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 new graduate RN is assigned a complex patient with
sepsis and must plan care. The RN notices the bedside aide
preparing an intervention outside their scope. Which action
should the RN take first?
A. Ask the aide to continue because the RN is busy with another
patient.
,B. Immediately intervene and perform the intervention
themself.
C. Stop the aide, clarify scope, and assign an appropriate task
within the aide’s competency.
D. Notify the nurse manager about the aide’s actions after the
shift.
Correct answer: C
Rationales — Correct (C): Stopping the aide and clarifying
scope aligns with standards of professional nursing practice and
the RN’s accountability for safe delegation. It prevents unsafe
practice and promotes patient safety while using delegation
appropriately. Using the NCSBN Clinical Judgment steps, the RN
recognizes unsafe activity, analyzes scope/competence, and
plans a corrective action.
Rationales — Incorrect:
A: Allowing the aide to continue is unsafe and abdicates RN
accountability.
B: Immediately performing the intervention may be
unnecessary if it can be safely delegated; first clarify and correct
delegation.
D: Waiting to report after the shift delays corrective action and
risks patient harm.
Teaching point: Nurses must clarify delegation and stop unsafe
tasks immediately.
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 — Nursing Core
Competencies: Patient-Centered Care
Stem: An RN is admitting an older adult who prefers traditional
remedies and limited pharmacotherapy. The provider orders a
new analgesic. What is the RN’s best initial action?
A. Administer the analgesic as ordered without discussion.
B. Refuse to give the medication due to the patient’s
preferences.
C. Explain the medication benefits/risks, elicit patient values,
and collaborate on the plan.
D. Tell the patient they must take the medication to be
discharged.
Correct answer: C
Rationales — Correct (C): Patient-centered care requires
eliciting patient values and informed decision-making. The RN
recognizes preferences (Recognize), analyzes options, and plans
an approach that balances evidence and patient goals. This
aligns with Lewis’s competency frameworks and
consent/education practices.
Rationales — Incorrect:
A: Administering without discussion ignores patient autonomy
and informed consent.
B: Refusing medication unilaterally neglects clinician
responsibilities to educate and collaborate.
D: Coercion is unethical and undermines therapeutic alliance
and shared decision-making.
, Teaching point: Elicit patient values and collaborate on care
decisions for safe, patient-centered care.
Citation: Harding et al. (2023). Ch. 1.
3
Reference: Ch. 1 — Professional Nursing — Clinical Judgment /
NCSBN-CJM
Stem: During shift report, a nurse hears a colleague describe a
postoperative patient with increasing confusion and shallow
respirations. Which step of the NCSBN Clinical Judgment Model
should the nurse perform immediately?
A. Plan — develop long-term discharge goals.
B. Recognize — identify current cues of deterioration.
C. Evaluate — determine if prior interventions worked.
D. Intervene — delegate routine tasks to assistive personnel.
Correct answer: B
Rationales — Correct (B): The initial CJM step is to recognize
relevant cues (new confusion and shallow respirations).
Recognizing urgent cues allows immediate analysis of possible
causes like hypoxia or analgesic effects. This directs rapid
assessment and prioritization for safety.
Rationales — Incorrect:
A: Planning is premature before recognizing and analyzing
current instability.
C: Evaluation presumes interventions were already done; first
identify the problem.
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 new graduate RN is assigned a complex patient with
sepsis and must plan care. The RN notices the bedside aide
preparing an intervention outside their scope. Which action
should the RN take first?
A. Ask the aide to continue because the RN is busy with another
patient.
,B. Immediately intervene and perform the intervention
themself.
C. Stop the aide, clarify scope, and assign an appropriate task
within the aide’s competency.
D. Notify the nurse manager about the aide’s actions after the
shift.
Correct answer: C
Rationales — Correct (C): Stopping the aide and clarifying
scope aligns with standards of professional nursing practice and
the RN’s accountability for safe delegation. It prevents unsafe
practice and promotes patient safety while using delegation
appropriately. Using the NCSBN Clinical Judgment steps, the RN
recognizes unsafe activity, analyzes scope/competence, and
plans a corrective action.
Rationales — Incorrect:
A: Allowing the aide to continue is unsafe and abdicates RN
accountability.
B: Immediately performing the intervention may be
unnecessary if it can be safely delegated; first clarify and correct
delegation.
D: Waiting to report after the shift delays corrective action and
risks patient harm.
Teaching point: Nurses must clarify delegation and stop unsafe
tasks immediately.
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 — Nursing Core
Competencies: Patient-Centered Care
Stem: An RN is admitting an older adult who prefers traditional
remedies and limited pharmacotherapy. The provider orders a
new analgesic. What is the RN’s best initial action?
A. Administer the analgesic as ordered without discussion.
B. Refuse to give the medication due to the patient’s
preferences.
C. Explain the medication benefits/risks, elicit patient values,
and collaborate on the plan.
D. Tell the patient they must take the medication to be
discharged.
Correct answer: C
Rationales — Correct (C): Patient-centered care requires
eliciting patient values and informed decision-making. The RN
recognizes preferences (Recognize), analyzes options, and plans
an approach that balances evidence and patient goals. This
aligns with Lewis’s competency frameworks and
consent/education practices.
Rationales — Incorrect:
A: Administering without discussion ignores patient autonomy
and informed consent.
B: Refusing medication unilaterally neglects clinician
responsibilities to educate and collaborate.
D: Coercion is unethical and undermines therapeutic alliance
and shared decision-making.
, Teaching point: Elicit patient values and collaborate on care
decisions for safe, patient-centered care.
Citation: Harding et al. (2023). Ch. 1.
3
Reference: Ch. 1 — Professional Nursing — Clinical Judgment /
NCSBN-CJM
Stem: During shift report, a nurse hears a colleague describe a
postoperative patient with increasing confusion and shallow
respirations. Which step of the NCSBN Clinical Judgment Model
should the nurse perform immediately?
A. Plan — develop long-term discharge goals.
B. Recognize — identify current cues of deterioration.
C. Evaluate — determine if prior interventions worked.
D. Intervene — delegate routine tasks to assistive personnel.
Correct answer: B
Rationales — Correct (B): The initial CJM step is to recognize
relevant cues (new confusion and shallow respirations).
Recognizing urgent cues allows immediate analysis of possible
causes like hypoxia or analgesic effects. This directs rapid
assessment and prioritization for safety.
Rationales — Incorrect:
A: Planning is premature before recognizing and analyzing
current instability.
C: Evaluation presumes interventions were already done; first
identify the problem.
