TEST BANK FOR LEWIS’S MEDICAL SURGICAL
NURSING 11TH EDITION HARDING CHAPTER 1-
68|COMPLETE GUIDE-2024
,Chapter 01: Professional Nursing
Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. The nurse completes an admission database and explains that the plan of care and discharge
goals will be developed with the patient’s input. The patient asks, “How is this different from
what the doctor does?” Which response would be most appropriate for the nurse to make?
a. “The role of the nurse is to administer medications and other treatments prescribed
by your doctor.”
b. “In addition to caring for you while you are sick, the nurses will help you plan to
maintain your health.”
c. “The nurse’s job is to help the doctor by collecting information and
communicating any problems that occur.”
d. “Nurses perform many of the same procedures as the doctor, but nurses are with
the patients for a longer time than the doctor.”
ANS: B
The American Nurses Association (ANA) definition of nursing describes the role of nurses in
promoting health. The other responses describe dependent and collaborative functions of the
nursing role but do not accurately describe the nurse’s unique role in the health care system.
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. The nurse describes to a student nurse how to use evidence-based practice (EBP) when caring
TESTBANKWORLD.ORG
for patients. Which statement by the nurse accurately describes the use of EBP?
a. “Inferences from all published articles are used as a guide.”
b. “Patient care is based on clinical judgment, experience, and traditions.”
c. “Data are analyzed later to show that the patient outcomes are consistently met.”
d. “Recommendations are based on research, clinical expertise, and patient
preferences.”
ANS: D
Evidence-based practice (EBP) is the use of the best research-based evidence combined with
clinician expertise and consideration of patient preferences. Clinical judgment based on the
nurse’s clinical experience is part of EBP, but clinical decision making should also
incorporate current research and research-based guidelines. Evaluation of patient outcomes is
important, but data analysis is not required to use EBP. All published articles do not provide
research evidence; interventions should be based on credible research, preferably randomized
controlled studies with a large number of subjects.
DIF: Cognitive Level: Remember (knowledge) TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
3. The nurse teaches a student nurse about how to apply the nursing process when providing
patient care. Which statement by the student nurse indicates that teaching was successful?
a. “The nursing process is a research method of diagnosing the patient’s health care
problems.”
b. “The nursing process is used primarily to explain nursing interventions to other
, health care professionals.”
c. “The nursing process is a problem-solving tool used to identify and treat the
patients’ health care needs.”
d. “The nursing process is based on nursing theory that incorporates the
biopsychosocial nature of humans.”
ANS: C
The nursing process is a problem-solving approach to the identification and treatment of
patients’ problems. Nursing process does not require research methods for diagnosis. The
primary use of the nursing process is in patient care, not to establish nursing theory or explain
nursing interventions to other health care professionals.
DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment
4. A patient admitted to the hospital for surgery tells the nurse, “I do not feel comfortable
leaving my children with my parents.” Which action should the nurse take next?
a. Reassure the patient that these feelings are common for parents.
b. Have the patient call the children to ensure that they are doing well.
c. Gather information on the patient’s concerns about the child care arrangements.
d. Call the patient’s parents to determine whether adequate child care is being
provided.
ANS: C
Because 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. TESTBANKWORLD.ORG
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
5. A patient with a bacterial infection is hypovolemic due to a fever and excessive diaphoresis.
Which expected outcome would the nurse recognize as appropriate for this patient?
a. Patient has a balanced intake and output.
b. Patient’s bedding is kept clean and free of moisture.
c. Patient understands the need for increased fluid intake.
d. Patient’s skin remains cool and dry throughout hospitalization.
ANS: A
Balanced intake and output gives measurable data showing resolution of the problem of
deficient fluid volume. The other statements would not indicate that the problem of
hypovolemia was resolved.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
6. After administering medication, the nurse asks the patient if pain was relieved. What is the
purpose of the evaluation phase of the nursing process?
a. To document the nursing care plan in the progress notes of the health record
b. To determine if interventions have been effective in meeting patient outcomes
, c. To decide whether the patient’s health problems have been completely resolved
d. To establish if the patient agrees that the nursing care provided was satisfactory
ANS: B
Evaluation consists of determining whether the desired patient outcomes have been met and
whether the nursing interventions were appropriate. The other responses do not describe the
evaluation phase.
DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment
7. The nurse interviews a patient while completing the health history and physical examination.
What is the purpose of the assessment phase of the nursing process?
a. To teach interventions that relieve health problems
b. To use patient data to evaluate patient care outcomes
c. To help the patient identify realistic outcomes for health problems
d. To obtain data with which to diagnose patient strengths and problems
ANS: D
During the assessment phase, the nurse gathers information about the patient to diagnose
patient strengths and problems. The other responses are examples of the planning,
intervention, and evaluation phases of the nursing process.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
8. The nurse admits a patient to the hospital and develops a plan of care. What components
should the nurse include in thTeEpS TBtApro
atien NKblWOR
em stL
ateDm.eO
ntR
?G
a. The problem and the suggested patient goals or outcomes
b. The problem, its causes, and the signs and symptoms of the problem
c. The problem with the possible etiology and the planned interventions
d. The problem, the pathophysiology of the problem, and the expected outcome
ANS: B
When writing patient problems or nursing diagnoses, this format should be used: problem,
etiology, and signs and symptoms. The subjective as well as objective data should be
included. Goals, outcomes, and interventions are not included in the problem statement.
DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Diagnosis
MSC: NCLEX: Safe and Effective Care Environment
9. Which patient care task is appropriate for the nurse to delegate to experienced unlicensed
assistive personnel (UAP)?
a. Instruct the patient about the need to alternate activity and rest.
b. Monitor level of shortness of breath or fatigue after ambulation.
c. Obtain the patient’s blood pressure and pulse rate after ambulation.
d. Determine whether the patient is ready to increase the activity level.
ANS: C
UAP education includes accurate vital sign measurement. Assessment and patient teaching
require registered nurse education and scope of practice and cannot be delegated.
, DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
10. A nurse is caring for a group of patients on the medical-surgical unit with the help of one float
registered nurse (RN), one unlicensed assistive personnel (UAP), and one licensed
practical/vocational nurse (LPN/VN). Which assignment, if delegated by the nurse, would be
inappropriate?
a. Check for the presence of bowel sounds by UAP
b. Administration of oral medications by LPN/VN
c. Insulin administration by float RN from the pediatric unit
d. Measurement of a patient’s urinary catheter output by UAP
ANS: A
Assessment requires RN education and scope of practice so it cannot be delegated to an
LPN/VN or UAP. The other assignments made by the RN are appropriate for the role of the
team member.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
11. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse
(LPN/VN)?
a. Complete the initial admission assessment and plan of care.
b. Measure bedside blood glucose before administering insulin.
c. Document teaching completed before a diagnostic procedure.
d. Instruct a patient about loT
wE-fS
atT
, rB
edAuN
ceK
dWsoOdR
iuL
mDd.
ieO
taR
ryGrestrictions.
ANS: B
The education and scope of practice of the LPN/LVN include activities such as obtaining
glucose testing using a finger stick and administering insulin. Patient teaching and the initial
assessment and development of the plan of care are nursing actions that require registered
nurse education and scope of practice.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
12. A nurse is assigned as a case manager for a hospitalized patient with a spinal cord injury.
Which activity can the patient expect the nurse in this role to perform?
a. Care for the patient during hospitalization for the injuries.
b. Assist the patient with home care activities during recovery.
c. Coordinate the services the patient receives in the hospital and at home.
d. Determine what medical care the patient needs for optimal rehabilitation.
ANS: C
The role of the case manager is to coordinate the patient’s care through multiple settings and
levels of care to allow the maximal patient benefit at the least cost. The case manager does not
provide direct care in the acute or home setting. The case manager coordinates and advocates
for care the HCP determines what medical care is needed.
, DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
13. The nurse is caring for an older adult patient who needs continued nursing care and physical
therapy to improve mobility after surgery to repair a fractured hip. The nurse would help to
arrange for transfer of the patient to which facility?
a. A skilled care facility
b. A transitional care facility
c. A residential care facility
d. An intermediate care facility
ANS: B
Transitional care settings are appropriate for patients who need continued rehabilitation before
discharge to home or to long-term care settings. The patient is no longer in need of the more
continuous assessment and care given in acute care settings. There is no indication that the
patient will need the permanent and ongoing medical and nursing services available in
intermediate or skilled care. The patient is not yet independent enough to transfer to a
residential care facility.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
14. A home care nurse is planning care for a patient who has just been diagnosed with type 2
diabetes. Which task is appropriate for the nurse to delegate to the home health aide?
a. Assist the patient to choose appropriate foods.
b. Help the patient with a daily bath and oral care.
c. Check the patient’s feet for signs of breakdown.
d. Teach the patient how to TESTBANKWORLD
monitor blood glucose. .ORG
ANS: B
Assisting with patient hygiene is included in home health-aide education and scope of
practice. Assessment of the patient and instructing the patient in new skills, such as diet and
blood glucose monitoring, are complex skills that are included in registered nurse education
and scope of practice.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
15. The nurse is providing education to nursing staff on quality care initiatives. Which statement
is an accurate description of the impact of health care financing on quality care?
a. “If a patient develops a catheter-related infection, the hospital receives additional
funding.”
b. “Payment for patient care is primarily based on clinical outcomes and patient
satisfaction.”
c. “Hospitals are reimbursed for all costs incurred if care is documented
electronically.”
d. “Because hospitals are accountable for overall care, it is not nursing’s
responsibility to monitor care delivered by others.”
ANS: B
, Payment for health care services programs reimburses hospitals for their performance on
overall quality-of-care measures. These measures include clinical outcomes and patient
satisfaction. Nurses are responsible for coordinating complex aspects of patient care,
including the care delivered by others, and identifying issues that are associated with poor
quality care. Payment for care can be withheld if something happens to the patient that is
considered preventable (e.g., acquiring a catheter-related urinary tract infection).
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
16. The nurse documenting the patient’s progress in the electronic health record before an
interprofessional discharge conference is demonstrating competency in which QSEN
category?
a. Patient-centered care
b. Evidence-based practice
c. Quality improvement
d. Informatics and technology
ANS: D
The nurse is displaying competency in the QSEN area of informatics and technology. Using a
computerized information system to document patient needs and progress and communicate
vital information about the patient with the interprofessional care team members provides
evidence that nursing practice standards related to the nursing process have been maintained
during the care of the patient.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
TESTBANKWO RLD.ORG
MULTIPLE RESPONSE
1. Which information will the nurse consider when deciding what nursing actions to delegate to
a licensed practical/vocational nurse (LPN/VN) who is working on a medical-surgical unit?
(Select all that apply.)
a. Institutional policies
b. Stability of the patients
c. State nurse practice act
d. LPN/VN teaching abilities
e. Experience of the LPN/VN
ANS: A, B, C, E
The nurse should assess the experience of LPN/VNs when delegating. In addition, state nurse
practice acts and institutional policies must be considered. In general, while the LPN/VN
scope of practice includes caring for patients who are stable, registered nurses should provide
most of the care for unstable patients. Because the LPN/VN scope of practice does not include
patient education, this will not be part of the delegation process.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
, 2. Which actions by the nurse administering medications are consistent with promoting safe
delivery of patient care? (Select all that apply)
a. Discards a medication that unlabeled.
b. Uses a hand sanitizer before preparing a medication.
c. Identifies the patient by the room number on the door.
d. Checks laboratory test results before administering a diuretic.
e. Gives the patient a list of current medications upon discharge.
ANS: A, B, D, E
National Patient Safety Goals have been established to promote safe delivery of care. The
nurse should use at least 2 reliable ways to identify the patient such as asking the patient’s full
name and date of birth before medication administration. Other actions that improve patient
safety include performing hand hygiene, disposing of unlabeled medications, completing
appropriate assessments before administering medications, and giving a list of the current
medicines to the patient and caregiver before discharge.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
OTHER
1. The nurse uses the Situation-Background-Assessment-Recommendation (SBAR) format to
communicate a change in patient status to a health care provider. In which order should the
nurse make the following statements? (Put a comma and a space between each answer choice
[A, B, C, D].)
a. “The patient needs to be evaluated immediately and may need intubation and mechanical
ventilation.” TESTBANKWORLD.ORG
b. “The patient was admitted yesterday with heart failure and has been receiving furosemide
(Lasix) for diuresis, but urine output has been low.”
c. “The patient has crackles audible throughout the posterior chest, and the most recent
oxygen saturation is 89%. Her condition is very unstable.”
d. “This is the nurse on the surgical unit. After assessing the patient, I am very concerned
about increased shortness of breath over the past hour.”
ANS:
D, B, C, A
The order of the nurse’s statements follows the SBAR format.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
,Chapter 02: Health Equity and Culturally Competent Care
Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. The nurse is obtaining a health history from a new patient. Which data will be the focus of
patient teaching?
a. Family history
b. Age and genders
c. Dietary fat intake
d. Race and ethnicity
ANS: C
Behaviors are strongly linked to many health care problems. The patient’s fat intake is a
behavior that the patient can change. The other information will be useful as the nurse
develops an individualized plan for improving the patient’s health but will not be the focus of
patient teaching.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
2. The nurse works in a clinic located in a community where many of the residents are Hispanic.
Which strategy, if implemented by the nurse, would decrease health care disparities and
promote health equity for this community?
a. Improve public transportation to the clinic.
b. Update equipment and supplies at the clinic. LD.ORG
TESTBANKWOR
c. Teach clinic staff about cultural health beliefs.
d. Obtain low-cost medications for clinic patients.
ANS: C
Health care disparities are caused by stereotyping, biases, and prejudice of health care
providers. The nurse can decrease these through staff education. The other strategies may also
be addressed by the nurse but will not directly impact health disparities.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
3. What information should the nurse collect when assessing the health status of a community?
a. Air pollution levels
b. Number of healthy food stores
c. Most common causes of death
d. Education level of the individuals
ANS: C
Health status measures of a community include birth and death rates, life expectancy, access
to care, and morbidity and mortality rates related to disease and injury. Although air pollution,
access to health food stores, and education level are factors that affect a community’s health
status, they are not health measures.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
, 4. The nurse is caring for a patient who has traditional Native American beliefs about health and
illness. Which action by the nurse is most appropriate?
a. Avoid asking questions unless the patient initiates the conversation.
b. Ask the patient whether it is important that cultural healers are contacted.
c. Explain the usual hospital routines for meal times, care, and family visits.
d. Obtain information about the patient’s cultural beliefs from a family member.
ANS: B
Because the patient has traditional health care beliefs, it is appropriate for the nurse to ask
whether the patient would like a visit by a shaman or other cultural healer. There is no cultural
reason for the nurse to avoid asking the patient questions because these questions are
necessary to obtain health information. The patient (rather than the family) should be
consulted first about personal cultural beliefs. The hospital routines for meals, care, and visits
should be adapted to the patient’s preferences rather than expecting the patient to adapt to the
hospital schedule.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
5. The nurse is caring for an Asian patient who is being admitted to the hospital. Which action
would be most appropriate for the nurse to take when interviewing this patient?
a. Avoid eye contact with the patient.
b. Observe the patient’s use of eye contact.
c. Look directly at the patient when interacting.
d. Ask a family member about the patient’s cultural beliefs.
ANS: B TESTBANKWORLD.ORG
Observation of the patient’s use of eye contact will be most useful in determining the best way
to communicate effectively with the patient. Looking directly at the patient or avoiding eye
contact may be appropriate, depending on the patient’s individual cultural beliefs. The nurse
should assess the patient, rather than asking family members about the patient’s beliefs.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
6. A female staff nurse is assessing a male patient of Arab descent who is admitted with
complaints of severe headaches. It is important for the charge nurse to intervene if the nurse
takes which action?
a. The nurse explains the 0 to 10 intensity pain scale.
b. The nurse asks the patient when the headaches started.
c. The nurse approaches the bedside and closes the privacy curtain.
d. The nurse calls for a male nurse to bring a hospital gown to the room.
ANS: C
Many men of Arab ethnicity do not believe it is appropriate to be alone with any female
except for their spouse. The other actions are appropriate.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
