TEST BANK
Test Bank for Lewis’s Medical Surgical Nursing
12th Edition
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,Table of Content
Chapter 01: Professional Nursing ................................................................................................................................................. 4
Chapter 02: Social Determinants of Health ................................................................................................................................ 10
Chapter 03: Health History and Physical Examination Harding: Lewis’sMedical-Surgical Nursing, 12th Edition..................... 15
Chapter 04: Patient and Caregiver Teaching .............................................................................................................................. 20
Chapter 05: Chronic Illness and Older Adults ............................................................................................................................ 26
Harding: Lewis’s Medical-Surgical Nursing, 12th Edition......................................................................................................... 34
Chapter 07: Stress Management ................................................................................................................................................. 38
Chapter 08: Sleep and Sleep Disorders ....................................................................................................................................... 42
Chapter 09: Pain.......................................................................................................................................................................... 47
Chapter 10: Palliative and End-of-Life Care .............................................................................................................................. 56
Chapter 11: Substance Use Disorders in Acute Care .................................................................................................................. 61
Chapter 12: Inflammation and Healing ....................................................................................................................................... 69
Chapter 13: Genetics ................................................................................................................................................................... 76
Chapter 14: Immune Responses and Transplantation Harding: Lewis’sMedical-Surgical Nursing, 12th Edition ....................... 79
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Chapter 15: Infection .................................................................................................................................................................. 87
Chapter 16: Cancer ..................................................................................................................................................................... 97
Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances Harding: Lewis’s Medical-Surgical Nursing, 12th Edition ......... 111
Chapter 18: Preoperative Care ................................................................................................................................................. 124
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Chapter 19: Intraoperative Care ............................................................................................................................................... 131
Chapter 20: Postoperative Care................................................................................................................................................. 137
Chapter 21: Emergency and Disaster Nursing .......................................................................................................................... 145
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Chapter 22: Assessment and Management: Visual Problems Harding: Lewis’s Medical-Surgical Nursing, 12th Edition ...... 154
Chapter 23: Assessment and Management: Auditory Problems Harding: Lewis’s Medical-Surgical Nursing, 12th Edition 167
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Chapter 24: Assessment: Integumentary System Harding: Lewis’sMedical-Surgical Nursing, 12th Edition............................ 174
Chapter 25: Integumentary Problems ....................................................................................................................................... 180
Chapter 26: Burns ..................................................................................................................................................................... 188
Chapter 27: Assessment: Respiratory System........................................................................................................................... 198
Chapter 28: Supporting Ventilation .......................................................................................................................................... 206
Chapter 29: Upper Respiratory Problems ................................................................................................................................. 217
Chapter 30: Lower Respiratory Problems ................................................................................................................................. 223
Chapter 31: Obstructive Pulmonary Diseases ........................................................................................................................... 238
Chapter 32: Acute Respiratory Failure and Acute Respiratory Distress Syndrome Harding: Lewis’s Medical-Surgical Nursing,
12th Edition............................................................................................................................................................................... 251
first? ...................................................................................................................................................................................... 256
Chapter 33: Assessment: Hematologic System......................................................................................................................... 260
Chapter 34: Hematologic Problems .......................................................................................................................................... 265
Chapter 35: Assessment: Cardiovascular System Harding: Lewis’sMedical-Surgical Nursing, 12th Edition ........................... 280
Chapter 36: Hypertension ......................................................................................................................................................... 293
Chapter 38: Heart Failure.......................................................................................................................................................... 315
Chapter 39: Dysrhythmias ........................................................................................................................................................ 323
Chapter 40: Inflammatory and Structural Heart Disorders Harding: Lewis’s Medical-Surgical Nursing, 12th Edition .......... 333
, first? ...................................................................................................................................................................................... 343
Chapter 41: Vascular Disorders ................................................................................................................................................ 345
Chapter 43: Assessment: Gastrointestinal System Harding: Lewis’sMedical-Surgical Nursing, 12th Edition .......................... 368
Chapter 44: Nutrition Problems ................................................................................................................................................ 373
Chapter 45: Obesity .................................................................................................................................................................. 381
Chapter 46: Upper Gastrointestinal Problems .......................................................................................................................... 387
Chapter 47: Lower Gastrointestinal Problems .......................................................................................................................... 401
first? ...................................................................................................................................................................................... 412
Chapter 48: Liver, Biliary Tract, and Pancreas Problems Harding: Lewis’s Medical-Surgical Nursing, 12th Edition ............. 418
Chapter 49: Assessment: Urinary System ................................................................................................................................. 433
Chapter 50: Renal and Urologic Problems ............................................................................................................................... 440
Chapter 51: Acute Kidney Injury and Chronic Kidney Disease Harding: Lewis’s Medical-Surgical Nursing, 12th Edition .. 454
Chapter 52: Assessment: Endocrine System ............................................................................................................................. 466
Chapter 53: Diabetes ................................................................................................................................................................. 474
Chapter 54: Endocrine Problems .............................................................................................................................................. 489
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first? ...................................................................................................................................................................................... 499
Chapter 55: Assessment: Reproductive System Harding: Lewis’s Medical-Surgical Nursing, 12th Edition ............................ 504
first? ...................................................................................................................................................................................... 507
Chapter 56: Breast Problems .................................................................................................................................................... 508
Chapter 57: Sexually Transmitted Infections............................................................................................................................ 517
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Chapter 58: Female Reproductive Problems ............................................................................................................................ 524
Chapter 59: Male Reproductive Problems ................................................................................................................................ 538
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Chapter 60: Assessment: Nervous System................................................................................................................................ 549
Chapter 61: Acute Intracranial Problems .................................................................................................................................. 555
Chapter 62: Stroke .................................................................................................................................................................... 572
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Chapter 63: Chronic Neurologic Problems ............................................................................................................................... 582
Chapter 64: Dementia and Delirium ......................................................................................................................................... 593
Chapter 65: Spinal Cord and Peripheral Nerve Problems Harding: Lewis’s Medical-Surgical Nursing, 12th Edition ............ 601
Chapter 66: Assessment: Musculoskeletal System Harding: Lewis’sMedical-Surgical Nursing, 12th Edition ......................... 611
Chapter 68: Musculoskeletal Problems .................................................................................................................................... 630
Chapter 69: Arthritis and Connective Tissue Diseases Harding: Lewis’sMedical-Surgical Nursing, 12th Edition ................... 637
,Mariann M. Harding: Lewis’s Medical-Surgical Nursing, 12th Edition
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.
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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.”
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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
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patient preferences.”
ANS: D
Evidence-based practice (EBP) is the use of the best research-based evidence combined with
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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
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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: NursingProcess: Assessment MSC: NCLEX: Psychosocial Integrity
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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?
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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.
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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: NursingProcess: 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
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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
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to support the problem‘s existence should be included. Goals, outcomes, and interventions
are not included in the problem statement.
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DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Diagnosis
MSC: NCLEX: Safe and Effective Care Environment
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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.
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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.
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DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
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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.
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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
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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.
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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
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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 hospitalreceives
additional funding.”
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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).
