ISBN: 9780323789615 Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems 11th Edition TESTBANK

TEST BANK for Lewis's Medical-Surgical Nursing Assessment
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andManagement of Clinical Problems 12th Edition By Harding &
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Kwong
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Chapter01:Professional Nursing b
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Harding: Lewis’s Medical-Surgical
b z b z b z Nursing, b z 12th b z Edition


MULTIPLECHOICE b
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1. The nurse completes an admission database and explains that the plan
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discharge goals will be developed with the patient‗s input. The patient asks, ―How is
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this different from what the physician does?‖ Which response would the nurse provide?
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a. ―Theroleofthenurseistoadministermedicationsandothertreatmentsprescribed by z
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your physician.‖
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b. ―Inadditiontocaring for youwhile you aresick,the nurseswillhelp youplanto
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maintain your health.‖
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c. ―Thenurse‗sjob isto collectinformationand communicate anyproblemsthat z
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occur to the physician.‖
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d. ―Nursesperformmanyofthe same procedures asthephysician,butnurses are
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with the patients for a longer time than the physician.‖
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ANS: B b z




The American Nurses Association (ANA) definition of nursing describes the role of nurses
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inpromoting health. The other responses describe dependent and collaborative functions of
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the nursing role but do not accurately describe the nurse‗s unique role in the health care
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system.
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DIF: bz bz bz bz b z CognitiveLevel:Analyze(Analysis) z
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TOP: bz bz bz bz b z Nursing Process: Implementation MSC: NCLEX:SafeandEffective CareEnvironment
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2. Which statement bythe nurse accuratelydescribes the useof evidence-based practice (EBP)?
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a. ―Patientcareisbasedonclinicaljudgment,experience, andtraditions.‖
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b. ―Dataareanalyzed latertoshowthatthepatientoutcomesareconsistentlymet.‖
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c. ―Researchfrom allpublishedarticles areused as aguideforplanning patientcare.‖ z
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d. ―Recommendationsarebased on research,clinical expertise,and patient z
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bz preferences.‖
ANS: D b z




Evidence-based practice (EBP) is the use of the best research-based evidence combined bz bz bz bz bz bz bz bz bz bz bz




withclinician expertise and consideration of patient preferences. Clinical judgment based
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onthe nurse‗s clinical experience is part of EBP, but clinical decision making should also
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incorporate current research and research-based guidelines. Evaluation of patient outcomes
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isimportant, but data analysis is not required to use EBP. All published articles do not
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provide research evidence; interventions should be based on credible research, preferably
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randomizedcontrolled studies with a large numberof subjects.
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DIF: Cognitive Level: Understand (Comprehension) TOP: bz bz bz




NursingProcess:PlanningMSC: NCLEX: Safe and Effective Care Environment
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3. Which statement bythe nurseprovides a clear explanation ofthe nursingprocess?
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a. ―Thenursingprocessisaresearchmethodofdiagnosing thepatient‗shealthcare z
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bz problems.‖
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,b. ―Thenursing processis usedprimarilytoexplain nursing interventionstoother
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health care professionals.‖
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c. ―Thenursing processisa problem-solving toolused toidentifyandmanage the
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, patients‗health careneeds.‖ z
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d. ―Thenursing processis basedonnursingtheorythat incorporates the io z
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bz biopsychosocial nature of humans.‖ bz bz bz




ANS: C b z




The nursing process is a problem-solving approach to the identification and treatment of
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patients‗ problems. Nursing process does not require research methods for diagnosis.
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Theprimaryuse of the nursing process is in patient care, not to establish nursing theoryor
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explainnursinginterventions to other health care professionals.
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DIF: Cognitive Level: Understand (Comprehension) TOP: bz bz bz




NursingProcess:EvaluationMSC: NCLEX: Safe and Effective Care Environment
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4. A patient admitted to the hospital for surgery tells the nurse, ―I do not feel
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comfortableleaving my children with my parents.‖ Which action would the nursetake
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next?
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a. Reassurethepatient that thesefeelings arecommon forparents. z
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b. Havethe patient call the children to ensure that theyaredoingwell.
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c. Gatherinformation onthepatient‗s concerns about thechildcarearrangements. bz bz z
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d. Callthepatient‗s parents todeterminewhetheradequatechild
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careisbeingprovided.
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ANS: C b z




Because a complete assessment is necessary in order to identify a problem and choose an
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appropriate intervention, the nurse‗s first action should be to obtain more information.
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Theother actions maybe appropriate, but more assessment is needed before the best
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interventioncan be chosen.
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DIF: CognitiveLevel:Analyze(Analysis) z
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TOP: NursingProcess: Assessment z
b bz MSC: NCLEX:PsychosocialIntegrity b z bz bz




5. Apatient withabacterial infectionishypovolemic duetoafever and
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excessivediaphoresis.Which expected outcome would the nurse select for this
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patient?
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a. Patienthasabalanced intakeand output. z
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b. Patient‗sbeddingiskeptclean andfreeofmoisture. bz bz z
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c. Patient understands theneed forincreased fluidintake. bz bz z
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d. Patient‗s skin remains cool and dry throughout hospitalization. bz b z b z b z b z bz b z




ANS: A b z




Balanced intake and output gives measurable data showingresolution of the problem
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ofdeficient fluid volume. The other statements would not indicate that the problem
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ofhypovolemia was resolved.
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DIF: Cognitive Level: Apply(Application) bz bz z
b TOP: Nursing Process: bz bzbz io



PlanningMSC: NCLEX: Physiological Integrity
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6. Whichstatement describes the purposeoftheevaluation phase ofthe nursingprocess?
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a. Todocument the nursing careplan in theprogress notes of thehealth record
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b. Todetermineifinterventions havebeen effective in meetingpatient outcomes
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c. Todecidewhetherthepatient‗s healthproblems havebeen completelyresolved
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d. Toestablish if thepatient agrees that thenursingcareprovided was satisfactory
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ANS: B b z




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, Evaluation consists of determining whether the desired patient outcomes haveb z b z b z b z b z b z b z b z b z




been met and whether the nursing interventions were appropriate. The other responses do
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not describe theevaluation phase.
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DIF: Cognitive Level: Understand (Comprehension)
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Process:EvaluationMSC: NCLEX: Safe and Effective Care Environment
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7. Whichstatement describes the purposeoftheassessment phaseofthenursingprocess?
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a. Toteachinterventionsthatrelievehealthproblems
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b. To usepatient data to evaluatepatient careoutcomes
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c. Toobtaindatatodiagnosepatient strengths and problems
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d. Tohelp thepatient identifyrealisticoutcomes for healthproblems
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ANS: C b z




During theassessment phase,the nurse gathers information about thepatient to diagnosepatient
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strengths and problems. The other responses are examples of the planning,intervention, and
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evaluation phases of the nursing process.
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DIF: CognitiveLevel:Understand(Comprehension) z
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TOP: NursingProcess: Assessment MSC: NCLEX:SafeandEffective CareEnvironment z
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8. Whendevelopingthe plan ofcare, which components would thenurseincludein
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theclinicalproblem statement?
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a. Theproblem and thesuggested patient goals oroutcomes bz bz z
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b. Theproblem,its causes, andthesigns and symptoms oftheproblem
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c. Theproblem with thepossible etiologyand theplanned interventions
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d. Theproblem, itspathophysiology, and theexpected outcome bz bz bz bz bz bz




ANS: B b z




When writing clinical problems or nursing diagnoses, the subjective as well as objective data to
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support the problem‗s existence should be included. Goals, outcomes, and interventions
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arenot included in the problem statement.
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DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: bz bz bz bz b z io



DiagnosisMSC: NCLEX: Safe and Effective Care Environment
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9. Whichpatient caretask would the nursedelegate to experienced assistive personnel (AP)?
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a. Instruct the patient about the need to alternate activityand rest. bz bz bz bz bz bz bz bz bz




b. Monitorlevel ofshortness ofbreath orfatigue after ambulation. z
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c. Obtainthepatient‗sbloodpressureandpulserate afterambulation. z
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d. Determinewhetherthe patient is readyto increase the activitylevel. z
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ANS: C b z




AP education includes accurate vital sign measurement. Assessment and patient
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teachingrequire registered nurse education and scopeof practice and cannot be delegated.
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DIF: Cognitive Level: Apply(Application) TOP: Nursing Process: bz bz z
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PlanningMSC: NCLEX: Safe and Effective Care Environment
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