Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank, Exams of Nursing

Download Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank and more Exams Nursing in PDF only on Docsity! Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 Chapter 01: Overview of Professional Nursing Concepts for Medical-Surgical Nursing Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A new nurse is working with a preceptor on a medical-surgical unit. The preceptor advises the new nurse that which is the priority when working as a professional nurse? a. Attending to holistic client needs b. 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. Health care errors have been widely reported for 25 years, many of which result in client injury, death, and increased health care costs. There are several national and international organizations that have either recommended or mandated safety initiatives. Every nurse has the responsibility to guard the client’s safety. The other actions are important for quality nursing, but they are not as vital as providing safety. Not making medication errors does provide safety, but is too narrow in scope to be the best answer. DIF: Understanding TOP: Integrated Process: Nursing Process: Intervention KEY: Client safety MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 2. A nurse is orienting a new client and family to the medical-surgical unit. What information does the nurse provide to best help the client promote his or her own safety? a. Encourage the client and 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 safety partner is the most critical. The other actions are very limited in scope and do not provide Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 the broad protection that being active and involved does. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Client safety MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Client safety, Informatics MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 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 and family. d. Treats the client fairly compared to other clients. ANS: A Autonomy is self-determination. The client would 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. DIF: Applying TOP: Integrated Process: Caring KEY: Ethics, Autonomy MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 7. A nurse asks a more seasoned colleague to explain best practices when communicating with a person from the lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) community. What answer by the faculty is most accurate? a. Avoid embarrassing the client by asking questions. b. Don’t make assumptions about his or her 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 and may be reluctant to seek health care. The nurse would 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. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Health care disparities, LGBTQ MSC: Client Needs Category: Psychosocial Integrity 8. A nurse is calling the on-call health care provider about a client who had a hysterectomy 2 days ago and has pain that is unrelieved by the prescribed opioid pain medication. Which statement comprises the background portion of the SBAR format for communication? a. “I would like you to order a different pain medication.” Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 b. “This client has allergies to morphine and codeine.” c. “Dr. Smith doesn’t like nonsteroidal anti-inflammatory meds.” d. “This client had a vaginal hysterectomy 2 days ago.” ANS: B Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 SBAR is a recommended form of communication, and the acronym stands for Situation, Background, Assessment, and Recommendation. Appropriate background information includes allergies to medications the on-call health care provider 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; none of the options has assessment information. Asking for a different pain medication is a recommendation. Recommendation is a statement of what is needed or what outcome is desired. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Teamwork and collaboration, SBAR MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 9. A nurse working on a cardiac unit delegated taking vital signs to an experienced assistive personnel (AP). Four hours later, the nurse notes that the client’s blood pressure taken by the AP was much higher than previous readings, and the client’s mental status has changed. What action by the nurse would most likely have prevented this negative outcome? a. Determining if the AP knew how to take blood pressure b. Double-checking the AP by taking another blood pressure c. Providing more appropriate supervision of the AP d. Taking the blood pressure instead of delegating the task ANS: C Supervision is one of the five rights of delegation and includes directing, evaluating, and following up on delegated tasks. The nurse would either have asked the AP about the vital signs or instructed the AP to report them right away. An experienced AP would know how to take vital signs and the nurse would 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 AP and are permissible to delegate. The only appropriate answer is that the nurse did not provide adequate instruction to the AP. DIF: Analyzing TOP: Integrated Process: Communication and Documentation KEY: Teamwork and collaboration, Delegation MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 10. A newly graduated nurse in the hospital states that because of being so new, participation in quality improvement (QI) projects is not wise. What response by the precepting nurse is best? a. “All staff nurses are required to participate in quality improvement here.” b. “Even being new, you can implement activities designed to improve care.” c. “It’s easy to identify what indicators would be used to measure quality.” d. “You should ask to be assigned to the research and quality committee.” Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 2. A nurse is interested in making interprofessional work a high priority. Which actions by the nurse best demonstrate this skill? (Select all that apply.) a. Consults with other disciplines on client care. b. Coordinates discharge planning for home safety. c. Participates in comprehensive client rounding. d. Routinely asks other disciplines about client progress. Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 e. Shows the nursing care plans to other disciplines. f. Delegate tasks to unlicensed personnel appropriately. ANS: A, B, C, D, F Collaborating with the interprofessional team involves planning, implementing, and evaluating client care as a team with all other involved disciplines included. Simply showing other caregivers the nursing care plan is not actively involving them or collaborating with them. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Teamwork and collaboration, Interprofessional team MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 3. The nurse utilizing evidence-based practice (EBP) considers which factors when planning care? (Select all that apply.) a. Cost-saving measures b. Nurse’s expertise c. Client preferences d. Research findings e. Values of the client f. Plan-do-study-act model ANS: B, C, D, E EBP consists of utilizing current evidence, the client’s values and preferences, and the nurse’s expertise when planning care. It does not include cost-saving measures. The PDSA model is a systematic model for quality improvement, but is not a specific component of EBP. DIF: Remembering TOP: Integrated Process: Nursing Process: Planning KEY: Evidence-based practice (EBP) MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 4. A nurse manager wants to improve hand-off communication among the staff. What actions by the manager would best help achieve this goal? (Select all that apply.) a. Attend hand-off rounds to coach and mentor. b. Create a template of suggested topics to include in report. c. Encourage staff to ask questions during hand-off. d. Give raises based on compliance with reporting. e. Provide education on the SBAR method of communication ANS: A, B, C, E The SBAR method of communication has been identified as an excellent method of communication between health care professionals. It is a formalized structure consisting of Situation, Background, Assessment, and Recommendation/Request. Using a formalized mechanism for communication helps ensure successful hand-off and fewer client errors. When establishing this Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 new format for report, the most helpful actions by the manager would be to provide initial education on the process, develop a template with suggested topics under each heading, attend rounds to coach and mentor, and encourage staff to ask questions to clarify information. Basing raises on compliance would not be the most helpful method because raises are often determined only once a year and are based on multiple criteria. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Teamwork and collaboration, Communication Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 All options are good choices for an altruistic nurse wishing to influence health outcomes; however, being involved in policy creation and health care reform is an activity specifically recognized to improve health outcomes. This action will also affect a wider population than the more local options. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Health outcomes MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 4. What factor best predicts a nurse’s willingness to employ critical thinking? a. Caring b. Knowledge c. Presence d. Skills ANS: A All attributes are important in nursing, however; the nurse’s willingness to think critically is predicted by caring behaviors, self-reflection, and insight. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Critical thinking MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 5. To demonstrate clinical reasoning skills, what action does the nurse take? a. Collaborating with co-workers to buddy up for lunch breaks b. Delegating frequent vital signs on a new postoperative patient c. Documenting a complete history and physical on an admission d. Requesting the provider order medication for a client with high potassium ANS: D The components of clinical reasoning include assessing, analyzing, planning, implementing, and evaluating. This nurse shows the ability to analyze by interpreting the meaning of the lab value, to plan by anticipating the consequences of the lab value, and to implement by taking action. DIF: Analyzing TOP: Integrated Process: Nursing Process: Implementation KEY: Clinical judgment MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 6. The new nurse asks the preceptor how context affects clinical judgment. What response by the preceptor is best? a. “Context considers the whole of the patient’s story and circumstances.” b. “It shouldn’t, only nursing knowledge would affect clinical judgment.” c. “Outside influences such as environment in which you provide care, influence your decisions.” Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 d. “The context of the situation provides an extra layer of complexity to consider.” ANS: C The context of a situation considers and supports clinical judgment. The factors within this layer—such as environment, time pressure, availability or content of electronic health records, resources, and individual nursing knowledge—have a direct impact on clinical judgment. The other two options are too vague to provide appropriate information. Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Clinical judgment MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 7. Once the nurse has considered all possible collaborative and client problems, what action does the nurse take next? a. Act on the observed cues. b. Determine desired outcomes. c. Generate solutions. d. Prioritize the hypotheses. ANS: D Analyzing cues lead to a list of potential hypotheses. The nurse prioritizes them, determines the desired outcomes, generates solutions, and acts. This is part of the six-step clinical judgment model. DIF: Understanding TOP: Integrated Process: Nursing Process: Diagnosis KEY: Clinical judgment MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 8. A nurse working in a medical home would do which of the following as part of the job? a. Advocate with insurance companies. b. Coordinate interprofessional care. c. Hold monthly team meetings. d. Provide out-of-network specialty referrals. ANS: B The medical home concept came into being to decrease the fragmentation of care. On a daily basis, this nurse would expect to coordinate with the interprofessional care team. Advocating with insurance companies would not be a daily function. Monthly team meetings may or may not be needed. Out of network referrals would not be needed as the interprofessional team strives to provide comprehensive care. DIF: Remembering TOP: Integrated Process: Nursing Process: Implementation KEY: Medical home MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 9. A nurse is confused on why systems thinking is important since working on the unit involves caring for a few specific clients. What explanation by the nurse manager is best? a. “It’s a good way to conduct root-cause analysis.” b. “It is important for quality improvement and safety.” c. “Systems thinking helps you see the bigger picture.” d. “You may enter management 1 day and need to know this.” Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 Management of Care 3. According to the WHO, what does primary care involve? (Select all that apply.) a. Empowered people and communities b. Essential public functions c. Multisectoral policy and action d. Primary care e. Priority consideration of chronic diseases Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 f. Elimination of chronic diseases ANS: A, B, C, D According to the WHO, primary care involves three main areas: empowered people and communities, primary care and essential public functions, and multisectoral policy and action. Primary care focuses on both prevention and management of chronic disease. DIF: Remembering TOP: Integrated Process: Teaching/Learning KEY: Primary care, Systems thinking MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 4. A nurse wishes to work in a community-based practice setting. Which areas would this nurse explore for employment? (Select all that apply.) a. Hospice facility b. “Minute clinic” c. Mobile mammography unit d. Small community hospital e. Telehealth f. Home health care ANS: A, B, C, E, F The multiple avenues providing community-based care include hospice, “minute” or retail clinics, mobile screening and diagnostic services, telehealth, private medical practices, outpatient services, freestanding points of care, home health care, long-term ambulatory care, public health, and free clinics. Inpatient services in a hospital are not considered primary care sites. DIF: Remembering TOP: Integrated Process: NA KEY: Community-based care MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 Chapter 03: Overview of Health Concepts for Medical-Surgical Nursing Ignatavicius: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse is caring for a client who is acidotic. The nurse asks the charge nurse why the client is breathing rapidly. What response by the charge nurse is best? a. Anxiety is causing the client to breathe rapidly. b. The client is trying to get rid of excess body acids. c. The rapid respirations cause buildup of bicarbonate. d. An increased respiratory rate is due to increased metabolism. ANS: B The client is acidotic, and the respiratory system is attempting to compensate by “blowing off” excess acid in the form of carbon dioxide. The increased respiratory rate is not due to anxiety or increased metabolism. An increased respiratory rate does not cause a buildup of bicarbonate. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Acid-base balance MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 2. A client had a recent thromboembolism and must resume work which requires frequent car and plane travel. What self-care measure does the nurse teach to reduce the risk of impaired clotting in this client? a. Get up and walk around at least every 2 hours while traveling. b. Use a soft toothbrush and an electric razor for safety. c. Be sure to sit with the legs elevated as much as possible. d. Increase fiber in the diet so as not to strain to move the bowels. ANS: A Clients who are at risk of increased clotting (as evidenced by prior thromboembolic event) can take several measures to reduce their risk of further problems. One measure is to get up and walk frequently when sitting for a long period of time. Using a soft toothbrush and an electric razor and needing to prevent constipation would be important for a client at risk of bleeding. Elevating the legs is not as beneficial as ambulating. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Clotting, Health teaching MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. A nurse is caring for four clients. Which client does the nurse assess first for impaired cognition? a. A 28-year-old client 2 days post-open cholecystectomy b. An 88-year-old client 3 days post-hemorrhagic stroke c. A 32-year-old client with a 20–pack-year history of smoking Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 DIF: Analyzing TOP: Integrated Process: Nursing Process: Evaluation KEY: Tissue integrity, Incontinence MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 6. The registered nurse asks the nursing assistant why a cardiac client’s morning weight has not yet been done. The nursing assistant says, “I’ll get to it, what’s the big deal?” When deciding how to respond, the nurse considers what information about weight? a. Decisions on treatment often depend on the daily weight. b. The nursing assistant needs to ensure that tasks are done on time. c. Weight is the most accurate noninvasive indicator of fluid status. d. A change in weight may indicate the need to change IV fluids. ANS: C Weight is the best (noninvasive) indicator of fluid status. Primary health care providers may base treatment decisions on weight, because the weight reflects fluid balance, but this answer does not explain why. IV fluid rates or solutions may change for the same reason. The nursing assistant would perform tasks on a timely basis, but this is not related to information about weight. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Fluid and electrolytes MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation 7. The nurse in the emergency department (ED) is caring for four clients. Which client does the nurse assess for gas exchange abnormalities first? a. Involved in motor vehicle crash, has broken femur. b. Brought in unconscious by roommate after opioid overdose. c. Asthmatic client being discharged after bronchodilator therapy. d. History of COPD, presents to ED after being bitten by a dog. ANS: B Opioid medications can cause respiratory depression, so this client is most at risk for gas exchange problems. Diminished respirations will allow a buildup of carbon dioxide in the blood. The clients with asthma and COPD have the potential for gas exchange problems but this is not indicated in answer option as he or she is being discharged. The client with a broken femur does not have information suggesting gas exchange problems. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Gas exchange, Risk factors MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care 8. The nurse caring for a client with malnutrition assesses which laboratory value as the priority? a. Albumin b. Prealbumin c. Prothrombin time d. Serum sodium ANS: B Both albumin and prealbumin are indicators for nutrition. However, prealbumin Medical Surgical Nursing 10th Edition Ignatavicius Workman Test Bank Uploaded 2022/2023 changes more rapidly with decreased nutrition, so it is the better test. Prothrombin time and serum sodium are not directly related to nutritional status. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Nutrition, Laboratory values