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
Q1
Reference: Ch. 1 — Professional Nursing Practice / Definitions
of Nursing
Stem: A 68-year-old postoperative patient has increasing
confusion, shallow respirations, and oxygen saturation 88% on
room air. As the RN overseeing care, which action best reflects
the professional nursing role and immediate priority?
A. Ask the nursing assistant to reposition the patient and report
back.
,B. Assess airway patency, apply supplemental oxygen, and
notify the surgeon.
C. Document the findings and reassess in 30 minutes.
D. Call the primary care provider for a medication review.
Correct answer: B
Rationale (correct): This action aligns with the professional
nursing role to prioritize immediate assessment and
intervention for compromised oxygenation (Recognize →
Analyze → Plan → Intervene → Evaluate). Applying oxygen and
assessing airway addresses the ABCs and prevents further
hypoxia while notifying the surgeon ensures timely escalation.
Lewis emphasizes nursing’s responsibility for rapid recognition
and initiation of life-saving measures.
Rationale (A): Delegating repositioning without the RN first
assessing airway/oxygenation delays critical intervention and
misapplies delegation principles.
Rationale (C): Waiting 30 minutes is unsafe for hypoxemia;
documentation alone ignores immediate clinical needs.
Rationale (D): Contacting the PCP delays urgent airway/oxygen
interventions; surgeon or rapid response is more appropriate.
Teaching point: Prioritize airway and oxygenation first; notify
appropriate surgical/rapid response team.
Citation: Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C.
(2023). Lewis’s Medical-Surgical Nursing (12th Ed.). Ch. 1.
Q2
,Reference: Ch. 1 — Domain of Nursing Practice / Scope of
Nursing Practice
Stem: A newly licensed RN questions whether to perform a
central line dressing change requested by a senior RN who is
assisting with multiple patients. The RN’s scope-of-practice
decision should be guided by what action?
A. Refuse because central line care is an advanced skill outside
RN scope.
B. Proceed only if institutional policy, competency validation,
and provider orders support it.
C. Ask the nursing assistant to perform the dressing change to
save time.
D. Complete it without documentation of competency because
the senior RN asked.
Correct answer: B
Rationale (correct): Scope and delegation require institutional
policies and demonstrated competency. Lewis states that RNs
must practice within their legal scope and obtain required
training/validation before advanced procedures. The RN follows
the Clinical Judgment Model by recognizing task demands,
analyzing competence, planning safe care, and intervening
within scope.
Rationale (A): Incorrect—central line care may be within RN
scope if competency and policy allow; blanket refusal is not
appropriate.
Rationale (C): Nursing assistants cannot perform sterile
dressing changes; this is unsafe delegation.
, Rationale (D): Performing advanced procedures without
competency documentation violates scope and legal/ethical
standards.
Teaching point: Perform procedures only when policy and
competency validation support RN practice.
Citation: Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C.
(2023). Lewis’s Medical-Surgical Nursing (12th Ed.). Ch. 1.
Q3
Reference: Ch. 1 — Standards of Professional Nursing Practice /
Nursing Core Competencies
Stem: An RN caring for a patient with sepsis notes the patient’s
urine output decreased to 10 mL/hr and blood pressure
dropped 20 mm Hg from baseline. Which nursing action best
meets professional standards and nursing core competencies?
A. Continue routine vital signs and notify the provider at the
next scheduled update.
B. Immediately implement sepsis bundle interventions and
activate rapid response per policy.
C. Increase oral fluid intake and observe for 4 hours.
D. Place the patient on strict intake/output and reassess in 2
hours.
Correct answer: B
Rationale (correct): Rapid deterioration with oliguria and
hypotension requires immediate evidence-based sepsis
interventions and escalation. Lewis emphasizes timely
ASSESSMENT AND MANAGEMENT OF
CLINICAL PROBLEMS, SINGLE VOLUME
12TH EDITION
• AUTHOR(S)MARIANN M. HARDING;
JEFFREY KWONG; DEBRA HAGLER;
COURTNEY REINISCH
TEST BANK
Q1
Reference: Ch. 1 — Professional Nursing Practice / Definitions
of Nursing
Stem: A 68-year-old postoperative patient has increasing
confusion, shallow respirations, and oxygen saturation 88% on
room air. As the RN overseeing care, which action best reflects
the professional nursing role and immediate priority?
A. Ask the nursing assistant to reposition the patient and report
back.
,B. Assess airway patency, apply supplemental oxygen, and
notify the surgeon.
C. Document the findings and reassess in 30 minutes.
D. Call the primary care provider for a medication review.
Correct answer: B
Rationale (correct): This action aligns with the professional
nursing role to prioritize immediate assessment and
intervention for compromised oxygenation (Recognize →
Analyze → Plan → Intervene → Evaluate). Applying oxygen and
assessing airway addresses the ABCs and prevents further
hypoxia while notifying the surgeon ensures timely escalation.
Lewis emphasizes nursing’s responsibility for rapid recognition
and initiation of life-saving measures.
Rationale (A): Delegating repositioning without the RN first
assessing airway/oxygenation delays critical intervention and
misapplies delegation principles.
Rationale (C): Waiting 30 minutes is unsafe for hypoxemia;
documentation alone ignores immediate clinical needs.
Rationale (D): Contacting the PCP delays urgent airway/oxygen
interventions; surgeon or rapid response is more appropriate.
Teaching point: Prioritize airway and oxygenation first; notify
appropriate surgical/rapid response team.
Citation: Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C.
(2023). Lewis’s Medical-Surgical Nursing (12th Ed.). Ch. 1.
Q2
,Reference: Ch. 1 — Domain of Nursing Practice / Scope of
Nursing Practice
Stem: A newly licensed RN questions whether to perform a
central line dressing change requested by a senior RN who is
assisting with multiple patients. The RN’s scope-of-practice
decision should be guided by what action?
A. Refuse because central line care is an advanced skill outside
RN scope.
B. Proceed only if institutional policy, competency validation,
and provider orders support it.
C. Ask the nursing assistant to perform the dressing change to
save time.
D. Complete it without documentation of competency because
the senior RN asked.
Correct answer: B
Rationale (correct): Scope and delegation require institutional
policies and demonstrated competency. Lewis states that RNs
must practice within their legal scope and obtain required
training/validation before advanced procedures. The RN follows
the Clinical Judgment Model by recognizing task demands,
analyzing competence, planning safe care, and intervening
within scope.
Rationale (A): Incorrect—central line care may be within RN
scope if competency and policy allow; blanket refusal is not
appropriate.
Rationale (C): Nursing assistants cannot perform sterile
dressing changes; this is unsafe delegation.
, Rationale (D): Performing advanced procedures without
competency documentation violates scope and legal/ethical
standards.
Teaching point: Perform procedures only when policy and
competency validation support RN practice.
Citation: Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C.
(2023). Lewis’s Medical-Surgical Nursing (12th Ed.). Ch. 1.
Q3
Reference: Ch. 1 — Standards of Professional Nursing Practice /
Nursing Core Competencies
Stem: An RN caring for a patient with sepsis notes the patient’s
urine output decreased to 10 mL/hr and blood pressure
dropped 20 mm Hg from baseline. Which nursing action best
meets professional standards and nursing core competencies?
A. Continue routine vital signs and notify the provider at the
next scheduled update.
B. Immediately implement sepsis bundle interventions and
activate rapid response per policy.
C. Increase oral fluid intake and observe for 4 hours.
D. Place the patient on strict intake/output and reassess in 2
hours.
Correct answer: B
Rationale (correct): Rapid deterioration with oliguria and
hypotension requires immediate evidence-based sepsis
interventions and escalation. Lewis emphasizes timely
