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Medical-Surgical Nursing in Canada 5th Edition Lewi Test Bank
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Chapter 01: Introduction to Medical-
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Surgical Nursing Practice in Canada Lewis: Medical-
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Surgical Nursing in Canada, 5th Canadian Edition
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MULTIPLE CHOICE u/




1. When caring for clients using evidence-
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informed practice, which of the following does the nurse use?
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a. Clinical judgement based on experience u/ u/ u/ u/


b. Evidence from a clinical research study u/ u/ u/ u/ u/


c. The best available evidence to guide clinical expertise
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d. Evaluation of data showing that the client outcomes are met u/ u/ u/ u/ u/ u/ u/ u/ u/




ANS: C u /


Evidence-
informed nursing practice is a continuous interactive process involving the explicit, conscienti
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ous, and judicious consideration of the best available evidence to provide care. Four primary el
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ements are: (a) clinical state, setting, and circumstances; (b) client preferences and actions; (c
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) best research evidence; and (d) health care resources. Clinical judgement based on the nurse‘s
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clinical experience is part of EIP, but clinical decision making also should incorporate curren
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t research and research-
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based guidelines. Evidence from one clinical research study does not provide an adequate sub
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stantiation for interventions. Evaluation of client outcomes is important, but interventions sho
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uld be based on research from randomized control studies with a large number of subjects.
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DIF: Cognitive Level: Comprehension u/ u/ TOP: Nursing Process: Planning
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2. Which of the following best expl a ins the nu r s e s ‘ primary use of the nursing process when p
N R I G B . C M
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roviding care to clients? u/ u/ u/
USNT u/ u/ u/ O
a. To explain nursing interventions to other health care professionals
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b. As a problem-solving tool to identify and treat clients‘ health care needs
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c. As a scientific-based process of diagnosing the client‘s health care problems
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d. To establish nursing theory that incorporates the biopsychosocial nature of humans
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ANS: B u /


The nursing process is an assertive problem-
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solving approach to the identification and treatment of clients‘ problems. Diagnosis is only o
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ne phase of the nursing process. The primary use of the nursing process is in client care, not to
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establish nursing theory or explain nursing interventions to other health care professionals.
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DIF: Cognitive Level: Comprehension u/ u/ TOP: Nursing Process: Implementation
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3. The nurse is caring for a critically ill client in the intensive care unit and plans an every 2-
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hour turning schedule to prevent skin breakdown. Which type of nursing function is demonst
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rated with this turning schedule?
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a. Dependent
b. Cooperative
c. Independent
d. Collaborative
ANS: D u /




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When implementing collaborative nursing actions, the nurse is responsible primarily for monit
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oring for complications of acute illness or providing care to prevent or treat complications. In
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dependent nursing actions are focused on health promotion, illness prevention, and client adv
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ocacy. A dependent action would require a physician order to implement. Cooperative nursin
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g functions are not described as one of the formal nursing functions.
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DIF: Cognitive Level: Application u/ u/ TOP: Nursing Process: Implementation
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4. The nurse is caring for a client who has been admitted to the hospital for surgery and tells the
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nurse, ―I do not feel right about leaving my children with my neighbour.‖ Which action sh
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ould the nurse take next? u/ u/ u/ u/


a. Reassure the client that these feelings are common for parents. u/ u/ u/ u/ u/ u/ u/ u/ u/


b. Have the client call the children to ensure that they are doing well.
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c. Call the neighbour to determine whether adequate childcare is being provided.
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d. Gather more data about the client‘s feelings about the childcare arrangements.
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ANS: D u /


Since a complete assessment is necessary in order to identify a problem and choose an appro
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priate intervention, the nurse‘s first action should be to obtain more information. The other ac
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tions may be appropriate, but more assessment is needed before the best intervention can be ch
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osen.

DIF: Cognitive Level: Application u/ u/ TOP: Nursing Process: Assessment
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5. The nurse is caring for a client who has left-
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sided paralysis as the result of a stroke and assesses a pressure injury on the clie nt‘s lef
N Ris theImostG appropriate
B.C Mnursing diagnosis f Uo r t Sh is cNlienT
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t h ip . Which of the following
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t? u/ O
a. Impaired physical mobility related to decrease in muscle control (left-sided u/ u/ u/ u/ u/ u/ u/ u/ u/


paralysis)
b. Risk for impaired tissue integrity as evidenced by insufficient knowledge about
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protecting tissue integrity u/ u/


c. Impaired skin integrity related to pressure over bony prominence (impaired u/ u/ u/ u/ u/ u/ u/ u/ u/ u/


circulation)
d. Ineffective tissue perfusion related to sedentary lifestyle u/ u/ u/ u/ u/ u/




ANS: C u /


The client‘s major problem is the impaired skin integrity as demonstrated by the presence of a
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pressure injury. The nurse is able to treat the cause of altered circulation and pressure by freq
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uently repositioning the client. Although left-
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sided weakness is a problem for the client, the nurse cannot treat the weakness. The ―risk for‖
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diagnosis is not appropriate for this client, who already has impaired tissue integrity. The clien
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t does have ineffective tissue perfusion, but the impaired skin integrity diagnosis indicates mo
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re clearly what the health problem is.
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DIF: Cognitive Level: Application u/ u/ TOP: Nursing Process: Diagnosisu / u/ u/




6. The nurse caring for a client with an infection has a nursing diagnosis of deficient fluid
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volume related to excessive diaphoresis. Which of the following is an appropriate client
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outcome?
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a. Client has a balanced intake and output. u/ u/ u/ u/ u/ u/


b. Client‘s bedding is changed when it becomes damp. u/ u/ u/ u/ u/ u/ u/




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c. Client understands the need for increased fluid intake.
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d. Client‘s skin remains cool and dry throughout hospitalization.
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ANS: A u /


This statement gives measurable data showing resolution of the problem of deficient fluid vol
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ume that was identified in the nursing diagnosis statement. The other statements would not indi
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cate that the problem of deficient fluid volume was resolved.
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DIF: Cognitive Level: Application u/ u/ TOP: Nursing Process: Planning u / u/ u/




7. Which of the following represents a nursing activity that is carried out during the evaluation
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phase of the nursing process?
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a. Determining if interventions have been effective in meeting client outcomes u/ u/ u/ u/ u/ u/ u/ u/ u/


b. Documenting the nursing care plan in the progress notes in the medical record u/ u/ u/ u/ u/ u/ u/ u/ u/ u/ u/ u/


c. Deciding whether the client‘s health problems have been completely resolved
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d. Asking the client to evaluate whether the nursing care provided was satisfactory
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ANS: A u /


Evaluation consists of determining whether the desired client outcomes have been met and w
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hether the nursing interventions were appropriate. The other responses do not describe the eval
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uation phase. u/




DIF: Cognitive Level: Comprehension u/ u/ TOP: Nursing Process: Evaluation
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8. Which of the following would the nurse perform during the assessment phase of the nursing
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process?
a. Obtains data with which to diagnose client problems u/ u/ u/ u/ u/ u/ u/


b. Uses client data to develoNp p R
ri o riIt y nGursB
U S N T in.
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diagMnoses
c. Teaches interventions to relieve client health problems u/
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d. Assists the client to identify realistic outcomes to health problems
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ANS: A u /


During the assessment phase, the nurse gathers information about the client. The other respon
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ses are examples of the intervention, diagnosis, and planning phases of the nursing process.
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DIF: Cognitive Level: Knowledge u/ u/ TOP: Nursing Process: Assessment
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9. Which of the following is an example of a correctly written nursing diagnosis statement?
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a. Altered tissue perfusion related to heart failure u/ u/ u/ u/ u/ u/


b. Risk for impaired tissue integrity related to sacral redness
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c. Ineffective coping related to insufficient sense of control. u/ u/ u/ u/ u/ u/ u/


d. Altered urinary elimination related to urinary tract infection
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ANS: C u /


This diagnosis statement includes a NANDA nursing diagnosis and an etiology that describes
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a client‘s response to a health problem that can be treated by nursing. The use of a medical d
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iagnosis (as in the responses beginning ―Altered tissue perfusion‖ and ―Altered urinary elim
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ination‖) is not appropriate. The response beginning ―Risk for impaired tissue integrity‖ uses
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the defining characteristics as the etiology.
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DIF: Cognitive Level: Comprehension u/ u/ TOP: Nursing Process: Diagnosisu / u/ u/





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