Lewis Medical Surgical Nursing in Canada 4th Edition Authored by
Lewis, Dirksen, Heitkemper, Bucher, Barry, Goldsworthy, Lok, Tyerman
LATEST VERSION with verified answers Chapters 1-56
,Table of Contents
CHAPTER ONE: INTRODUCTION ....................................................................................................................................... 4
CHAPTER 02: CULTURAL COMPETENCE AND HEALTH EQUITY IN NURSING CARE ........................................... 9
CHAPTER 03: HEALTH HISTORY AND PHYSICAL EXAMINATION........................................................................... 15
CHAPTER 04: PATIENT AND CAREGIVER TEACHING................................................................................................. 20
CHAPTER 05: CHRONIC ILLNESS ..................................................................................................................................... 27
CHAPTER 06: COMMUNITY-BASED NURSING AND HOME CARE ............................................................................ 32
CHAPTER 07: OLDER ADULTS.......................................................................................................................................... 36
CHAPTER 10: PAIN .............................................................................................................................................................. 51
CHAPTER 11: SUBSTANCE USE ........................................................................................................................................ 60
CHAPTER 12: COMPLEMENTARY AND ALTERNATIVE THERAPIES ........................................................................ 67
CHAPTER 14: INFLAMMATION AND WOUND HEALING ............................................................................................ 77
CHAPTER 15: GENETICS .................................................................................................................................................... 84
CHAPTER 16: ALTERED IMMUNE RESPONSE AND TRANSPLANTATION ............................................................. 88
CHAPTER 17: INFECTION AND HUMAN IMMUNODEFICIENCY VIRUS INFECTION ............................................ 97
CHAPTER 18: CANCER ..................................................................................................................................................... 104
CHAPTER 19: FLUID, ELECTROLYTE, AND ACID–BASE IMBALANCES ................................................................ 118
CHAPTER 20: NURSING MANAGEMENT: PREOPERATIVE CARE............................................................................ 129
CHAPTER 21: NURSING MANAGEMENT: INTRAOPERATIVE CARE....................................................................... 137
CHAPTER 22: NURSING MANAGEMENT: POSTOPERATIVE CARE ..................................................................... 143
CHAPTER 23: NURSING ASSESSMENT: VISUAL AND AUDITORY SYSTEMS ............................................... 151
CHAPTER 24: NURSING MANAGEMENT: VISUAL AND AUDITORY PROBLEMS................................................ 159
CHAPTER 25: NURSING ASSESSMENT: INTEGUMENTARY SYSTEM ................................................................ 172
CHAPTER 26: NURSING MANAGEMENT: INTEGUMENTARY PROBLEMS .................................................... 176
CHAPTER 27: NURSING MANAGEMENT: BURNS ....................................................................................................... 184
CHAPTER 28: NURSING ASSESSMENT: RESPIRATORY SYSTEM ............................................................................ 194
Chapter 29: NURSING MANAGEMENT: UPPER RESPIRATORY PROBLEMS .......................................................... 201
CHAPTER 30: NURSING MANAGEMENT: LOWER RESPIRATORY PROBLEMS ............................................ 209
CHAPTER 31: NURSING MANAGEMENT: OBSTRUCTIVE PULMONARY DISEASES .......................................... 224
CHAPTER 32: NURSING ASSESSMENT: HEMATOLOGICAL SYSTEM ..................................................................... 238
CHAPTER 33: NURSING MANAGEMENT: HEMATOLOGICAL PROBLEMS ........................................................... 243
CHAPTER 34: NURSING ASSESSMENT: CARDIOVASCULAR SYSTEM................................................................... 256
CHAPTER 35: NURSING MANAGEMENT: HYPERTENSION ...................................................................................... 262
CHAPTER 36: NURSING MANAGEMENT: CORONARY ARTERY DISEASE AND ACUTE CORONARY
SYNDROME ........................................................................................................................................................................ 270
CHAPTER 37: NURSING MANAGEMENT: HEART FAILURE ..................................................................................... 283
CHAPTER 38: NURSING MANAGEMENT: DYSRHYTHMIAS ..................................................................................... 291
CHAPTER 39: NURSING MANAGEMENT: INFLAMMATORY AND STRUCTURAL HEART DISORDERS.......... 301
CHAPTER 40: NURSING MANAGEMENT: VASCULAR DISORDERS ........................................................................ 311
CHAPTER 41: NURSING ASSESSMENT: GASTRO-INTESTINAL SYSTEM ............................................................... 321
CHAPTER 42: NURSING MANAGEMENT: NUTRITIONAL PROBLEMS .................................................................... 326
,CHAPTER 43: NURSING MANAGEMENT: OBESITY.................................................................................................... 334
CHAPTER 44: NURSING MANAGEMENT: UPPER GASTRO-INTESTINAL PROBLEMS ........................................ 341
Chapter 45: NURSING MANAGEMENT: LOWER GASTRO-INTESTINAL PROBLEMS............................................. 354
Chapter 46: NURSING MANAGEMENT: LIVER, PANCREAS, AND BILIARY TRACT PROBLEMS ....................... 370
Chapter 47: NURSING ASSESSMENT: URINARY SYSTEM ....................................................................................... 383
Chapter 48: NURSING MANAGEMENT: RENAL AND UROLOGIC PROBLEMS ...................................................... 390
Chapter 49: NURSING MANAGEMENT: ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE ............... 403
Chapter 50: NURSING ASSESSMENT: ENDOCRINE SYSTEM ...................................................................................... 415
Chapter 51: NURSING MANAGEMENT: ENDOCRINE PROBLEMS ............................................................................. 421
Chapter 52: NURSING MANAGEMENT: DIABETES MELLITUS .................................................................................. 434
Chapter 53: NURSING ASSESSMENT: REPRODUCTIVE SYSTEM .............................................................................. 447
Chapter 54: NURSING MANAGEMENT: BREAST DISORDERS.................................................................................... 452
Chapter 55: NURSING MANAGEMENT: SEXUALLY TRANSMITTED INFECTIONS ............................................... 461
Chapter 56: NURSING MANAGEMENT: FEMALE REPRODUCTIVE PROBLEMS Le ............................................... 467
, CHAPTER ONE: INTRODUCTION
QUESTION WITH MULTIPLE CHOICES:
1. The nurse is caring for a client with a new diagnosis of pneumonia and
explains to the client that together they will plan the client’s care and set
goals for discharge. The client asks, “How is that different from what the
doctor does?” Which response by the nurse is most appropriate?
a. “The role of the nurse is to administer medications and other treatments prescribed
by your doctor.”
b. “The nurse’s job is to help the doctor by collecting data and communicating when
there are problems.”
c. “Nurses perform many of the procedures done by physicians, but nurses are here in
the hospital for a longer time than doctors.”
d. “In addition to caring for you while you are sick, the nurses will assist you to
develop an individualized plan to maintain your health.”
CORRECT ANSWERS >>> D
Justification
This response is consistent with the Canadian Nurses Association (CNA) definition of nursing.
Registered nurses are self-regulated health care professionals who work autonomously and in
collaboration with others. RNs enable individuals, families, groups, communities and populations to
achieve their optimal level of health. RNs coordinate health care, deliver direct services, and support
clients in their self-care decisions and actions in situations of health, illness, injury, and disability in all
stages of life. The other responses describe some of the dependent and collaborative functions of the
nursing role but do not accurately describe the nurse’s role in the health care system.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
2. 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 ANSWERS >>> C
Justification
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.
Lewis, Dirksen, Heitkemper, Bucher, Barry, Goldsworthy, Lok, Tyerman
LATEST VERSION with verified answers Chapters 1-56
,Table of Contents
CHAPTER ONE: INTRODUCTION ....................................................................................................................................... 4
CHAPTER 02: CULTURAL COMPETENCE AND HEALTH EQUITY IN NURSING CARE ........................................... 9
CHAPTER 03: HEALTH HISTORY AND PHYSICAL EXAMINATION........................................................................... 15
CHAPTER 04: PATIENT AND CAREGIVER TEACHING................................................................................................. 20
CHAPTER 05: CHRONIC ILLNESS ..................................................................................................................................... 27
CHAPTER 06: COMMUNITY-BASED NURSING AND HOME CARE ............................................................................ 32
CHAPTER 07: OLDER ADULTS.......................................................................................................................................... 36
CHAPTER 10: PAIN .............................................................................................................................................................. 51
CHAPTER 11: SUBSTANCE USE ........................................................................................................................................ 60
CHAPTER 12: COMPLEMENTARY AND ALTERNATIVE THERAPIES ........................................................................ 67
CHAPTER 14: INFLAMMATION AND WOUND HEALING ............................................................................................ 77
CHAPTER 15: GENETICS .................................................................................................................................................... 84
CHAPTER 16: ALTERED IMMUNE RESPONSE AND TRANSPLANTATION ............................................................. 88
CHAPTER 17: INFECTION AND HUMAN IMMUNODEFICIENCY VIRUS INFECTION ............................................ 97
CHAPTER 18: CANCER ..................................................................................................................................................... 104
CHAPTER 19: FLUID, ELECTROLYTE, AND ACID–BASE IMBALANCES ................................................................ 118
CHAPTER 20: NURSING MANAGEMENT: PREOPERATIVE CARE............................................................................ 129
CHAPTER 21: NURSING MANAGEMENT: INTRAOPERATIVE CARE....................................................................... 137
CHAPTER 22: NURSING MANAGEMENT: POSTOPERATIVE CARE ..................................................................... 143
CHAPTER 23: NURSING ASSESSMENT: VISUAL AND AUDITORY SYSTEMS ............................................... 151
CHAPTER 24: NURSING MANAGEMENT: VISUAL AND AUDITORY PROBLEMS................................................ 159
CHAPTER 25: NURSING ASSESSMENT: INTEGUMENTARY SYSTEM ................................................................ 172
CHAPTER 26: NURSING MANAGEMENT: INTEGUMENTARY PROBLEMS .................................................... 176
CHAPTER 27: NURSING MANAGEMENT: BURNS ....................................................................................................... 184
CHAPTER 28: NURSING ASSESSMENT: RESPIRATORY SYSTEM ............................................................................ 194
Chapter 29: NURSING MANAGEMENT: UPPER RESPIRATORY PROBLEMS .......................................................... 201
CHAPTER 30: NURSING MANAGEMENT: LOWER RESPIRATORY PROBLEMS ............................................ 209
CHAPTER 31: NURSING MANAGEMENT: OBSTRUCTIVE PULMONARY DISEASES .......................................... 224
CHAPTER 32: NURSING ASSESSMENT: HEMATOLOGICAL SYSTEM ..................................................................... 238
CHAPTER 33: NURSING MANAGEMENT: HEMATOLOGICAL PROBLEMS ........................................................... 243
CHAPTER 34: NURSING ASSESSMENT: CARDIOVASCULAR SYSTEM................................................................... 256
CHAPTER 35: NURSING MANAGEMENT: HYPERTENSION ...................................................................................... 262
CHAPTER 36: NURSING MANAGEMENT: CORONARY ARTERY DISEASE AND ACUTE CORONARY
SYNDROME ........................................................................................................................................................................ 270
CHAPTER 37: NURSING MANAGEMENT: HEART FAILURE ..................................................................................... 283
CHAPTER 38: NURSING MANAGEMENT: DYSRHYTHMIAS ..................................................................................... 291
CHAPTER 39: NURSING MANAGEMENT: INFLAMMATORY AND STRUCTURAL HEART DISORDERS.......... 301
CHAPTER 40: NURSING MANAGEMENT: VASCULAR DISORDERS ........................................................................ 311
CHAPTER 41: NURSING ASSESSMENT: GASTRO-INTESTINAL SYSTEM ............................................................... 321
CHAPTER 42: NURSING MANAGEMENT: NUTRITIONAL PROBLEMS .................................................................... 326
,CHAPTER 43: NURSING MANAGEMENT: OBESITY.................................................................................................... 334
CHAPTER 44: NURSING MANAGEMENT: UPPER GASTRO-INTESTINAL PROBLEMS ........................................ 341
Chapter 45: NURSING MANAGEMENT: LOWER GASTRO-INTESTINAL PROBLEMS............................................. 354
Chapter 46: NURSING MANAGEMENT: LIVER, PANCREAS, AND BILIARY TRACT PROBLEMS ....................... 370
Chapter 47: NURSING ASSESSMENT: URINARY SYSTEM ....................................................................................... 383
Chapter 48: NURSING MANAGEMENT: RENAL AND UROLOGIC PROBLEMS ...................................................... 390
Chapter 49: NURSING MANAGEMENT: ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE ............... 403
Chapter 50: NURSING ASSESSMENT: ENDOCRINE SYSTEM ...................................................................................... 415
Chapter 51: NURSING MANAGEMENT: ENDOCRINE PROBLEMS ............................................................................. 421
Chapter 52: NURSING MANAGEMENT: DIABETES MELLITUS .................................................................................. 434
Chapter 53: NURSING ASSESSMENT: REPRODUCTIVE SYSTEM .............................................................................. 447
Chapter 54: NURSING MANAGEMENT: BREAST DISORDERS.................................................................................... 452
Chapter 55: NURSING MANAGEMENT: SEXUALLY TRANSMITTED INFECTIONS ............................................... 461
Chapter 56: NURSING MANAGEMENT: FEMALE REPRODUCTIVE PROBLEMS Le ............................................... 467
, CHAPTER ONE: INTRODUCTION
QUESTION WITH MULTIPLE CHOICES:
1. The nurse is caring for a client with a new diagnosis of pneumonia and
explains to the client that together they will plan the client’s care and set
goals for discharge. The client asks, “How is that different from what the
doctor does?” Which response by the nurse is most appropriate?
a. “The role of the nurse is to administer medications and other treatments prescribed
by your doctor.”
b. “The nurse’s job is to help the doctor by collecting data and communicating when
there are problems.”
c. “Nurses perform many of the procedures done by physicians, but nurses are here in
the hospital for a longer time than doctors.”
d. “In addition to caring for you while you are sick, the nurses will assist you to
develop an individualized plan to maintain your health.”
CORRECT ANSWERS >>> D
Justification
This response is consistent with the Canadian Nurses Association (CNA) definition of nursing.
Registered nurses are self-regulated health care professionals who work autonomously and in
collaboration with others. RNs enable individuals, families, groups, communities and populations to
achieve their optimal level of health. RNs coordinate health care, deliver direct services, and support
clients in their self-care decisions and actions in situations of health, illness, injury, and disability in all
stages of life. The other responses describe some of the dependent and collaborative functions of the
nursing role but do not accurately describe the nurse’s role in the health care system.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
2. 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 ANSWERS >>> C
Justification
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.
