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TESTyBANKyfor yMedical-Surgical yNursing: yConceptsyfor yClinical yJudgment y and y Collaborative y Care y11thyEditionybyyDonna yD. yIgnatavicius, y y All ychapters y1y- y74$19.49
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TESTyBANKyfor yMedical-Surgical yNursing: yConceptsyfor yClinical yJudgment y and y Collaborative y Care y11thyEditionybyyDonna yD. yIgnatavicius, y y All ychapters y1y- y74
TESTyBANKyfor yMedical-Surgical yNursing:
yConceptsyfor yClinical yJudgment y and y Collaborative
y Care y11thyEditionybyyDonna yD. yIgnatavicius, y
y All ychapters y1y- y74
y Conceptsfor Clinical Judgment and Collaborative
y y y y y
y Care 11th Edition by Donna D. Ignatavicius,
y y y y y y y
y All chapters 1 - 74
y y y y
,
,
, Chapter 01: Overview of Professional Nursing Concepts for Medical- y y y y y y y y
Surgical Nursing
y y
MULTIPLE CHOICE y
1. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse
y y y y y y y y y y y y y y
bestdemonstrates this concept?
y y y y
a. Assesses for cultural influences affecting health care y y y y y y
b. Ensures that all the clients basic needs are met y y y y y y y y
c. Tells the client and family about all upcoming tests
y y y y y y y y
d. Thoroughly orients the client and family to the room y y y y y y y y
CORRECT ANSWER: A y y
Competency in client-focused care is demonstrated when the nurse focuses on communication, culture, respect
y y y y y y y y y y y y y
y compassion, client education, and empowerment. By assessing the effect of the clients culture on health
y y y y y y y y y y y y y y
y care, this nurse is practicing client-focused care. Providing for basic needs does not demonstrate this
y y y y y y y y y y y y y y
y competence. Simply telling the client about all upcoming tests is not providing empowering education. Orienting
y y y y y y y y y y y y y y
y the clientand family to the room is an important safety measure, but not directly related to demonstrating client-
y y y y y y y y y y y y y y y y y y
centered care. y
DIF: Understanding/Comprehension REF: 3
y y y
KEY: Patient-centered care| culture MSC: Integrated Process:
y y y y y y
y CaringNOT: Client Needs Category: Psychosocial Integrity
y y y y y y
2. A nurse is caring for a postoperative client on the surgical unit. The clients blood pressure was 142/76
y y y y y y y y y y y y y y y y y
y mmHg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is best?
y y y y y y y y y y y y y y y y y
a. Call the Rapid Response Team. y y y y
b. Document and continue to monitor. y y y y
c. Notify the primary care provider. y y y y
d. Repeat blood pressure measurement in 15 minutes. y y y y y y
CORRECT ANSWER: A y y
The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating before they suffer
y y y y y y y y y y y y y y y y y
y either respiratory or cardiac arrest. Since the client has manifested a significant change, the nurse shouldcall the
y y y y y y y y y y y y y y y y y
y RRT. Changes in blood pressure, mental status, heart rate, and pain are particularly significant.
y y y y y y y y y y y y y
Documentation is vital, but the nurse must do more than document. The primary care provider should be
y y y y y y y y y y y y y y y y
y notified, but this is not the priority over calling the RRT. The clients blood pressure should be reassessed
y y y y y y y y y y y y y y y y y
y frequently, but the priority is getting the rapid care to the client.
y y y y y y y y y y y
DIF: Applying/Application REF: 3
y y y
KEY: Rapid Response Team (RRT)| medical emergencies
y y y y y y
y MSC: Integrated Process: Communication and Documentation
y y y y y
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
y y y y y y y
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