Test Bank Lewis Medical-Surgical Nursing:
Assessment and Management of Clinical Problems
12th Edition By Harding & Kwong
,Chapter 01: Professional Nursing
z z z
Harding: Lewis’s Medical-Surgical Nursing, 12th Edition
z z z z z
MULTIPLE zCHOICE
1. The znurse zcompletes zan zadmission zdatabase zand zexplains zthat zthe zplan zof zcare zand
discharge zgoals zwill zbe zdeveloped zwith zthe zpatient‘s zinput. zThe zpatient zasks, z“How zis zthis
z
different zfrom zwhat zthe zphysician zdoes?” zWhich zresponse zwould zthe znurse zprovide?
z
a. “The zrole zof zthe znurse zis zto zadminister zmedications zand zother ztreatments zprescribed
zby zyour zphysician.”
b. “In zaddition zto zcaring zfor zyou zwhile zyou zare zsick, zthe znurses zwill zhelp zyou zplan zto
zmaintain zyour zhealth.”
c. “The znurse‘s zjob zis zto zcollect zinformation zand zcommunicate zanyzproblems zthat
zoccur zto zthe zphysician.”
d. “Nurses zperform zmany zof zthe zsame zprocedures zas zthe zphysician, zbut znurses zare
zwith zthe zpatients zfor za zlonger ztime zthan zthe zphysician.”
ANS: z B
The zAmerican zNurses zAssociation z(ANA) zdefinition zof znursing zdescribes zthe zrole zof znurses zin
zpromoting zhealth. zThe zother zresponses zdescribe zdependent zand zcollaborative zfunctions zof
zthe znursing zrole zbut zdo znot zaccurately zdescribe zthe znurse‘s zunique zrole zin zthe zhealth zcare
zsystem.
DIF: z z Cognitive zLevel: zAnalyze z(Analysis)
TOP: z Nursing zProcess: zImplementation z z z MSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
2. Which zstatement zby zthe znurse zaccurately zdescribes zthe zuse zof zevidence-based zpractice z(EBP)?
a. “Patient zcare zis zbased zon zclinical zjudgment, zexperience, zand ztraditions.”
b. “Data zare zanalyzed zlater zto zshow zthat zthe zpatient zoutcomes zare zconsistently zmet.”
c. “Research zfrom zall zpublished zarticles zare zused zas za zguide zfor zplanning zpatient zcare.”
d. “Recommendations zare zbased zon zresearch, zclinical zexpertise, zand zpatient
preferences.”
z
ANS: z D
Evidence-based zpractice z(EBP) zis zthe zuse zof zthe zbest zresearch-based zevidence zcombined
zwith zclinician zexpertise zand zconsideration zof zpatient zpreferences. zClinical zjudgment zbased
zon zthe znurse‘s zclinical zexperience zis zpart zof zEBP, zbut zclinical zdecision zmaking zshould zalso
zincorporate zcurrent zresearch zand zresearch-based zguidelines. zEvaluation zof zpatient zoutcomes zis
zimportant, zbut zdata zanalysis zis znot zrequired zto zuse zEBP. zAll zpublished zarticles zdo znot
zprovide zresearch zevidence; zinterventions zshould zbe zbased zon zcredible zresearch, zpreferably
zrandomized zcontrolled zstudies zwith za zlarge znumber zof zsubjects.
DIF: Cognitive zLevel: zUnderstand z(Comprehension) TOP: z Nursing zProcess: zPlanning
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
3. Which zstatement zby zthe znurse zprovides za zclear zexplanation zof zthe znursing zprocess?
a. “The znursing zprocess zis za zresearch zmethod zof zdiagnosing zthe zpatient‘s zhealth zcare
z problems.”
b. “The znursing zprocess zis zused zprimarily zto zexplain znursing zinterventions zto zother
z health zcare zprofessionals.”
c. “The znursing zprocess zis za zproblem-solving ztool zused zto zidentify zand zmanage zthe
, patients‘ zhealth zcare zneeds.”
d. “The znursing zprocess zis zbased zon znursingztheoryzthat zincorporates zthe
z biopsychosocial znature zof zhumans.”
ANS: z C
The znursing zprocess zis za zproblem-solving zapproach zto zthe zidentification zand ztreatment zof
zpatients‘ zproblems. zNursing zprocess zdoes znot zrequire zresearch zmethods zfor zdiagnosis. zThe
zprimary zuse zof zthe znursing zprocess zis zin zpatient zcare, znot zto zestablish znursing ztheory zor
zexplain znursing zinterventions zto zother zhealth zcare zprofessionals.
DIF: Cognitive zLevel: zUnderstand z(Comprehension) TOP: zNursing zProcess: zEvaluation
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
4. A zpatient zadmitted zto zthe zhospital zfor zsurgery ztells zthe znurse, z“Izdo znot zfeel zcomfortable
leaving zmy zchildren zwith zmy zparents.” zWhich zaction zwould zthe znurse ztake znext?
z
a. Reassure zthe zpatient zthat zthese zfeelings zare zcommon zfor zparents.
b. Have zthe zpatient zcall zthe zchildren zto zensure zthat zthey zare zdoing zwell.
c. Gather zinformation zon zthe zpatient‘s zconcerns zabout zthe zchild zcare zarrangements.
d. Call zthe zpatient‘s zparents zto zdetermine zwhether zadequate zchild zcare zis zbeing
zprovided.
ANS: z C
Because za zcomplete zassessment zis znecessary zin zorder zto zidentify za zproblem zand zchoose zan
zappropriate zintervention, zthe znurse‘s zfirst zaction zshould zbe zto zobtain zmore zinformation. zThe
zother zactions zmay zbe zappropriate, zbut zmore zassessment zis zneeded zbefore zthe zbest zintervention
zcan zbe zchosen.
DIF: Cognitive zLevel: zAnalyze z(Analysis)
TOP: z Nursing zProcess: zAssessment MSC: z NCLEX: zPsychosocial zIntegrity
5. A zpatient zwith za zbacterial zinfection zis zhypovolemic zdue zto za zfever zand zexcessive
diaphoresis. zWhich zexpected zoutcome zwould zthe znurse zselect zfor zthis zpatient?
z
a. Patient zhas za zbalanced zintake zand zoutput.
b. Patient‘s zbedding zis zkept zclean zand zfree zof zmoisture.
c. Patient zunderstands zthe zneed zfor zincreased zfluid zintake.
d. Patient‘s zskin zremains zcool zand zdry zthroughout zhospitalization.
ANS: z A
Balanced zintake zand zoutput zgives zmeasurable zdata zshowing zresolution zof zthe zproblem zof
zdeficient zfluid zvolume. zThe zother zstatements zwould znot zindicate zthat zthe zproblem zof
zhypovolemia zwas zresolved.
DIF: Cognitive zLevel: zApply z(Application) TOP: z Nursing zProcess: zPlanning
zMSC: z NCLEX: zPhysiological zIntegrity
6. Which zstatement zdescribes zthe zpurpose zof zthe zevaluation zphase zof zthe znursing zprocess?
a. To zdocument zthe znursing zcare zplan zin zthe zprogress znotes zof zthe zhealth zrecord
b. To zdetermine zif zinterventions zhave zbeen zeffective zin zmeeting zpatient zoutcomes
c. To zdecide zwhether zthe zpatient‘s zhealth zproblems zhave zbeen zcompletely zresolved
d. To zestablish zif zthe zpatient zagrees zthat zthe znursing zcare zprovided zwas zsatisfactory
ANS: z B
, Evaluation zconsists zof zdetermining zwhether zthe zdesired zpatient zoutcomes zhave zbeen zmet
zand zwhether zthe znursing zinterventions zwere zappropriate. zThe zother zresponses zdo znot
zdescribe zthe zevaluation zphase.
DIF: z Cognitive zLevel: zUnderstand z(Comprehension) TOP: zNursing zProcess: zEvaluation
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
7. Which zstatement zdescribes zthe zpurpose zof zthe zassessment zphase zof zthe znursing zprocess?
a. To zteach zinterventions zthat zrelieve zhealth zproblems
b. To zuse zpatient zdata zto zevaluate zpatient zcare zoutcomes
c. To zobtain zdata zto zdiagnose zpatient zstrengths zand zproblems
d. To zhelp zthe zpatient zidentify zrealistic zoutcomes zfor zhealth zproblems
ANS: z C
During zthe zassessment zphase, zthe znurse zgathers zinformation zabout zthe zpatient zto zdiagnose
zpatient zstrengths zand zproblems. zThe zother zresponses zare zexamples zof zthe zplanning,
zintervention, zand zevaluation zphases zof zthe znursing zprocess.
DIF: Cognitive zLevel: zUnderstand z(Comprehension)
TOP: z Nursing zProcess: zAssessment MSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
8. When zdeveloping zthe zplan zof zcare, zwhich zcomponents zwould zthe znurse zinclude zin zthe zclinical
z problem zstatement?
a. The zproblem zand zthe zsuggested zpatient zgoals zor zoutcomes
b. The zproblem, zits zcauses, zand zthe zsigns zand zsymptoms zof zthe zproblem
c. The zproblem zwith zthe zpossible zetiology zand zthe zplanned zinterventions
d. The zproblem, zits zpathophysiology, zand zthe zexpected zoutcome
ANS: z B
When zwriting zclinical zproblems zor znursing zdiagnoses, zthe zsubjective zas zwell zas zobjective
zdata zto zsupport zthe zproblem‘s zexistence zshould zbe zincluded. zGoals, zoutcomes, zand
zinterventions zare znot zincluded zin zthe zproblem zstatement.
DIF: Cognitive zLevel: zUnderstand z(Comprehension) TOP: z Nursing zProcess: zDiagnosis
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
9. Which zpatient zcare ztask zwould zthe znurse zdelegate zto zexperienced zassistive zpersonnel z(AP)?
a. Instruct zthe zpatient zabout zthe zneed zto zalternate zactivity zand zrest.
b. Monitor zlevel zof zshortness zof zbreath zor zfatigue zafter zambulation.
c. Obtain zthe zpatient‘s zblood zpressure zand zpulse zrate zafter zambulation.
d. Determine zwhether zthe zpatient zis zready zto zincrease zthe zactivity zlevel.
ANS: z C
AP zeducation zincludes zaccurate zvital zsign zmeasurement. zAssessment zand zpatient zteaching
zrequire zregistered znurse zeducation zand zscope zof zpractice zand zcannot zbe zdelegated.
DIF: Cognitive zLevel: zApply z(Application) TOP: z Nursing zProcess: zPlanning
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
Assessment and Management of Clinical Problems
12th Edition By Harding & Kwong
,Chapter 01: Professional Nursing
z z z
Harding: Lewis’s Medical-Surgical Nursing, 12th Edition
z z z z z
MULTIPLE zCHOICE
1. The znurse zcompletes zan zadmission zdatabase zand zexplains zthat zthe zplan zof zcare zand
discharge zgoals zwill zbe zdeveloped zwith zthe zpatient‘s zinput. zThe zpatient zasks, z“How zis zthis
z
different zfrom zwhat zthe zphysician zdoes?” zWhich zresponse zwould zthe znurse zprovide?
z
a. “The zrole zof zthe znurse zis zto zadminister zmedications zand zother ztreatments zprescribed
zby zyour zphysician.”
b. “In zaddition zto zcaring zfor zyou zwhile zyou zare zsick, zthe znurses zwill zhelp zyou zplan zto
zmaintain zyour zhealth.”
c. “The znurse‘s zjob zis zto zcollect zinformation zand zcommunicate zanyzproblems zthat
zoccur zto zthe zphysician.”
d. “Nurses zperform zmany zof zthe zsame zprocedures zas zthe zphysician, zbut znurses zare
zwith zthe zpatients zfor za zlonger ztime zthan zthe zphysician.”
ANS: z B
The zAmerican zNurses zAssociation z(ANA) zdefinition zof znursing zdescribes zthe zrole zof znurses zin
zpromoting zhealth. zThe zother zresponses zdescribe zdependent zand zcollaborative zfunctions zof
zthe znursing zrole zbut zdo znot zaccurately zdescribe zthe znurse‘s zunique zrole zin zthe zhealth zcare
zsystem.
DIF: z z Cognitive zLevel: zAnalyze z(Analysis)
TOP: z Nursing zProcess: zImplementation z z z MSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
2. Which zstatement zby zthe znurse zaccurately zdescribes zthe zuse zof zevidence-based zpractice z(EBP)?
a. “Patient zcare zis zbased zon zclinical zjudgment, zexperience, zand ztraditions.”
b. “Data zare zanalyzed zlater zto zshow zthat zthe zpatient zoutcomes zare zconsistently zmet.”
c. “Research zfrom zall zpublished zarticles zare zused zas za zguide zfor zplanning zpatient zcare.”
d. “Recommendations zare zbased zon zresearch, zclinical zexpertise, zand zpatient
preferences.”
z
ANS: z D
Evidence-based zpractice z(EBP) zis zthe zuse zof zthe zbest zresearch-based zevidence zcombined
zwith zclinician zexpertise zand zconsideration zof zpatient zpreferences. zClinical zjudgment zbased
zon zthe znurse‘s zclinical zexperience zis zpart zof zEBP, zbut zclinical zdecision zmaking zshould zalso
zincorporate zcurrent zresearch zand zresearch-based zguidelines. zEvaluation zof zpatient zoutcomes zis
zimportant, zbut zdata zanalysis zis znot zrequired zto zuse zEBP. zAll zpublished zarticles zdo znot
zprovide zresearch zevidence; zinterventions zshould zbe zbased zon zcredible zresearch, zpreferably
zrandomized zcontrolled zstudies zwith za zlarge znumber zof zsubjects.
DIF: Cognitive zLevel: zUnderstand z(Comprehension) TOP: z Nursing zProcess: zPlanning
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
3. Which zstatement zby zthe znurse zprovides za zclear zexplanation zof zthe znursing zprocess?
a. “The znursing zprocess zis za zresearch zmethod zof zdiagnosing zthe zpatient‘s zhealth zcare
z problems.”
b. “The znursing zprocess zis zused zprimarily zto zexplain znursing zinterventions zto zother
z health zcare zprofessionals.”
c. “The znursing zprocess zis za zproblem-solving ztool zused zto zidentify zand zmanage zthe
, patients‘ zhealth zcare zneeds.”
d. “The znursing zprocess zis zbased zon znursingztheoryzthat zincorporates zthe
z biopsychosocial znature zof zhumans.”
ANS: z C
The znursing zprocess zis za zproblem-solving zapproach zto zthe zidentification zand ztreatment zof
zpatients‘ zproblems. zNursing zprocess zdoes znot zrequire zresearch zmethods zfor zdiagnosis. zThe
zprimary zuse zof zthe znursing zprocess zis zin zpatient zcare, znot zto zestablish znursing ztheory zor
zexplain znursing zinterventions zto zother zhealth zcare zprofessionals.
DIF: Cognitive zLevel: zUnderstand z(Comprehension) TOP: zNursing zProcess: zEvaluation
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
4. A zpatient zadmitted zto zthe zhospital zfor zsurgery ztells zthe znurse, z“Izdo znot zfeel zcomfortable
leaving zmy zchildren zwith zmy zparents.” zWhich zaction zwould zthe znurse ztake znext?
z
a. Reassure zthe zpatient zthat zthese zfeelings zare zcommon zfor zparents.
b. Have zthe zpatient zcall zthe zchildren zto zensure zthat zthey zare zdoing zwell.
c. Gather zinformation zon zthe zpatient‘s zconcerns zabout zthe zchild zcare zarrangements.
d. Call zthe zpatient‘s zparents zto zdetermine zwhether zadequate zchild zcare zis zbeing
zprovided.
ANS: z C
Because za zcomplete zassessment zis znecessary zin zorder zto zidentify za zproblem zand zchoose zan
zappropriate zintervention, zthe znurse‘s zfirst zaction zshould zbe zto zobtain zmore zinformation. zThe
zother zactions zmay zbe zappropriate, zbut zmore zassessment zis zneeded zbefore zthe zbest zintervention
zcan zbe zchosen.
DIF: Cognitive zLevel: zAnalyze z(Analysis)
TOP: z Nursing zProcess: zAssessment MSC: z NCLEX: zPsychosocial zIntegrity
5. A zpatient zwith za zbacterial zinfection zis zhypovolemic zdue zto za zfever zand zexcessive
diaphoresis. zWhich zexpected zoutcome zwould zthe znurse zselect zfor zthis zpatient?
z
a. Patient zhas za zbalanced zintake zand zoutput.
b. Patient‘s zbedding zis zkept zclean zand zfree zof zmoisture.
c. Patient zunderstands zthe zneed zfor zincreased zfluid zintake.
d. Patient‘s zskin zremains zcool zand zdry zthroughout zhospitalization.
ANS: z A
Balanced zintake zand zoutput zgives zmeasurable zdata zshowing zresolution zof zthe zproblem zof
zdeficient zfluid zvolume. zThe zother zstatements zwould znot zindicate zthat zthe zproblem zof
zhypovolemia zwas zresolved.
DIF: Cognitive zLevel: zApply z(Application) TOP: z Nursing zProcess: zPlanning
zMSC: z NCLEX: zPhysiological zIntegrity
6. Which zstatement zdescribes zthe zpurpose zof zthe zevaluation zphase zof zthe znursing zprocess?
a. To zdocument zthe znursing zcare zplan zin zthe zprogress znotes zof zthe zhealth zrecord
b. To zdetermine zif zinterventions zhave zbeen zeffective zin zmeeting zpatient zoutcomes
c. To zdecide zwhether zthe zpatient‘s zhealth zproblems zhave zbeen zcompletely zresolved
d. To zestablish zif zthe zpatient zagrees zthat zthe znursing zcare zprovided zwas zsatisfactory
ANS: z B
, Evaluation zconsists zof zdetermining zwhether zthe zdesired zpatient zoutcomes zhave zbeen zmet
zand zwhether zthe znursing zinterventions zwere zappropriate. zThe zother zresponses zdo znot
zdescribe zthe zevaluation zphase.
DIF: z Cognitive zLevel: zUnderstand z(Comprehension) TOP: zNursing zProcess: zEvaluation
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
7. Which zstatement zdescribes zthe zpurpose zof zthe zassessment zphase zof zthe znursing zprocess?
a. To zteach zinterventions zthat zrelieve zhealth zproblems
b. To zuse zpatient zdata zto zevaluate zpatient zcare zoutcomes
c. To zobtain zdata zto zdiagnose zpatient zstrengths zand zproblems
d. To zhelp zthe zpatient zidentify zrealistic zoutcomes zfor zhealth zproblems
ANS: z C
During zthe zassessment zphase, zthe znurse zgathers zinformation zabout zthe zpatient zto zdiagnose
zpatient zstrengths zand zproblems. zThe zother zresponses zare zexamples zof zthe zplanning,
zintervention, zand zevaluation zphases zof zthe znursing zprocess.
DIF: Cognitive zLevel: zUnderstand z(Comprehension)
TOP: z Nursing zProcess: zAssessment MSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
8. When zdeveloping zthe zplan zof zcare, zwhich zcomponents zwould zthe znurse zinclude zin zthe zclinical
z problem zstatement?
a. The zproblem zand zthe zsuggested zpatient zgoals zor zoutcomes
b. The zproblem, zits zcauses, zand zthe zsigns zand zsymptoms zof zthe zproblem
c. The zproblem zwith zthe zpossible zetiology zand zthe zplanned zinterventions
d. The zproblem, zits zpathophysiology, zand zthe zexpected zoutcome
ANS: z B
When zwriting zclinical zproblems zor znursing zdiagnoses, zthe zsubjective zas zwell zas zobjective
zdata zto zsupport zthe zproblem‘s zexistence zshould zbe zincluded. zGoals, zoutcomes, zand
zinterventions zare znot zincluded zin zthe zproblem zstatement.
DIF: Cognitive zLevel: zUnderstand z(Comprehension) TOP: z Nursing zProcess: zDiagnosis
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
9. Which zpatient zcare ztask zwould zthe znurse zdelegate zto zexperienced zassistive zpersonnel z(AP)?
a. Instruct zthe zpatient zabout zthe zneed zto zalternate zactivity zand zrest.
b. Monitor zlevel zof zshortness zof zbreath zor zfatigue zafter zambulation.
c. Obtain zthe zpatient‘s zblood zpressure zand zpulse zrate zafter zambulation.
d. Determine zwhether zthe zpatient zis zready zto zincrease zthe zactivity zlevel.
ANS: z C
AP zeducation zincludes zaccurate zvital zsign zmeasurement. zAssessment zand zpatient zteaching
zrequire zregistered znurse zeducation zand zscope zof zpractice zand zcannot zbe zdelegated.
DIF: Cognitive zLevel: zApply z(Application) TOP: z Nursing zProcess: zPlanning
zMSC: z NCLEX: zSafe zand zEffective zCare zEnvironment
