LEWIS'S MEDICAL-SURGICAL NURSING
ASSESSMENT AND MANAGEMENT OF
CLINICAL PROBLEMS, SINGLE VOLUME
12TH EDITION
• AUTHOR(S)MARIANN M. HARDING;
JEFFREY KWONG; DEBRA HAGLER;
COURTNEY REINISCH
TEST BANK
1
Reference: Ch. 1 — Professional Nursing — Standards of
Professional Nursing Practice
Stem: A newly graduated RN is orienting to the med-surg unit
and is asked to perform a focused respiratory assessment on a
patient with dyspnea. Which action best demonstrates
adherence to the Standards of Professional Nursing Practice?
A. Begin oxygen therapy at 4 L/min via nasal cannula without a
provider order.
,B. Perform a focused respiratory assessment and document
findings before notifying the provider.
C. Delegate the respiratory assessment to a nursing assistant to
save time.
D. Start a nebulizer treatment based on prior shift notes
without reassessing the patient.
Correct Answer: B
Rationale — Correct: Performing and documenting a focused
respiratory assessment before contacting the provider follows
the nursing practice standard of assessment and clinical
judgment. It ensures accurate data collection drives subsequent
interventions.
Rationale — Incorrect:
A. Initiating oxygen without an order is outside scope and not
consistent with standards unless emergency protocol applies.
C. Delegation to an assistant is inappropriate for assessment
requiring RN clinical judgment.
D. Starting a treatment without reassessment risks delivering
inappropriate therapy and violates standards.
Teaching Point: Always assess and document before initiating
provider-level interventions.
Citation: Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C.
(2023). Lewis’s Medical-Surgical Nursing (12th Ed.). Ch. 1.
2
,Reference: Ch. 1 — Professional Nursing — Scope of Nursing
Practice
Stem: A nurse manager reviews a new hire’s job description
that includes medication titration. The new graduate questions
whether titrating a vasoactive infusion is appropriate. Based on
Scope of Nursing Practice, what is the nurse manager’s best
response?
A. “All RNs can titrate vasoactive meds—no extra training is
needed.”
B. “Titration requires unit-specific competency and an order
with explicit parameters.”
C. “You should refuse—titration is only for advanced practice
nurses.”
D. “Only the provider may change infusion rates; you must call
them each time.”
Correct Answer: B
Rationale — Correct: Scope of practice permits titration if the
RN has demonstrated competency and follows provider orders
with clear parameters; this balances safety and autonomy.
Rationale — Incorrect:
A. Incorrect — not all RNs can safely titrate without competency
validation.
C. Incorrect — RNs may perform titration under defined
protocols and competency.
D. Incorrect — requiring provider presence for every small
titration is impractical and not consistent with delegated RN
responsibilities when protocols exist.
, Teaching Point: Titration requires verified competency and
clear provider parameters.
Citation: Harding et al. (2023). Ch. 1.
3
Reference: Ch. 1 — Professional Nursing — Nursing Core
Competencies — Patient-Centered Care
Stem: An older adult with limited English proficiency arrives for
discharge. Which action best exemplifies patient-centered care
competency?
A. Handing the patient a generic discharge brochure in English.
B. Using a professional medical interpreter to explain the
discharge plan and confirm understanding.
C. Asking a bilingual family member to interpret complex
discharge instructions.
D. Telling the patient to call the clinic if anything goes wrong.
Correct Answer: B
Rationale — Correct: Using a professional interpreter ensures
accurate communication and confirms patient understanding,
aligning with patient-centered competence and safety.
Rationale — Incorrect:
A. A brochure alone doesn't ensure comprehension.
C. Family members may introduce errors or withhold
information; professional interpreters protect privacy and
accuracy.
D. Defers responsibility and fails to ensure safe discharge
ASSESSMENT AND MANAGEMENT OF
CLINICAL PROBLEMS, SINGLE VOLUME
12TH EDITION
• AUTHOR(S)MARIANN M. HARDING;
JEFFREY KWONG; DEBRA HAGLER;
COURTNEY REINISCH
TEST BANK
1
Reference: Ch. 1 — Professional Nursing — Standards of
Professional Nursing Practice
Stem: A newly graduated RN is orienting to the med-surg unit
and is asked to perform a focused respiratory assessment on a
patient with dyspnea. Which action best demonstrates
adherence to the Standards of Professional Nursing Practice?
A. Begin oxygen therapy at 4 L/min via nasal cannula without a
provider order.
,B. Perform a focused respiratory assessment and document
findings before notifying the provider.
C. Delegate the respiratory assessment to a nursing assistant to
save time.
D. Start a nebulizer treatment based on prior shift notes
without reassessing the patient.
Correct Answer: B
Rationale — Correct: Performing and documenting a focused
respiratory assessment before contacting the provider follows
the nursing practice standard of assessment and clinical
judgment. It ensures accurate data collection drives subsequent
interventions.
Rationale — Incorrect:
A. Initiating oxygen without an order is outside scope and not
consistent with standards unless emergency protocol applies.
C. Delegation to an assistant is inappropriate for assessment
requiring RN clinical judgment.
D. Starting a treatment without reassessment risks delivering
inappropriate therapy and violates standards.
Teaching Point: Always assess and document before initiating
provider-level interventions.
Citation: Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C.
(2023). Lewis’s Medical-Surgical Nursing (12th Ed.). Ch. 1.
2
,Reference: Ch. 1 — Professional Nursing — Scope of Nursing
Practice
Stem: A nurse manager reviews a new hire’s job description
that includes medication titration. The new graduate questions
whether titrating a vasoactive infusion is appropriate. Based on
Scope of Nursing Practice, what is the nurse manager’s best
response?
A. “All RNs can titrate vasoactive meds—no extra training is
needed.”
B. “Titration requires unit-specific competency and an order
with explicit parameters.”
C. “You should refuse—titration is only for advanced practice
nurses.”
D. “Only the provider may change infusion rates; you must call
them each time.”
Correct Answer: B
Rationale — Correct: Scope of practice permits titration if the
RN has demonstrated competency and follows provider orders
with clear parameters; this balances safety and autonomy.
Rationale — Incorrect:
A. Incorrect — not all RNs can safely titrate without competency
validation.
C. Incorrect — RNs may perform titration under defined
protocols and competency.
D. Incorrect — requiring provider presence for every small
titration is impractical and not consistent with delegated RN
responsibilities when protocols exist.
, Teaching Point: Titration requires verified competency and
clear provider parameters.
Citation: Harding et al. (2023). Ch. 1.
3
Reference: Ch. 1 — Professional Nursing — Nursing Core
Competencies — Patient-Centered Care
Stem: An older adult with limited English proficiency arrives for
discharge. Which action best exemplifies patient-centered care
competency?
A. Handing the patient a generic discharge brochure in English.
B. Using a professional medical interpreter to explain the
discharge plan and confirm understanding.
C. Asking a bilingual family member to interpret complex
discharge instructions.
D. Telling the patient to call the clinic if anything goes wrong.
Correct Answer: B
Rationale — Correct: Using a professional interpreter ensures
accurate communication and confirms patient understanding,
aligning with patient-centered competence and safety.
Rationale — Incorrect:
A. A brochure alone doesn't ensure comprehension.
C. Family members may introduce errors or withhold
information; professional interpreters protect privacy and
accuracy.
D. Defers responsibility and fails to ensure safe discharge
