Lewis's Medical Surgical Nursing in Canada 5th Edition by Jane Tyerman and Shelley Cobbett Complete From Chapters 1-72.

TABLE OF CONTENTS 1 Introduction to Medical-Surgical Nursing Practice in Canada 2 Cultural Competence and Health Equity in Care 3 Health History and Physical Examination 4 Patient and Caregiver Teaching 5 Chronic Illness 6 Community-Based Nursing and Home Care 7 Older Adults 8 Stress and Stress Management 9 9 Sleep and Sleep Disorders 10 Pain 11 Substance Use 12 Complementary and Alternative Therapies 13 Palliative Care at the End of Life Section Two – Pathophysiological Mechanisms of Disease 14 Inflammation and Wound Healing 15 Genetics 16 Altered Immune Response and Transplantation 17 Infection and Human Immunodeficiency Virus Infection 18 Cancer 19 Fluid, Electrolyte, and Acid–Base Imbalances Section Three – Perioperative Care 20 Nursing Management: Preoperative Care 21 Nursing Management: Intraoperative Care 22 Nursing Management: Post-operative Care Section Four – Problems Related to Altered Sensory Input 23 Nursing Assessment: Visual and Auditory Systems 24 Nursing Management: Visual and Auditory Problems 25 Nursing Assessment: Integumentary System 26 Nursing Management: Integumentary Problems 27 Nursing Management: Burns Section Five – Problems of Oxygenation: Ventilation 28 Nursing Assessment: Respiratory System 29 Nursing Management: Upper Respiratory Problems 30 Nursing Management: Lower Respiratory Problems 31 Nursing Management: Obstructive Pulmonary Diseases Section Six – Problems of Oxygenation: Transport 32 Nursing Assessment: Hematological System 33 Nursing Management: Hematological Problems Section Seven – Problems of Oxygenation: Perfusion 34 Nursing Assessment: Cardiovascular System 35 Nursing Management: Hypertension 36 Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome 37 Nursing Management: Heart Failure 38 Nursing Management: Dysrhythmias 39 Nursing Management: Inflammatory and Structural Heart Diseases 40 Nursing Management: Vascular Disorders Section Eight – Problems of Ingestion, Digestion, Absorption, and Elimination 41 Nursing Assessment: Gastrointestinal System 42 Nursing Management: Nutritional Problems 43 Nursing Management: Obesity 44 Nursing Management: Upper Gastrointestinal Problems 45 Nursing Management: Lower Gastrointestinal Problems 46 Nursing Management: Liver, Pancreas, and Biliary Tract Problems Section Nine – Problems of Urinary Function 47 Nursing Assessment: Urinary System 48 Nursing Management: Renal and Urological Problems 49 Nursing Management: Acute Kidney Injury and Chronic Kidney Disease Section Ten – Problems Related to Regulatory and Reproductive Mechanisms 50 Nursing Assessment: Endocrine System 51 Nursing Management: Endocrine Problems 52 Nursing Management: Diabetes Mellitus 53 Nursing Assessment: Reproductive System 54 Nursing Management: Breast Disorders 55 Nursing Management: Sexually Transmitted Infections 56 Nursing Management: Female Reproductive Problems 57 Nursing Management: Male Reproductive Problems Section Eleven – Problems Related to Movement and Coordination 58 Nursing Assessment: Nervous System 59 Nursing Management: Acute Intracranial Problems 60 Nursing Management: Stroke 61 Nursing Management: Chronic Neurological Problems 62 Nursing Management: Delirium, Alzheimer’s Disease, and Other Dementias 63 Nursing Management: Peripheral Nerve and Spinal Cord Problems 64 Nursing Assessment: Musculoskeletal System 65 Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery 66 Nursing Management: Musculoskeletal Problems 67 Nursing Management: Arthritis and Connective Tissue Diseases Section Twelve – Nursing Care in Specialized Settings 68 Nursing Management: Critical Care Environment 69 Nursing Management: Shock, Systemic Inflammatory Response Syndrome, and Multiple-Organ Dysfunction Syndrome 70 Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome 71 Nursing Management: Emergency Care Situations 72 Emergency Management and Disaster Planning Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition MULTIPLE CHOICE 1. When caring for clients using evidence-informed practice, which of the following does the nurse use? a. Clinical judgement based on experience b. Evidence from a clinical research study c. The best available evidence to guide clinical expertise d. Evaluation of data showing that the client outcomes are met CORRECT ANSWER: C Evidence-informed nursing practice is a continuous interactive process involving the explicit, conscientious, and judicious consideration of the best available evidence to provide care. Four primary elements are: (a) clinical state, setting, and circumstances; (b) client preferences and actions; (c) best research evidence; and (d) health care resources. Clinical judgement based on the nurse’s clinical experience is part of EIP, but clinical decision making also should incorporate current research and research-based guidelines. Evidence from one clinical research study does not provide an adequate substantiation for interventions. Evaluation of client outcomes is important, but interventions should be based on research from randomized control studies with a large number of subjects. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning 2. Which of the following best Ne xp lRa in sIth eGn uBr se s. C’ prMimary use of the nursing process when providing care to clients? U S N T O a. To explain nursing interventions to other health care professionals b. As a problem-solving tool to identify and treat clients’ health care needs c. As a scientific-based process of diagnosing the client’s health care problems d. To establish nursing theory that incorporates the biopsychosocial nature of humans CORRECT ANSWER: B The nursing process is an assertive problem-solving approach to the identification and treatment of clients’ problems. Diagnosis is only one phase of the nursing process. The primary use of the nursing process is in client care, not to establish nursing theory or explain nursing interventions to other health care professionals. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation 3. The nurse is caring for a critically ill client in the intensive care unit and plans an every 2hour turning schedule to prevent skin breakdown. Which type of nursing function is demonstrated with this turning schedule? a. Dependent b. Cooperative c. Independent d. Collaborative CORRECT ANSWER: D When implementing collaborative nursing actions, the nurse is responsible primarily for monitoring for complications of acute illness or providing care to prevent or treat complications. Independent nursing actions are focused on health promotion, illness prevention, and client advocacy. A dependent action would require a physician order to implement. Cooperative nursing functions are not described as one of the formal nursing functions. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 4. The nurse is caring for a client who has been admitted to the hospital for surgery and tells the nurse, “I do not feel right about leaving my children with my neighbour.” Which action should the nurse take next? a. Reassure the client that these feelings are common for parents. b. Have the client call the children to ensure that they are doing well. c. Call the neighbour to determine whether adequate childcare is being provided. d. Gather more data about the client’s feelings about the childcare arrangements. CORRECT ANSWER: D Since 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: Application TOP: Nursing Process: Assessment 5. The nurse is caring for a client who has left-sided paralysis as the result of a stroke and assesses a pressure injury on the c lient ’ s le ft hip. W hich of the following is the N R I G B. C M most appropriate nursing diagnosis fUo r tSh is cNli e nTt ? O a. Impaired physical mobility related to decrease in muscle control (left-sided paralysis) b. Risk for impaired tissue integrity as evidenced by insufficient knowledge about protecting tissue integrity c. Impaired skin integrity related to pressure over bony prominence (impaired circulation) d. Ineffective tissue perfusion related to sedentary lifestyle CORRECT ANSWER: C The client’s major problem is the impaired skin integrity as demonstrated by the presence of a pressure injury. The nurse is able to treat the cause of altered circulation and pressure by frequently repositioning the client. Although left-sided weakness is a problem for the client, the nurse cannot treat the weakness. The “risk for” diagnosis is not appropriate for this client, who already has impaired tissue integrity. The client does have ineffective tissue perfusion, but the impaired skin integrity diagnosis indicates more clearly what the health problem is. DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis 6. The nurse caring for a client with an infection has a nursing diagnosis of deficient fluid volume related to excessive diaphoresis. Which of the following is an appropriate client outcome? a. Client has a balanced intake and output. b. Client’s bedding is changed when it becomes damp. c. Client understands the need for increased fluid intake. d. Client’s skin remains cool and dry throughout hospitalization. CORRECT ANSWER: A This statement gives measurable data showing resolution of the problem of deficient fluid volume that was identified in the nursing diagnosis statement. The other statements would not indicate that the problem of deficient fluid volume was resolved. DIF: Cognitive Level: Application TOP: Nursing Process: Planning 7. Which of the following represents a nursing activity that is carried out during the evaluation phase of the nursing process? a. Determining if interventions have been effective in meeting client outcomes b. Documenting the nursing care plan in the progress notes in the medical record c. Deciding whether the client’s health problems have been completely resolved d. Asking the client to evaluate whether the nursing care provided was satisfactory CORRECT ANSWER: A Evaluation consists of determining whether the desired client outcomes have been met and whether the nursing interventions were appropriate. The other responses do not describe the evaluation phase. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Evaluation 8. Which of the following would the nurse perform during the assessment phase of the nursing process? a. Obtains data with which to diagnose client problems b. Uses client data to develoNp p c. Teaches interventions to relieve client health problems U S N TRr io rIit y nGurs Bin.g CdiagMnoses d. Assists the client to identify realistic outcomes to health problems CORRECT ANSWER: A During the assessment phase, the nurse gathers information about the client. The other responses are examples of the intervention, diagnosis, and planning phases of the nursing process. DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment 9. Which of the following is an example of a correctly written nursing diagnosis statement? a. Altered tissue perfusion related to heart failure b. Risk for impaired tissue integrity related to sacral redness c. Ineffective coping related to insufficient sense of control. d. Altered urinary elimination related to urinary tract infection CORRECT ANSWER: C This diagnosis statement includes a NANDA nursing diagnosis and an etiology that describes a client’s response to a health problem that can be treated by nursing. The use of a medical diagnosis (as in the responses beginning “Altered tissue perfusion” and “Altered urinary elimination”) is not appropriate. The response beginning “Risk for impaired tissue integrity” uses the defining characteristics as the etiology. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Diagnosis 10. Which of the following includes the components required for a complete nursing diagnosis statement? a. A problem and the suggested client goals or outcomes b. A problem, its cause, and objective data that support the problem c. A problem with all its possible causes and the planned interventions d. A problem with its etiology and the signs and symptoms of the problem CORRECT ANSWER: D The PES format is used when writing nursing diagnoses. The subjective, as well as objective, data should be included in the defining characteristics. Interventions and outcomes are not included in the nursing diagnosis statement. DIF: Cognitive Level: Knowledge TOP: Nursing Process: Diagnosis 11. Which of the following refers to a situation that results in unintended harm to the client and is related to the care or services provided rather than the client’s medical condition? a. Negligence b. Adverse event c. Incident report d. Nonmaleficence CORRECT ANSWER: B An adverse event is an event that results in unintended harm to the client and is related to the care or services provided to the client rather than to the client’s underlying medical condition. DIF: Cognitive Level: Knowledge N 12. When using the Five Steps Uh RSINGTOP: Nursing Process: Evaluation T-B.COMpractice (EIP) Process, which of the of t e evidence informed flowing elements is the final step when constructing a clinical question? a. Comparison of interest b. Population of interest c. Outcome of interest d. Timeframe of interest CORRECT ANSWER: D The order of the nurse’s statements follows the PICOT format with the final step being the “T”, or timeframe of interest. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation Chapter 02: Cultural Competence and Health Equity in Nursing Care Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition MULTIPLE CHOICE 1. Which of the following terms refers to characteristics of a group whose members share a common social, cultural, linguistic, or religious heritage? a. Diversity b. Ethnicity c. Ethnocentrism d. Cultural imposition CORRECT ANSWER: B Ethnicity is the common social, cultural, linguistic, or religious heritage of a group of people. Diversity is a presence of persons with differences from the majority or dominant group that is assumed to be the norm. Ethnocentrism is a tendency of individuals to believe that their way of viewing and responding to the world is the most correct, natural, and superior one. Cultural imposition is imposition of one person's own cultural beliefs and practices, intentionally or unintentionally, on another person or group of people. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning 2. The nurse is caring for Indigenous clients in a community clinic setting. Which of the following would the nurse include when developing strategies to decrease health care disparities? a. Improve public transportaNtion b. Obtain low-cost medicationUs. R. S N T I G B.C M O c. Update equipment and supplies for the clinic. d. Educate staff about Indigenous health beliefs. CORRECT ANSWER: D Health care disparities are due to stereotyping, biases, and prejudice of health care providers; the nurse can decrease these through staff education. The other strategies also may be addressed by the nurse but will not impact health disparities. DIF: Cognitive Level: Application TOP: Nursing Process: Planning 3. A family member of an elderly Hispanic client admitted to the hospital tells the nurse that the client has traditional beliefs about health and illness. Which of the following actions is most appropriate for the nurse in this situation? a. Avoid asking any questions unless the client initiates conversation. b. Ask the client whether it is important that cultural healers are contacted. c. Explain the usual hospital routines for meal times, care, and family visits. d. Obtain further information about the client’s cultural beliefs from the daughter. CORRECT ANSWER: B Because the client has traditional health care beliefs, it is appropriate for the nurse to ask whether the client would like a visit from a cultural healer. Nurses ask key questions with regard to language, diet, religion, and acculturation and eliciting the client’s explanatory model of health and illness. There is no cultural reason for the nurse to avoid asking the client questions, and questions may be necessary to obtain necessary health information. The client (rather than the daughter) should be consulted about personal cultural beliefs. The hospital routines for meals, care, and visits should be adapted to the client’s preferences rather than expecting the client to adapt to the hospital schedule. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 4. When caring for an Indigenous client, which of the following actions is the best initial approach in relation to eye contact for the nurse to take? a. Avoid all eye contact with the client. b. Observe the client’s use of eye contact. c. Look directly at the client when interacting. d. Ask the family about the client’s cultural beliefs. CORRECT ANSWER: B Eye contact varies greatly among and within cultures so the nurses’ initial action is to assess the client’s use of eye contact. Although nurses are often taught to maintain direct eye contact, clients who are Asian, Arab, or Indigenous may avoid direct eye contact and consider direct eye contact disrespectful or aggressive. Looking directly at the client or avoiding eye contact may be appropriate, depending on the client’s individual cultural beliefs. The nurse should assess the client, rather than asking family members about the client’s beliefs. DIF: Cognitive Level: ApplicNationR I GU S N T T OBP :.CN ur sMOi ng Process: Implementation 5. A graduate nurse is assessing a newly admitted non–English-speaking Chinese client who complains of severe headaches. Which of the following actions by the graduate nurse would cause the charge nurse to intervene during this assessment interview? a. Sit down at the bedside. b. Palpate the client’s scalp. c. Call for a medical interpreter. d. Avoid eye contact with the client. CORRECT ANSWER: B Many people of Asian ethnicity believe that touching a person’s head is disrespectful; the nurse should always ask permission before touching any client’s head. The other actions are appropriate. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 6. The nurse is caring for a client who speaks a language different from the nurse’s language and there is no interpreter available. Which of the following actions is the most appropriate for the nurse to implement? a. Use specific medical terms in the Latin form. b. Talk loudly and slowly so that each word is clearly heard. c. Repeat important words so that the client recognizes their importance. d. Use simple gestures to demonstrate meaning while talking to the client. CORRECT ANSWER: D The use of gestures will enable some information to be communicated to the client. The other actions will not improve communication with the client. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation 7. According to the ABC(DE)s of cultural competence, awareness of and sensitivity to cultural values is in which of the following domains? a. Skills domain b. Affective domain c. Knowledge domain d. Behavioural domain CORRECT ANSWER: B The affective domain reflects an awareness of and sensitivity to cultural values, needs, and biases. The skills domain does not reflect an awareness of and sensitivity to cultural values, needs, and biases. There is no skills or knowledge domain; with ABC(DE) it is affective, behavioural, and cognitive domains as well as dynamics of difference and environment. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning 8. Which of the following actions represents the best example of culturally appropriate nursing care when caring for a newly admitted client? a. Have family members provide most of the client’s personal care. b. Maintain a personal space of at least 0.5 m when assessing the client. c. Ask permission before touching a client during the physical assessment. d. Consider the client’s ethnicity as the most important factor in planning care. CORR NURSINGTB.COM CT ANSWE R: C Many cultures consider it disrespectful to touch a client without asking permission, so asking a client for permission is always culturally appropriate. The other actions may be appropriate for some clients but are not appropriate across all cultural groups or for all individual clients. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation 9. While talking with the nursing supervisor, a staff nurse expresses frustration that an Indigenous client always has several family members at the bedside. Which of the following actions is the most appropriate action for the nursing supervisor in this situation? a. Remind the nurse that family support is important to this family and client. b. Have the nurse explain to the family that too many visitors will tire the client. c. Suggest that the nurse ask family members to leave the room during client care. d. Ask about the nurse’s personal beliefs about family support during hospitalization. CORRECT ANSWER: D The first step in providing culturally competent care is to understand one’s own beliefs and values related to health and health care. Asking the nurse about personal beliefs will help to achieve this step. Reminding the nurse that this cultural practice is important to the family and client will not decrease the nurse’s frustration. The remaining responses (suggest that the nurse ask family members to leave the room, and have the nurse explain to family that too many visitors will tire the client) are not culturally appropriate for this client. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 10. An elderly Asian Canadian client tells the nurse that she has lived in Canada for 50 years. The client speaks English but lives in a predominantly Asian neighbourhood. Which of the following actions is most appropriate for the nurse? a. Arrange to have a folk healer available when planning the client’s care. b. Ask the client about any special cultural beliefs or practices. c. Avoid making direct eye contact with the client during care. d. Involve the client’s oldest son in making health care decisions. CORRECT ANSWER: B Further assessment of the client’s health care preferences is needed before making further plans for culturally appropriate care. The other responses indicate stereotyping of the client, based on ethnicity, and would not be appropriate initial actions. DIF: Cognitive Level: Application TOP: Nursing Process: Planning