Timbys Introductory Medical Surgical  Nursing 13th Edition By Loretta A. Donnelly-Moreno;

Test Bank For Timbys Introductory Medical Surgical 
Nursing 13th Edition By Loretta A. Donnelly-Moreno; 
Brigitte Moseley Chapter 1-72 With Rationale

Chapter 1: Concepts and Trends in Healthcare
◦ Which action by the nurse working with a client best demonstrates respect for
autonomy?
◦ Asks if the client has questions before signing a consent
◦ Gives the client accurate information when questioned
◦ Keeps the promises made to the client and family
◦ 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.
◦
◦ DIF: Applying/Application REF: 4
◦ KEY: Autonomy| ethical principles MSC: Integrated Process: Caring
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
of Care
◦
◦ A student nurse asks the faculty to explain best practices when communicating
with a person from the lesbian, gay, bisexual, transgender, and queer/
questioning (LGBTQ) community. What answer by the faculty is most
accurate?
◦ Avoid embarrassing the client by asking questions.
◦ Dont make assumptions about their health needs.
◦ Most LGBTQ people do not want to share information.
◦ 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 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.
◦ DIF: Understanding/Comprehension REF: 4
KEY: LGBTQ| diversity MSC: Integrated Process:
Teaching/Learning
◦ NOT: Client Needs Category: Psychosocial Integrity
◦
◦ A nurse is calling the on-call physician about a client who had a hysterectomy 2
days ago and has pain that is unrelieved by the prescribed narcotic pain
medication. Which statement is part of the SBAR format for communication?
◦ A: I would like you to order a different pain medication.
◦ B: This client has allergies to morphine and codeine.
◦ R: Dr. Smith doesnt like nonsteroidal anti-inflammatory meds.
◦ S: This client had a vaginal
hysterectomy 2 days ago. ANS: B
◦ 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 physician might
order. Situation describes what is happening right now that must be communicated;
the clients surgery 2 days ago would be considered background. Assessment would
include an analysis of the clients 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 surgeons preference
might be better placed in background.
◦ DIF: Applying/
Application REF: 5 KEY:
SBAR| communication
of Care
◦ MSC: Integrated Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
◦
◦ 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 clients blood pressure is much higher than previous readings, and
the clients mental status has changed. What action by the nurse would most
likely have prevented this negative outcome?
◦ Determining if the UAP knew how to take blood pressure
◦ Double-checking the UAP by taking another blood pressure
◦ Providing more appropriate supervision of the UAP
◦ 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 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 and 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 and are
permissible to delegate. The only appropriate answer is that the nurse did not provide
adequate instruction to the UAP.
◦ DIF: Applying/Application REF: 6
◦ KEY: Supervision| delegation|
unlicensed assistive personnel MSC: Integrated
Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
of Care
◦
◦ 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?
◦ All staff nurses are required to participate in quality improvement here.
◦ Even being new, you can implement activities designed to improve care.
◦ Its easy to identify what indicators should be used to measure quality.
◦ You should ask to be assigned to the research and
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 and
is dismissive. Identifying indicators of quality is not an easy, quick process and
would not be the best place to suggest a new nurse to start.
◦ Asking to be assigned to the QI committee does not give the nurse
information about how to implement QI in daily practice.
◦ DIF: Applying/
Application REF: 6 KEY:
Quality improvement
◦ MSC: Integrated Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care Environment: Management
of Care
◦
◦ A nurse is talking with a client who is moving to a new state and needs to find
a new doctor and hospital there. What advice by the nurse is best?
◦ Ask the hospitals there about standard nurse-client ratios.
◦ Choose the hospital that has the newest technology.
◦ Find a hospital that is accredited by The Joint Commission.
◦ 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 and 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.
◦ DIF: Understanding/
Comprehension REF: 2 KEY: The Joint
Commission (TJC)| accreditation
◦ MSC: Integrated Process: Communication and Documentation
◦ NOT: Client Needs Category: Safe and Effective Care
Environment: Safety and Infection Control