TEST BANK For Lewis's Medical Surgical
Nursing in Canada, 4th Edition
by Jane Tyerman, Shelley Cobbett
Chapters 1 - 72 Complete
,TABLE OF CONTENTS
Section One – Concepts in Nursing Practice
1 Introduction to Medical-Surgical Nursing Practice in Canada
2 Cultural Competence and Health Equity in Care
3 Health History and Physical Examination
4 Patient and Caregiver Teaching
5 Chronic Illness
6 Community-Based Nursing and Home Care
7 Older Adults
8 Stress and Stress Management
9 Sleep and Sleep Disorders
10 Pain
11 Substance Use
12 Complementary and Alternative Therapies
13 Palliative Care at the End of Life
Section Two – Pathophysiological Mechanisms of Disease
14 Inflammation and Wound Healing
15 Genetics
16 Altered Immune Response and Transplantation
17 Infection and Human Immunodeficiency Virus Infection
18 Cancer
19 Fluid, Electrolyte, and Acid–Base Imbalances
Section Three – Perioperative Care
20 Nursing Management: Preoperative Care
21 Nursing Management: Intraoperative Care
22 Nursing Management: Post-operative Care
Section Four – Problems Related to Altered Sensory Input
23 Nursing Assessment: Visual and Auditory Systems
24 Nursing Management: Visual and Auditory Problems
25 Nursing Assessment: Integumentary System
26 Nursing Management: Integumentary Problems
27 Nursing Management: Burns
Section Five – Problems of Oxygenation: Ventilation
28 Nursing Assessment: Respiratory System
29 Nursing Management: Upper Respiratory Problems
30 Nursing Management: Lower Respiratory Problems
31 Nursing Management: Obstructive Pulmonary Diseases
Section Six – Problems of Oxygenation: Transport
32 Nursing Assessment: Hematological System
33 Nursing Management: Hematological Problems
Section Seven – Problems of Oxygenation: Perfusion
,34 Nursing Assessment: Cardiovascular System
35 Nursing Management: Hypertension
36 Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome
37 Nursing Management: Heart Failure
38 Nursing Management: Dysrhythmias
39 Nursing Management: Inflammatory and Structural Heart Diseases
40 Nursing Management: Vascular Disorders
Section Eight – Problems of Ingestion, Digestion, Absorption, and Elimination
41 Nursing Assessment: Gastrointestinal System
42 Nursing Management: Nutritional Problems
43 Nursing Management: Obesity
44 Nursing Management: Upper Gastrointestinal Problems
45 Nursing Management: Lower Gastrointestinal Problems
46 Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Section Nine – Problems of Urinary Function
47 Nursing Assessment: Urinary System
48 Nursing Management: Renal and Urological Problems
49 Nursing Management: Acute Kidney Injury and Chronic Kidney Disease
Section Ten – Problems Related to Regulatory and Reproductive Mechanisms
50 Nursing Assessment: Endocrine System
51 Nursing Management: Endocrine Problems
52 Nursing Management: Diabetes Mellitus
53 Nursing Assessment: Reproductive System
54 Nursing Management: Breast Disorders
55 Nursing Management: Sexually Transmitted Infections
56 Nursing Management: Female Reproductive Problems
57 Nursing Management: Male Reproductive Problems
Section Eleven – Problems Related to Movement and Coordination
58 Nursing Assessment: Nervous System
59 Nursing Management: Acute Intracranial Problems
60 Nursing Management: Stroke
61 Nursing Management: Chronic Neurological Problems
62 Nursing Management: Delirium, Alzheimer’s Disease, and Other Dementias
63 Nursing Management: Peripheral Nerve and Spinal Cord Problems
64 Nursing Assessment: Musculoskeletal System
65 Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery
66 Nursing Management: Musculoskeletal Problems
67 Nursing Management: Arthritis and Connective Tissue Diseases
Section Twelve – Nursing Care in Specialized Settings
68 Nursing Management: Critical Care Environment
69 Nursing Management: Shock, Systemic Inflammatory Response Syndrome, and
Multiple-Organ Dysfunction Syndrome
70 Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome
71 Nursing Management: Emergency Care Situations
72 Emergency Management and Disaster Planning
,Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. When caring for clients using evidence-informed practice, which of the following does
the nurse use?
a. Clinical judgement based on experience
b. Evidence from a clinical research study
c. The best available evidence to guide clinical expertise
d. Evaluation of data showing that the client outcomes are met
CORRECT ANSWER: C
Evidence-informed nursing practice is a continuous interactive process involving the explicit,
conscientious, and judicious consideration of the best available evidence to provide care.
Four primary elements are: (a) clinical state, setting, and circumstances; (b) client
preferences and actions; (c) best research evidence; and (d) health care resources. Clinical
judgement based on the nurse’s clinical experience is part of EIP, but clinical decision making
also should incorporate current research and research-based guidelines. Evidence from one
clinical research study does not provide an adequate substantiation for interventions.
Evaluation of client outcomes is important, but interventions should be based on research
from randomized control studies with a large number of subjects.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning
2. Which of the following best N
e x p lRa i n sIt h eGn u B ’ prM
r s e. sC imary use of the nursing process when
providing care to USNT O
clients?
a. To explain nursing interventions to other health care professionals
b. As a problem-solving tool to identify and treat clients’ health care needs
c. As a scientific-based process of diagnosing the client’s health care problems
d. To establish nursing theory that incorporates the biopsychosocial nature of humans
CORRECT ANSWER: B
The nursing process is an assertive problem-solving approach to the identification and
treatment of clients’ problems. Diagnosis is only one phase of the nursing process. The
primary use of the nursing process is in client care, not to establish nursing theory or explain
nursing interventions to other health care professionals.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation
3. The nurse is caring for a critically ill client in the intensive care unit and plans an every 2-hour
turning schedule to prevent skin breakdown. Which type of nursing function is demonstrated
with this turning schedule?
a. Dependent
b. Cooperative
c. Independent
d. Collaborative
CORRECT ANSWER: D
, When implementing collaborative nursing actions, the nurse is responsible primarily for
monitoring for complications of acute illness or providing care to prevent or treat
complications. Independent nursing actions are focused on health promotion, illness
prevention, and client advocacy. A dependent action would require a physician order to
implement. Cooperative nursing functions are not described as one of the formal nursing
functions.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
4. The nurse is caring for a client who has been admitted to the hospital for surgery and tells
the nurse, “I do not feel right about leaving my children with my neighbour.” Which action
should the nurse take next?
a. Reassure the client that these feelings are common for parents.
b. Have the client call the children to ensure that they are doing well.
c. Call the neighbour to determine whether adequate childcare is being provided.
d. Gather more data about the client’s feelings about the childcare arrangements.
CORRECT ANSWER: D
Since a complete assessment is necessary in order to identify a problem and choose an
appropriate intervention, the nurse’s first action should be to obtain more information. The
other actions may be appropriate, but more assessment is needed before the best
intervention can be chosen.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
5. The nurse is caring for a client who has left-sided paralysis as the result of a stroke
and assesses a pressure injury o n t h e cl i en t ’ s l e f t hi p . W hich of the following is the
N R I G B. C M
most
appropriate nursing diagnosis fUo r t S
h i s cNl i e nTt ? O
a. Impaired physical mobility related to decrease in muscle control (left-
sided paralysis)
b. Risk for impaired tissue integrity as evidenced by insufficient knowledge about
protecting tissue integrity
c. Impaired skin integrity related to pressure over bony prominence
(impaired circulation)
d. Ineffective tissue perfusion related to sedentary lifestyle
CORRECT ANSWER: C
The client’s major problem is the impaired skin integrity as demonstrated by the presence of
a pressure injury. The nurse is able to treat the cause of altered circulation and pressure by
frequently repositioning the client. Although left-sided weakness is a problem for the client,
the nurse cannot treat the weakness. The “risk for” diagnosis is not appropriate for this
client, who already has impaired tissue integrity. The client does have ineffective tissue
perfusion, but the impaired skin integrity diagnosis indicates more clearly what the health
problem is.
DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis
6. The nurse caring for a client with an infection has a nursing diagnosis of deficient fluid
volume related to excessive diaphoresis. Which of the following is an appropriate
client outcome?
a. Client has a balanced intake and output.
,b. Client’s bedding is changed when it becomes damp.
, c. Client understands the need for increased fluid intake.
d. Client’s skin remains cool and dry throughout hospitalization.
CORRECT ANSWER: A
This statement gives measurable data showing resolution of the problem of deficient fluid
volume that was identified in the nursing diagnosis statement. The other statements would
not indicate that the problem of deficient fluid volume was resolved.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
7. Which of the following represents a nursing activity that is carried out during the
evaluation phase of the nursing process?
a. Determining if interventions have been effective in meeting client outcomes
b. Documenting the nursing care plan in the progress notes in the medical record
c. Deciding whether the client’s health problems have been completely resolved
d. Asking the client to evaluate whether the nursing care provided was satisfactory
CORRECT ANSWER: A
Evaluation consists of determining whether the desired client outcomes have been met and
whether the nursing interventions were appropriate. The other responses do not describe
the evaluation phase.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Evaluation
8. Which of the following would the nurse perform during the assessment phase of the
nursing process?
a. Obtains data with which to diagnose client problems
b. Uses client data to develoNp pR
Ur iorSIi tyNnGurs
TBin.g C O Mnoses
d iag
c. Teaches interventions to relieve client health problems
d. Assists the client to identify realistic outcomes to health problems
CORRECT ANSWER: A
During the assessment phase, the nurse gathers information about the client. The other
responses are examples of the intervention, diagnosis, and planning phases of the nursing
process.
DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment
9. Which of the following is an example of a correctly written nursing diagnosis statement?
a. Altered tissue perfusion related to heart failure
b. Risk for impaired tissue integrity related to sacral redness
c. Ineffective coping related to insufficient sense of control.
d. Altered urinary elimination related to urinary tract infection
CORRECT ANSWER: C
This diagnosis statement includes a NANDA nursing diagnosis and an etiology that describes
a client’s response to a health problem that can be treated by nursing. The use of a medical
diagnosis (as in the responses beginning “Altered tissue perfusion” and “Altered urinary
elimination”) is not appropriate. The response beginning “Risk for impaired tissue integrity”
uses the defining characteristics as the etiology.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Diagnosis
,10. Which of the following includes the components required for a complete nursing
diagnosis statement?
a. A problem and the suggested client goals or outcomes
b. A problem, its cause, and objective data that support the problem
c. A problem with all its possible causes and the planned interventions
d. A problem with its etiology and the signs and symptoms of the problem
CORRECT ANSWER: D
The PES format is used when writing nursing diagnoses. The subjective, as well as objective,
data should be included in the defining characteristics. Interventions and outcomes are not
included in the nursing diagnosis statement.
DIF: Cognitive Level: Knowledge TOP: Nursing Process: Diagnosis
11. Which of the following refers to a situation that results in unintended harm to the client and
is related to the care or services provided rather than the client’s medical condition?
a. Negligence
b. Adverse event
c. Incident report
d. Nonmaleficence
CORRECT ANSWER: B
An adverse event is an event that results in unintended harm to the client and is related to
the care or services provided to the client rather than to the client’s underlying medical
condition.
DIF: Cognitive Level: Knowledge TOP: Nursing Process: Evaluation
NUR ISG B.C
N TM O
12. When using the Five Steps of the evidence-informed practice (EIP) Process, which of the
flowing elements is the final step when constructing a clinical question?
a. Comparison of interest
b. Population of interest
c. Outcome of interest
d. Timeframe of interest
CORRECT ANSWER: D
The order of the nurse’s statements follows the PICOT format with the final step being the
“T”, or timeframe of interest.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
,Chapter 02: Cultural Competence and Health Equity in Nursing Care Lewis:
Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. Which of the following terms refers to characteristics of a group whose members share
a common social, cultural, linguistic, or religious heritage?
a. Diversity
b. Ethnicity
c. Ethnocentrism
d. Cultural imposition
CORRECT ANSWER: B
Ethnicity is the common social, cultural, linguistic, or religious heritage of a group of people.
Diversity is a presence of persons with differences from the majority or dominant group that
is assumed to be the norm. Ethnocentrism is a tendency of individuals to believe that their
way of viewing and responding to the world is the most correct, natural, and superior one.
Cultural imposition is imposition of one person's own cultural beliefs and practices,
intentionally or unintentionally, on another person or group of people.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning
2. The nurse is caring for Indigenous clients in a community clinic setting. Which of the
following would the nurse include when developing strategies to decrease health
care disparities?
a. Improve public I G B.C M
transportaNtionR.
b. Obtain low-cost medicationUs. S N T O
c. Update equipment and supplies for the clinic.
d. Educate staff about Indigenous health beliefs.
CORRECT ANSWER: D
Health care disparities are due to stereotyping, biases, and prejudice of health care
providers; the nurse can decrease these through staff education. The other strategies also
may be addressed by the nurse but will not impact health disparities.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
3. A family member of an elderly Hispanic client admitted to the hospital tells the nurse that
the client has traditional beliefs about health and illness. Which of the following actions is
most appropriate for the nurse in this situation?
a. Avoid asking any questions unless the client initiates conversation.
b. Ask the client whether it is important that cultural healers are contacted.
c. Explain the usual hospital routines for meal times, care, and family visits.
d. Obtain further information about the client’s cultural beliefs from the daughter.
CORRECT ANSWER: B
, Because the client has traditional health care beliefs, it is appropriate for the nurse to ask
whether the client would like a visit from a cultural healer. Nurses ask key questions with
regard to language, diet, religion, and acculturation and eliciting the client’s explanatory
model of health and illness. There is no cultural reason for the nurse to avoid asking the
client questions, and questions may be necessary to obtain necessary health information.
The client (rather than the daughter) should be consulted about personal cultural beliefs.
The hospital routines for meals, care, and visits should be adapted to the client’s preferences
rather than expecting the client to adapt to the hospital schedule.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
4. When caring for an Indigenous client, which of the following actions is the best initial
approach in relation to eye contact for the nurse to take?
a. Avoid all eye contact with the client.
b. Observe the client’s use of eye contact.
c. Look directly at the client when interacting.
d. Ask the family about the client’s cultural beliefs.
CORRECT ANSWER: B
Eye contact varies greatly among and within cultures so the nurses’ initial action is to assess
the client’s use of eye contact. Although nurses are often taught to maintain direct eye
contact, clients who are Asian, Arab, or Indigenous may avoid direct eye contact and
consider direct eye contact disrespectful or aggressive. Looking directly at the client or
avoiding eye contact may be appropriate, depending on the client’s individual cultural
beliefs. The nurse should assess the client, rather than asking family members about the
client’s beliefs.
DIF: Cognitive Level: Applic ation
N R I GT OBP :.C
N u r s i ng Process: Implementation
M
USNT O
5. A graduate nurse is assessing a newly admitted non–English-speaking Chinese client who
complains of severe headaches. Which of the following actions by the graduate nurse
would cause the charge nurse to intervene during this assessment interview?
a. Sit down at the bedside.
b. Palpate the client’s scalp.
c. Call for a medical interpreter.
d. Avoid eye contact with the client.
CORRECT ANSWER: B
Many people of Asian ethnicity believe that touching a person’s head is disrespectful; the
nurse should always ask permission before touching any client’s head. The other actions are
appropriate.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
6. The nurse is caring for a client who speaks a language different from the nurse’s language
and there is no interpreter available. Which of the following actions is the most appropriate
for the nurse to implement?
a. Use specific medical terms in the Latin form.
b. Talk loudly and slowly so that each word is clearly heard.
c. Repeat important words so that the client recognizes their importance.
d. Use simple gestures to demonstrate meaning while talking to the client.
