, 2) aredata;
achieved and interventions effective. (2) is the role of the (3) is a recommendation.
physician. (1, 3) encompass data collection and imple- 12. (1, 2, 3, 4) should be present. Since the data provides only
mentation, which are earlier steps in the nursing process. hip replacement as the patient’s problem, (5) thedietitian is
6. (1) is correct. The licensed practical nurse/licensed voca-tional not necessary.
nurse (LPN/LVN) can collect data, which includes
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, Answers
CHAPTER 2 EVIDENCE-BASED PRACTICE
EVIDENCE-BASED PRACTICE 1. proof
2. context
3. quality
AUDIO CASE STUDY
4. care
Marie and Evidence-Based Practice 5. randomized
1. Thirdhand smoke is the dangerous toxins of smoke that 6. outcomes
linger on hair, clothing, furniture, and other surfaces in an 7. gold
area after a cigarette is put out. Marie learned that exposure 8. nursing
to these toxins can be neurotoxic to children and can trigger 9. patient’s
asthma attacks in sensitive people. 10. information
2. Evidence-based practice is considered the gold standardof
health care. CLINICAL JUDGMENT
3. Step 1: Ask the burning question. Step 2: Search and 1. By questioning the existing way of doing things to ensure
collect the most relevant and best evidence available.Step that the patient receives the best care possible
3: Think critically. Appraise the evidence for validity, 2. A thorough search of the literature, with the assistance ofthe
relevance to the situation, and applicability. medical librarian, in the area of their burning ques- tion
Step 4: Measure the outcomes before and after institutingthe regarding music reducing preoperative anxiety.
change. Step 5: Make it happen. Step 6: Evaluate the practice
3. Cumulative Index to Nursing and Allied Health Literature
decision or change.
(CINAHL) Database, Joanna Briggs Instituteevidence-based
4. Combination therapy with a nicotine patch and nicotine resources, Cochrane Reviews, Medline/PubMed
lozenges worked best, although bupropion (Zyban) or
4. Measure patient outcomes before instituting the evidence-
varenicline (Chantix) and nicotine lozenges worked well,too. A
based change in practice so comparisons canbe made after
Cochrane Review found that advice and support from nursing
implementation to determine if the inter-vention worked
staff can increase patients’ success in quit- ting smoking,
5. Evaluate the results to determine whether the changemade
especially in a hospital setting.
a significant difference and if it was valuable interms of
VOCABULARY cost and time
Sample sentences will vary for the Vocabulary problems. REVIEW QUESTIONS
1. Evidence-based practice: A systematic process that usescurrent The correct answers are in boldface.
evidence in making decisions about patient care.
1. (3) is correct. Providing an explanation of why some- thing
2. Evidence-informed practice: Consideration of patient factors
is done promotes the understanding for why it is important
along with the use of evidence for shared decisionmaking
to be done and therefore will more likely be done. (1, 2, 4)
between the health-care provider and the patient.
only communicate the need to perform atask. They do not
3. Randomized controlled trials: True experimental studiesin provide rationale for the task to pro- mote understanding of
which as many factors as possible that could falsely change the importance of the task.
the results are controlled.
2. (3) is correct. Evidence-based nursing care that has been
4. Research: Scientific study, investigation, or experimenta-tion to evaluated as appropriate for an agency provides the best and
establish facts and analyze their significance. safest patient care. (1) Opinions may not be based on
5. Systematic review: A review of relevant research using
guidelines.
,2 Chapter 2 Answers
evidence. (2) Specific evidence-based nursing interven-tions 6. (1, 3, 4, 5, 6) are all independent nursing interventions
will not be found in orientation policies that famil-iarize the because no health-care provider’s order is required.
orientee with the organization. (4) A nursing program’s (2) is a dependent function because it requires a health-care
content has not been evaluated by the health-care agency for provider’s order.
its feasibility for the agency’s patients, which is a step in the 7. (4, 6) represent Level I research. (1, 2, 3, 5) are not
evidence-based practice process. systematic reviews or more than three randomized
3. (2) is correct. Joanna Briggs Institute evidence-based controlled trials of good quality with similar results.
resource is dedicated to identifying valid nursing evidence. 8. (1, 3, 5, 6) are correct because the evidence-based prac-tice
(1, 3, 4) do not reflect the highest levels of evidence, so they process involves “ASKMME”: ask, search, think, measure,
are not considered the best sources ofevidence. make it happen, and evaluate. (2, 4) are not steps in the
4. (4) is correct. The proposed change will need to go through process.
the policy and procedure committee for evalu- ation for 9. (1, 2, 5, 6) are correct. Research supports they are best
feasibility of using it at the agency. (1, 2, 3) donot follow practice for oral care. (3, 4) are not best practice for oral care.
appropriate protocols for the evidence-basedpractice process. They do not remove plaque and only freshen the mouth.
5. (1) Systematic reviews of randomized controlled trials are 10. (4) is correct. The search should be narrowed to include
the best place to look for evidence. (2, 3, 4) are not Level I keywords of the focus of the question. (1, 2, 3) do not
sources of evidence. narrow the search in order to focus only on the question
being asked.
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, Answers
CHAPTER 3 REVIEW QUESTIONS
ISSUES IN NURSING PRACTICE The correct answers are in boldface.
1. (1, 3, 4, 5, 6) are correct. Human-trafficking awareness
AUDIO CASE STUDY requires vigilance by everyone. Robotic use, such as in surgery
or to disinfect patient areas, is increasing. The older adult
Jim and the Health-Care System population is growing and will require more complex health
1. The use of information technology in nursing practice care. Multidrug-resistant infectious organisms provide
2. Ambulation, teaching leg exercises to prevent blood clots, and challenges and research opportunities. Telehealth use is
using sterile technique to prevent surgical siteinfections increasing via smartphones, apps, tablets,remote patient
3. To avoid violating the Health Insurance Portability and monitoring, and online video conferencing.
Accountability Act (HIPAA) (2) The increase in cultural diversity requires care to meetall
cultural needs.
VOCABULARY 2. (1, 2, 3, 5, 6) are correct. Assessment of conditions pres-ent
on admission and all care and education to prevent
Sample sentences will vary for the Vocabulary problems. complications, including patient refusal to participate, must
1. (3) be documented during hospitalization to ensure the agency is
2. (1) paid for care for a secondary diagnosis.
3. (4) (4) Encouragement to participate in preventive inter-
4. (2) ventions should be done. It should not be presented as
5. (8) optional for the patients’ safety.
6. (5) 3. (4, 5, 6) are correct. Ambulating a patient, administer- ing
7. (6) medications, and obtaining vital signs are within the
8. (7) LPN/LVN’s scope of practice. (1, 3) Assessing and
9. (10) developing the plan of care are within the RN’s scope of
10. (9) practice. (2) Delegation does not occur up the super-vision
line to an RN; it occurs downward to assistive personnel.
NURSING PRACTICE AND ETHICALAND 4. (3) is correct. Upon presentation of an idea, an autocratic
LEGAL PRINCIPLES leader will make a decision using their own knowledge. (1, 2,
4) Autocratic leaders do not seek input to make decisions.
1. abbreviations, confused, crushing, long-term, tall
5. (2) is correct. LPNs/LVNs consult with RNs in caring for
2. state, protect, quality
their patients. (1, 3, 4) Conducting interviews, evaluating other
3. Veracity staff, and supervising professional staff are not within an
4. beneficence, fidelity, justice LPN/LVN’s job description.
5. knowledgeable, role, humor, respect 6. (2) is correct. Because the patient is an adult, the nurse acts on
fidelity and protects the patient’s personal health information.
VALUES CLARIFICATION (1) The only person who can inform the mother is the adult
There are no correct answers to this section. This is an patient. (3, 4) The nurse does not pro-vide false information
exercise requiring personal responses. to the mother and tells the mother to talk to her child, who
can decide how to answer the mother’s questions.
CLINICAL JUDGMENT 7. (4) is correct. When patients refuse treatment, it can be a
dilemma related to life and death. However, if patientsare
There are no correct answers to this section. This is an ethical given correct information and understand the
exercise that has many choices to be considered forthe best
outcome for the patient.
,2 Chapter 3 Answers
consequences of their actions, it is their choice to refuse 13. (3) is correct. HIPAA requires protection to ensure the
treatment. (1) Does not convey the use of therapeutic privacy of personal health information. (1, 2, 4) HIPAAdoes
communication and is not within the nurse’s scope of practice not relate to licensure requirements, work condi- tions, or
to discuss the treatment regimen. (2) It is never okay to coerce insurance coverage.
patients with fear or make them feel badabout their decision. 14. (1, 2, 3, 6) are correct. See Box 3-2. (4) Victims are poor
(3) The nurse cannot state with certainty when death will historians, if their controller even allows them to answer
occur, so stating that it will occur is not appropriate. questions. (5) Victims often have no identification to
8. (4) is correct. If the patient has a valid advance direc- tive provide.
and the health-care provider uses a deontological perspective 15. (3) is correct. The nurse–patient relationship is based on
(i.e., do what’s right) and supports auton- omy (i.e., the trust that the nurse will maintain all patients’ rights.
patient’s wishes), then a feeding tube willnot be inserted. (1) (1) is a legal issue. (2) is a constitutional right, not an
This is not the patient’s wishes, so itshould not be done. (2) ethical issue. (4) is not an ethical principle.
The advance directive conveys the patient’s wishes for the 16. (3) is correct. Paternalism occurs when a health-care
patient’s current status, so itis not necessary to perform an provider tries to prevent patients from making auton- omous
EEG to carry out these wishes. (3) This does not necessarily decisions or decides what is best for patients without regard
mean that the advance directive stated not to insert a feeding for their preferences. (1) The nurse mightbe nonresponsive
tube. about the purpose of the medication due to lack of
9. (4) is correct. Utilitarianism supports decisions based on knowledge, but there are no indications that this is true. (2)
the best outcome for the greatest number of people.(1, 2, 3) Advocacy supports providing the medication information so
do not support the nurse’s reply. that the patient is informed tomake autonomous decisions.
10. (1) is correct. A resident who is asking to die may be feeling (4) Telling the patient not to worry is not therapeutic
depressed, especially when missing family. It is a good idea communication, as it does notaddress the patient’s concerns.
to try to understand more about how theresident is feeling. 17. (1) is correct. Knowing the patient’s wishes helps thenurse
(2) It is never okay to medicate theresident to “numb” advocate for and act in the best interest of the patient. (2,
these feelings. (3) While getting 3, 4) are not the wishes of the patient.
such residents involved in activities may be helpful, it isnot 18. (1, 2, 5, 6) are correct. These are all part of the five steps
therapeutic to minimize their feelings. (4) The nurseis not in of delegation. (3) In delegation, it is the right person, not
the same situation as the resident and cannot truly understand the right patient, that is to be considered.
the resident’s feelings. (4) The right route relates to medication administration.
11. (2, 3, 5) are correct. Institutional policies outline the proper 19. (1, 2, 3, 4) are correct. The patient is likely a victim of
manner for performing certain tasks and proce- dures for human trafficking. After completing data collection(ideally
employees who must comply with them; localnursing but unlikely in private), suspicions should be reported to
standards of care identify the degree of pru- dence and the health-care team and then local law
caution required for proper nursing practice; state nurse enforcement should be called. (5) Confrontation should not
practice laws outline the scope of practice ina given state that occur for the safety of all. (6) The patient should notbe
nurses must abide by when practicing under license in that alerted to impending assistance, as this might also alert the
state. (1, 4) National ethics and standards do not directly human trafficker.
guide a nurses’ performance oftasks within an institution or 20. (1, 3, 4, 5, 6) are correct. These techniques have been
locality. shown to reduce medication distractions and errors.
12. (1, 3, 4, 5, 6) are correct. All are ways to limit liability. (2) is a distraction that could result in a medication
(2) Breaching the duty of care increases liability. error.
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, Answers
CHAPTER 4 to another country, although they may practice in the
United States.
CULTURAL INFLUENCES ON 4. Present-oriented people accept the day as it comes
NURSING CARE with little regard for the past and see the future as unpre-
dictable. Past-oriented people may worship ancestors.
Future-oriented people anticipate a better future and place a
AUDIO CASE STUDY
high value on change. Some individuals balanceall three views;
Dan and Cultural Assessment they respect the past, enjoy living in thepresent, and plan for
the future.
1. Mrs. Basiouny did not want a male caregiver to bathe her or
provide her personal care. She wanted her husband
CRITICAL THINKING: IMMIGRANTS AND
to be present during the health history. She did not like
PERSONAL INSIGHTS
touch but did respond to eye contact. She preferred her own
traditional foods. There are no correct or incorrect answers for these sections.These
2. Patients can appear noncompliant when in reality theyare are exercises requiring personal responses.
not receiving culturally appropriate care.
3. Assess and learn from each patient and avoid CRITICAL THINKING: BATHING
stereotyping.
1. In some cultures, it is improper for someone of the oppo-site
VOCABULARY sex to help with bathing. It is important to assess whether this
is the case with this patient.
Sample sentences will vary for the Vocabulary problems. 2. Find a male nurse’s aide, ask a family member to help, orskip
1. (2) the bath again.
2. (10) 3. Having a male aide do the bath is the best
3. (3) solution. If no male aide is available, the family may be
4. (11) approached for help, although this is not the best solution.
5. (4) Because this is the fourth day without a bath,skipping the
6. (1) bath is not the best option.
7. (8)
8. (5) REVIEW QUESTIONS
9. (7) The correct answers are in boldface.
10. (6)
11. (12) 1. (4) is correct. Tay-Sachs disease is an inherited disease most
12. (9) common among people of Eastern European Jewish
(Ashkenazi) heritage. (1, 2, 3) are incorrect.
CULTURAL CHARACTERISTICS 2. (3) is correct. Ethnocentrism is the tendency for human
beings to think that their culture’s ways of thinking, act-ing,
1. Primary characteristics of culture include nationality, race, and believing are the only right, proper, and natural ways. (1,
skin color, gender, age, spirituality, and religiousaffiliation. 2, 4) are incorrect.
2. Secondary characteristics of culture include socioeco- nomic 3. (1) is correct. Hispanic (Latinx) Americans and American
status, education, occupation, military status, political beliefs, Indians generally have a higher glucose level than whites. They
length of time away from one’s countryof origin, urban versus also have a higher-than-average risk ofdiabetes. (2) is incorrect.
rural residence, marital status, parental status, physical 4. (3) is correct. Initially you must assess what the family’sfood
characteristics, sexual orienta- tion, and gender issues. practices are before an eating plan can be set up.
3. Traditional health-care providers are practitioners froma (1) Giving a patient who has just moved to the United States
patient’s native culture. They are typically native an exchange list of foods does not ensure the patientwill change
dietary practices. (2) Being able to calculate
, 2 Chapter 4 Answers
carbohydrates does not respect the family’s cultural preferences. two separate pies. The goal is to reduce overall fat and
(4) Although this is certainly an option for thefuture, the initial calorie consumption. (4) It is inconsistent with the goal of
step is to obtain a dietary assessment. reducing fat and calories.
5. (4) is correct. Patients can have religious counselors visitas 8. (2) is correct. The patient must make her own decision,but
long as the counselor does not do anything to interferewith she should be fully aware of the consequences.
treatment or cause a safety problem. (1) It is not necessary to (1) Scare tactics are not appropriate; she may live whether she
get the supervisor’s permission. However, itis a good idea to let receives radiation therapy or not. (3) It bor-ders on
the supervisor know that a religious counselor is going to visit. harassment by the staff. (4) Radiation therapy may be the
(2) Religious counselors are allowed to visit. (3) The patient best choice for this type of cancer.
has the right to see a religious counselor. 9. (2) is correct. Changing the schedule slightly is prefer- able
6. (4) is correct. Extended family may be very important to to omitting the medication. (1) Blood levels can be
members of some cultures, and it may help these patients to maintained on a different schedule, as long as the doses are
have them nearby. (1) Large numbers of family members in reasonably spread out. (3) Omitting the medica- tion will
the cafeteria may cause further disruption in the cafeteria. (2) alter blood levels. (4) It does not respect the patient’s
Large groups in the lobby may cause overcrowding for other religious beliefs.
families. (3) All family membersshould be allowed to visit. It 10. (3) is correct. This response seeks to discover the patient’s
may help to have them choose a spokesperson to control past spiritual practices. (1) Questionnaires arenot
visiting for this patient. appropriate when assessing a patient’s spirituality.
7. (2) is correct. Reducing portion size decreases the overall (2) Although it is important to be self-aware of one’sown
calorie and fat consumption but will still allow the patient to spirituality and beliefs, it is not appropriate to share those
cook and enjoy traditional foods in her culture. (1) Telling a beliefs with patients when they can causedistress, as in this
patient to not purchase lard does not mean she will comply. case. (4) “Why” questions tend to feel critical and
(3) Rarely does a person bake attribute blame.
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