Harrison's Principles of Internal Medicine
(Vol.1 & Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo;
J. Larry Jameson
TEST BANK
Ch. 1 — The Practice of Medicine
Question Stem: A 68-year-old man with multimorbidity wants
aggressive curative therapy for an advanced cancer with low
probability of benefit and high risk of treatment-related harm.
As the admitting nurse, which action best demonstrates patient-
centered, evidence-informed practice?
A. Arrange immediate initiation of the recommended aggressive
therapy per oncology consult.
B. Facilitate a goals-of-care conversation exploring the patient’s
values and acceptable trade-offs.
C. Recommend deferring decision-making to the patient’s adult
,children to reduce conflict.
D. Document the oncologist’s recommendation as the plan
without further discussion.
Correct Answer: B
Rationales — Correct: Facilitating a goals-of-care discussion
aligns treatment with the patient’s values and balances
benefits/harms; it is core to patient-centered practice.
Rationales — A: Starting aggressive therapy without aligning
with patient goals risks nonbeneficial care and harms.
Rationales — C: Transferring decision authority to family
without assessing the patient’s capacity undermines autonomy.
Rationales — D: Solely documenting the specialist’s plan
without engaging the patient neglects shared decision-making
and quality standards.
Teaching Point: Shared goals-of-care conversations align
treatments with patient values.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 1.
Ch. 2 — Promoting Good Health
Question Stem: A community clinic aims to reduce uncontrolled
hypertension rates. Which clinic-level intervention is most likely
to produce sustained population benefit?
A. Distribute educational pamphlets on healthy eating to all
patients.
,B. Implement team-based care with nurse-led follow-up and
medication titration protocols.
C. Ask individual clinicians to include BP counseling during visits
without system changes.
D. Provide one-time community talks about hypertension risk
factors.
Correct Answer: B
Rationales — Correct: Team-based care with protocolized
follow-up and nurse-driven titration has strong evidence for
improving population BP control through system-level change.
Rationales — A: Pamphlets alone have limited long-term impact
without system supports.
Rationales — C: Reliance on individual clinicians without
workflow redesign is inconsistent and less effective.
Rationales — D: One-time talks increase awareness but rarely
change sustained clinical outcomes.
Teaching Point: System-level, protocolized team care yields
greater population health gains.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 2.
Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem: During a preoperative visit a patient expresses
strong distrust of vaccines and refuses influenza vaccination.
Which nursing approach most effectively addresses vaccine
, hesitancy?
A. Insist that vaccination is mandatory for surgery and refuse to
proceed.
B. Provide empathetic listening, explore specific concerns, and
offer tailored information addressing those concerns.
C. Present statistics showing vaccines are safe without engaging
concerns.
D. Dismiss the concerns as misinformation and redirect to
surgical consent.
Correct Answer: B
Rationales — Correct: Empathetic exploration and tailored
education respects autonomy and is more effective in reducing
hesitancy than confrontation.
Rationales — A: Coercion undermines trust and may be
ethically inappropriate; mandates require policy/legal basis.
Rationales — C: Raw statistics without engagement are less
persuasive for hesitant patients.
Rationales — D: Dismissing concerns damages the therapeutic
relationship and reduces acceptance.
Teaching Point: Address hesitancy with empathy and tailored,
patient-specific information.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 3.
(Vol.1 & Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo;
J. Larry Jameson
TEST BANK
Ch. 1 — The Practice of Medicine
Question Stem: A 68-year-old man with multimorbidity wants
aggressive curative therapy for an advanced cancer with low
probability of benefit and high risk of treatment-related harm.
As the admitting nurse, which action best demonstrates patient-
centered, evidence-informed practice?
A. Arrange immediate initiation of the recommended aggressive
therapy per oncology consult.
B. Facilitate a goals-of-care conversation exploring the patient’s
values and acceptable trade-offs.
C. Recommend deferring decision-making to the patient’s adult
,children to reduce conflict.
D. Document the oncologist’s recommendation as the plan
without further discussion.
Correct Answer: B
Rationales — Correct: Facilitating a goals-of-care discussion
aligns treatment with the patient’s values and balances
benefits/harms; it is core to patient-centered practice.
Rationales — A: Starting aggressive therapy without aligning
with patient goals risks nonbeneficial care and harms.
Rationales — C: Transferring decision authority to family
without assessing the patient’s capacity undermines autonomy.
Rationales — D: Solely documenting the specialist’s plan
without engaging the patient neglects shared decision-making
and quality standards.
Teaching Point: Shared goals-of-care conversations align
treatments with patient values.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 1.
Ch. 2 — Promoting Good Health
Question Stem: A community clinic aims to reduce uncontrolled
hypertension rates. Which clinic-level intervention is most likely
to produce sustained population benefit?
A. Distribute educational pamphlets on healthy eating to all
patients.
,B. Implement team-based care with nurse-led follow-up and
medication titration protocols.
C. Ask individual clinicians to include BP counseling during visits
without system changes.
D. Provide one-time community talks about hypertension risk
factors.
Correct Answer: B
Rationales — Correct: Team-based care with protocolized
follow-up and nurse-driven titration has strong evidence for
improving population BP control through system-level change.
Rationales — A: Pamphlets alone have limited long-term impact
without system supports.
Rationales — C: Reliance on individual clinicians without
workflow redesign is inconsistent and less effective.
Rationales — D: One-time talks increase awareness but rarely
change sustained clinical outcomes.
Teaching Point: System-level, protocolized team care yields
greater population health gains.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 2.
Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem: During a preoperative visit a patient expresses
strong distrust of vaccines and refuses influenza vaccination.
Which nursing approach most effectively addresses vaccine
, hesitancy?
A. Insist that vaccination is mandatory for surgery and refuse to
proceed.
B. Provide empathetic listening, explore specific concerns, and
offer tailored information addressing those concerns.
C. Present statistics showing vaccines are safe without engaging
concerns.
D. Dismiss the concerns as misinformation and redirect to
surgical consent.
Correct Answer: B
Rationales — Correct: Empathetic exploration and tailored
education respects autonomy and is more effective in reducing
hesitancy than confrontation.
Rationales — A: Coercion undermines trust and may be
ethically inappropriate; mandates require policy/legal basis.
Rationales — C: Raw statistics without engagement are less
persuasive for hesitant patients.
Rationales — D: Dismissing concerns damages the therapeutic
relationship and reduces acceptance.
Teaching Point: Address hesitancy with empathy and tailored,
patient-specific information.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 3.
