TEST BANK
Lewis's Medical-Surgical Nursing 12th Edition
By Harding, Kwong & Hagler, All Chapters 1 - 69
,TABLE OF CONTENTS
SECTION 1 Concepts in Nursing Practice
1 Professional Nursing
2 Social Determinants of Health
3 Health History and Physical Examination
4 Patient and Caregiver Teaching
5 Chronic Illness and Older Adults
6 Caring for Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, and Gender Diverse
Patients
SECTION 2 Problems Related to Comfort and Coping
7 Stress Management
8 Sleep and Sleep Disorders
9 Pain
10 Palliative and End-of-Life Care
11 Substance Use Disorders in Acute Care
SECTION 3 Problems Related to Homeostasis and Protection
12 Inflammation and Healing
13 Genetics
14 Immune Responses and Transplantation
15 Infection
16 Cancer
17 Fluid, Electrolyte, and Acid-Base Imbalances
SECTION 4 Perioperative and Emergency Care
18 Preoperative Care
19 Intraoperative Care
20 Postoperative Care
21 Emergency and Disaster Nursing
SECTION 5 Problems Related to Altered Sensory Input
22 Assessment and Management: Visual Problems
23 Assessment and Management: Auditory Problems
24 Assessment: Integumentary System
25 Integumentary Problems
26 Burns
SECTION 6 Problems of Oxygenation: Ventilation
27 Assessment: Respiratory System
28 Supporting Ventilation
29 Upper Respiratory Problems
30 Lower Respiratory Problems
31 Obstructive Pulmonary Diseases
32 Acute Respiratory Failure and Acute Respiratory Distress Syndrome
SECTION 7 Problems of Oxygenation: Transport
33 Assessment: Hematologic System
34 Hematologic Problems
SECTION 8 Problems of Oxygenation: Perfusion
,35 Assessment: Cardiovascular System
36 Hypertension
37 Coronary Artery Disease and Acute Coronary Syndrome
38 Heart Failure
39 Dysrhythmias
40 Inflammatory and Structural Heart Disorders
41 Vascular Disorders
42 Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
SECTION 9 Problems of Ingestion, Digestion, Absorption, and Elimination
43 Assessment: Gastrointestinal System
44 Nutrition Problems
45 Obesity
46 Upper Gastrointestinal Problems
47 Lower Gastrointestinal Problems
48 Liver, Biliary Tract, and Pancreas Problems
SECTION 10 Problems of Urinary Function
49 Assessment: Urinary System
50 Renal and Urologic Problems
51 Acute Kidney Injury and Chronic Kidney Disease
SECTION 11 Problems Related to Regulatory and Reproductive Mechanisms
52 Assessment: Endocrine System
53 Diabetes
54 Endocrine Problems
55 Assessment: Reproductive System
56 Breast Problems
57 Sexually Transmitted Infections
58 Female Reproductive Problems
59 Male Reproductive Problems
SECTION 12 Problems Related to Movement and Coordination
60 Assessment: Nervous System
61 Acute Intracranial Problems
62 Stroke
63 Chronic Neurologic Problems
64 Dementia and Delirium
65 Spinal Cord and Peripheral Nerve Problems
66 Assessment: Musculoskeletal System
67 Musculoskeletal Trauma and Orthopedic Surgery
68 Musculoskeletal Problems
69 Arthritis and Connective Tissue Diseases ©
, Chapter 01: Professional Nursing
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 physician does?” Which response would the nurse provide?
a. ©“The role of the nurse is to administer medications and other treatments
prescribed by your physician.”
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 collect information and communicate any problems that
occur to the physician.”
d. “Nurses perform many of the same procedures as the physician, but nurses are
with the patients for a longer time than the physician.”
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. Which statement by the nurse accurately describes the use of evidence-based practice (EBP)?
a. “Patient care is based on clinical judgment, experience, and traditions.”
b. “Data are analyzed later to show that the patient outcomes are consistently met.”
c. “Research from all published articles are used as a guide for planning patient care.”
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: Understand (Comprehension) TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
3. Which statement by the nurse provides a clear explanation of the nursing process?
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 manage 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
would 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.
DIF: Cognitive Level: Analyze (Analysis)
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 select 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. Which statement describes 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. Which statement describes 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 obtain data to diagnose patient strengths and problems
d. To help the patient identify realistic outcomes for health problems
ANS: C
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. When developing the plan of care, which components would the nurse include in the
clinical problem statement?
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, its pathophysiology, and the expected outcome
ANS: B
When writing clinical problems or nursing diagnoses, the subjective as well as objective data
to support the problem‘s existence 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 would the nurse delegate to experienced assistive personnel (AP)?
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
AP 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) 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 assistive personnel (AP), and one licensed practical/vocational nurse
(LPN/VN). Which assignment, if delegated by the nurse, would be outside that individual‘s
scope of practice?
a. Check for the presence of bowel sounds by AP
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 AP
ANS: A
Assessment requires RN education and scope of practice so it cannot be delegated to an
LPN/VN or AP. The other assignments made by the RN are appropriate for the role of the team
member.
DIF: Cognitive Level: Apply (Application) 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 low-fat, reduced sodium dietary restrictions.
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) TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
12. A nurse is assigned as a case manager for a hospitalized patient who has 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 type of 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 monitor blood glucose.
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)
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).
