Harrison's Principles of Internal Medicine
(Vol.1 & Vol.2)
22nd Edition
• Author(s)Joseph Loscalzo; Anthony S.
Fauci; Dennis L. Kasper; Stephen Hauser;
Dan Longo; J. Larry Jameson
Test Bank
1. A nurse is educating a patient about primary prevention.
Which action by the nurse best exemplifies this concept?
A. Teaching a patient with diabetes how to perform foot care.
B. Ordering a mammogram for a 50-year-old patient.
C. Administering a seasonal influenza vaccine.
D. Prescribing physical therapy for a patient after a stroke.
Answer: C. Administering a seasonal influenza vaccine.
Rationale: Primary prevention aims to prevent disease before it
occurs. Immunization is a cornerstone of primary prevention, as
it prevents the initial development of a specific infectious
disease. Foot care for a diabetic patient is secondary prevention
(managing an existing condition to prevent complications),
screening mammograms are secondary prevention (early
,detection), and post-stroke rehab is tertiary prevention
(restoration and rehabilitation). (Harrison’s Principles of Internal
Medicine, 22nd ed., Chapter 2: Promoting Good Health)
2. A parent in a pediatric clinic expresses hesitancy about
childhood vaccines, stating, "I read online that they can cause
autism." What is the nurse's most appropriate initial
response?
A. Provide a detailed scientific rebuttal explaining the flaws in
the cited study.
B. Dismiss the concern and state that vaccines are mandatory
for school entry.
C. Acknowledge the parent's concern and ask what specific
information they have read.
D. Immediately schedule a consult with the physician to handle
the discussion.
Answer: C. Acknowledge the parent's concern and ask what
specific information they have read.
Rationale: Effective communication begins with building trust
and understanding the patient's or parent's specific fears and
information sources. Dismissing concerns or launching into a
complex scientific argument can increase defensiveness and
hesitancy. Engaging in a respectful, open dialogue is the first
step toward providing tailored, evidence-based education.
(Harrison’s Principles of Internal Medicine, 22nd ed., Chapter 3:
Vaccine Opposition and Hesitancy)
,3. When applying the principles of evidence-based medicine
(EBM) to plan care, a nurse understands that the correct
sequence integrates which of the following?
A. Clinical guidelines, patient preferences, and system
resources.
B. Best research evidence, clinical expertise, and patient values.
C. Pathophysiology, cost-effectiveness, and standard protocols.
D. Diagnostic test results, pharmacological data, and nurse
judgment.
Answer: B. Best research evidence, clinical expertise, and
patient values.
Rationale: EBM is explicitly defined as the conscientious
integration of the best available research evidence with
individual clinical expertise and patient values and preferences.
This triad ensures care is not only scientifically sound but also
tailored to the individual patient's context and desires.
(*Harrison’s Principles of Internal Medicine, 22nd ed., Chapter
4: Decision-Making in Clinical Medicine*)
4. A nurse is caring for a patient newly diagnosed with breast
cancer. The treatment plan involves a medication selected
based on the genetic profile of the tumor. This approach is
best described as:
A. Preventive medicine.
B. Personalized medicine.
C. Screening medicine.
D. Palliative medicine.
Answer: B. Personalized medicine.
,Rationale: Personalized (or precision) medicine uses
information about a person's genes, proteins, and environment
to prevent, diagnose, and treat disease. Selecting a cancer
therapy based on the specific genetic characteristics of the
patient's tumor, rather than a one-size-fits-all approach, is a key
example of this paradigm. (Harrison’s Principles of Internal
Medicine, 22nd ed., Chapter 5: Precision Medicine and Clinical
Care)
5. Which of the following screening tests is most appropriate
for a nurse to recommend to a general, asymptomatic adult
population based on established guidelines for effectiveness?
A. Annual chest X-ray for lung cancer.
B. Annual CA-125 blood test for ovarian cancer.
C. Colonoscopy every 10 years starting at age 45.
D. Whole-body CT scan for overall health.
Answer: C. Colonoscopy every 10 years starting at age 45.
Rationale: Screening tests must meet criteria of proven benefit,
including reducing mortality for the target condition.
Colonoscopy for colorectal cancer screening in average-risk
adults starting at age 45-50 is a well-established, evidence-
based recommendation. Chest X-rays for lung cancer in the
general population and CA-125 for ovarian cancer are not
recommended due to lack of mortality benefit and high false-
positive rates. Whole-body CT is not a recommended screening
tool. (Harrison’s Principles of Internal Medicine, 22nd ed.,
Chapter 6: Screening and Prevention of Disease)
,6. During a hand-off report, a nurse emphasizes the
importance of using two patient identifiers before
administering medication. This practice directly addresses
which primary aim of the National Quality Strategy?
A. Improving patient safety.
B. Promoting effective communication.
C. Making care affordable.
D. Engaging patients and families.
Answer: A. Improving patient safety.
Rationale: Using two patient identifiers is a foundational
patient safety practice designed to prevent errors, such as
wrong-patient medication administration. While it involves
communication, its primary and direct purpose is to enhance
safety by ensuring the right patient receives the right
intervention. (Harrison’s Principles of Internal Medicine, 22nd
ed., Chapter 7: The Safety and Quality of Health Care)
7. A nurse is preparing to discharge a patient with heart
failure. Which component of the physical examination
provides the most reliable, objective, and immediate data for
assessing the patient's volume status?
A. Measuring body weight.
B. Asking about shortness of breath.
C. Auscultating heart sounds.
D. Inspecting for jugular venous distension (JVD).
Answer: A. Measuring body weight.
Rationale: Daily weight is a critical, quantitative, and nurse-
driven component of the physical assessment for patients with
,heart failure. A rapid weight gain (e.g., 2-3 lbs in 24 hours) is a
key indicator of fluid retention and worsening failure, often
preceding subjective symptoms. JVD is also important but
requires more skill to assess reliably. (Harrison’s Principles of
Internal Medicine, 22nd ed., Chapter 8: The Value of the
Physical Examination in Modern Medicine)
8. A nurse manager notices a staff nurse making repeated
minor errors and appearing fatigued and withdrawn. The
manager suspects burnout. Which initial action by the
manager is most aligned with a systems approach to clinician
well-being?
A. Document the errors for potential disciplinary action.
B. Privately ask the nurse, "How are you coping with your
workload?"
C. Mandate the nurse to take a week of vacation immediately.
D. Refer the nurse to the employee assistance program (EAP).
Answer: B. Privately ask the nurse, "How are you coping with
your workload?"
Rationale: Burnout is recognized as a systems issue, not an
individual failing. The first, most supportive step is a non-
punitive, confidential conversation to express concern and open
a dialogue. This approach fosters trust and allows for
collaborative problem-solving about workload or other systemic
factors, rather than immediately assigning blame or a
mandatory solution. (*Harrison’s Principles of Internal
Medicine, 22nd ed., Chapter 9: Physician Well-Being*)
,9. A nurse reviews a patient's chart and notices a "pending"
lab result that would typically rule out a key differential
diagnosis. The physician is ready to discharge the patient.
What is the nurse's most appropriate action?
A. Carry out the discharge order as written by the physician.
B. Ask the unit clerk to call the lab for a stat result.
C. Politely alert the physician to the pending critical result
before discharge.
D. Inform the patient that discharge is delayed due to a lab
issue.
Answer: C. Politely alert the physician to the pending critical
result before discharge.
Rationale: This action embodies the nurse's critical role in
preventing diagnostic error by serving as a safety check within
the healthcare team. It respects the physician's authority while
ensuring all necessary information is considered in the
diagnostic reasoning process before a final disposition decision
is made. (Harrison’s Principles of Internal Medicine, 22nd ed.,
Chapter 10: Diagnosis: Reducing Errors and Improving Quality)
10. To provide culturally competent care and help reduce
health disparities, a nurse's priority action should be to:
A. Assume patients from minority groups have low health
literacy.
B. Use medical jargon to establish professional authority.
C. Recognize their own implicit biases and how they may affect
care.
D. Apply all clinical practice guidelines uniformly to every
,patient.
Answer: C. Recognize their own implicit biases and how they
may affect care.
Rationale: A foundational step in addressing disparities is for
healthcare providers to engage in self-reflection to become
aware of their own unconscious biases, stereotypes, and
assumptions that can negatively influence clinical decisions,
patient interactions, and trust. This introspection must precede
effective patient-centered communication and tailored care.
(Harrison’s Principles of Internal Medicine, 22nd ed., Chapter 11:
Racial and Ethnic Disparities in Health Care)
11. A competent, alert patient with metastatic cancer refuses
a recommended blood transfusion based on personal beliefs.
The nursing team disagrees with the decision. What is the
overriding ethical principle that must guide the nurses'
actions?
A. Beneficence (doing good).
B. Non-maleficence (avoiding harm).
C. Justice (fairness in care).
D. Respect for autonomy.
Answer: D. Respect for autonomy.
Rationale: For a competent adult patient, the ethical principle
of autonomy grants them the right to make informed decisions
about their own body and care, even if the healthcare team
believes the decision is unwise or will lead to a worse outcome.
The nurse's role is to ensure the patient is informed and then to
respect and uphold that choice. (Harrison’s Principles of Internal
,Medicine, 22nd ed., Chapter 12: Ethical Issues in Clinical
Medicine)
12. A nurse is discussing a "Do Not Resuscitate" (DNR) order
with a patient's family. The family asks, "If we agree to this,
does it mean you will stop all care for him?" The nurse's best
response is based on the understanding that DNR means:
A. Care shifts entirely to comfort measures only.
B. Only cardiopulmonary resuscitation (CPR) is withheld in the
event of cardiac arrest.
C. All life-sustaining treatments, like antibiotics, must be
discontinued.
D. The patient will not be admitted to the intensive care unit.
Answer: B. Only cardiopulmonary resuscitation (CPR) is
withheld in the event of cardiac arrest.
Rationale: A common and critical misconception is that DNR
equals "no care." Clarifying that a DNR order applies solely to
the specific intervention of CPR is essential. Patients with a DNR
order can and should continue to receive all other appropriate
medical, nursing, and comfort treatments aimed at helping
them recover or improving their quality of life. (*Harrison’s
Principles of Internal Medicine, 22nd ed., Chapter 13: Palliative
and End-of-Life Care*)
13. During a health fair, a nurse emphasizes lifestyle
modifications. Which recommendation represents the most
impactful behavioral change for primary prevention of chronic
disease in the general population?
, A. Taking a daily multivitamin.
B. Avoiding smoking in all forms.
C. Drinking two glasses of red wine daily.
D. Following a gluten-free diet.
Answer: B. Avoiding smoking in all forms.
Rationale: Smoking cessation is the single most effective
lifestyle intervention for preventing a vast array of chronic
diseases, including cardiovascular disease, chronic obstructive
pulmonary disease (COPD), and multiple cancers. Its public
health impact far exceeds that of other dietary supplements or
unproven diet trends for the general population. (Harrison’s
Principles of Internal Medicine, 22nd ed., Chapter 2: Promoting
Good Health)
14. A patient recovering from surgery says to the nurse, "My
doctor explained the procedure, but I'm still not sure it was
the right choice." Which element of shared decision-making
does this statement highlight as potentially lacking?
A. Clinical evidence.
B. Integration of patient preferences.
C. The surgeon's technical skill.
D. Informed consent documentation.
Answer: B. Integration of patient preferences.
Rationale: Shared decision-making is a collaborative process
where clinicians and patients work together to make choices
that align with the best evidence AND the patient's specific
values, goals, and preferences. The patient's doubt suggests
their personal values or concerns may not have been fully
(Vol.1 & Vol.2)
22nd Edition
• Author(s)Joseph Loscalzo; Anthony S.
Fauci; Dennis L. Kasper; Stephen Hauser;
Dan Longo; J. Larry Jameson
Test Bank
1. A nurse is educating a patient about primary prevention.
Which action by the nurse best exemplifies this concept?
A. Teaching a patient with diabetes how to perform foot care.
B. Ordering a mammogram for a 50-year-old patient.
C. Administering a seasonal influenza vaccine.
D. Prescribing physical therapy for a patient after a stroke.
Answer: C. Administering a seasonal influenza vaccine.
Rationale: Primary prevention aims to prevent disease before it
occurs. Immunization is a cornerstone of primary prevention, as
it prevents the initial development of a specific infectious
disease. Foot care for a diabetic patient is secondary prevention
(managing an existing condition to prevent complications),
screening mammograms are secondary prevention (early
,detection), and post-stroke rehab is tertiary prevention
(restoration and rehabilitation). (Harrison’s Principles of Internal
Medicine, 22nd ed., Chapter 2: Promoting Good Health)
2. A parent in a pediatric clinic expresses hesitancy about
childhood vaccines, stating, "I read online that they can cause
autism." What is the nurse's most appropriate initial
response?
A. Provide a detailed scientific rebuttal explaining the flaws in
the cited study.
B. Dismiss the concern and state that vaccines are mandatory
for school entry.
C. Acknowledge the parent's concern and ask what specific
information they have read.
D. Immediately schedule a consult with the physician to handle
the discussion.
Answer: C. Acknowledge the parent's concern and ask what
specific information they have read.
Rationale: Effective communication begins with building trust
and understanding the patient's or parent's specific fears and
information sources. Dismissing concerns or launching into a
complex scientific argument can increase defensiveness and
hesitancy. Engaging in a respectful, open dialogue is the first
step toward providing tailored, evidence-based education.
(Harrison’s Principles of Internal Medicine, 22nd ed., Chapter 3:
Vaccine Opposition and Hesitancy)
,3. When applying the principles of evidence-based medicine
(EBM) to plan care, a nurse understands that the correct
sequence integrates which of the following?
A. Clinical guidelines, patient preferences, and system
resources.
B. Best research evidence, clinical expertise, and patient values.
C. Pathophysiology, cost-effectiveness, and standard protocols.
D. Diagnostic test results, pharmacological data, and nurse
judgment.
Answer: B. Best research evidence, clinical expertise, and
patient values.
Rationale: EBM is explicitly defined as the conscientious
integration of the best available research evidence with
individual clinical expertise and patient values and preferences.
This triad ensures care is not only scientifically sound but also
tailored to the individual patient's context and desires.
(*Harrison’s Principles of Internal Medicine, 22nd ed., Chapter
4: Decision-Making in Clinical Medicine*)
4. A nurse is caring for a patient newly diagnosed with breast
cancer. The treatment plan involves a medication selected
based on the genetic profile of the tumor. This approach is
best described as:
A. Preventive medicine.
B. Personalized medicine.
C. Screening medicine.
D. Palliative medicine.
Answer: B. Personalized medicine.
,Rationale: Personalized (or precision) medicine uses
information about a person's genes, proteins, and environment
to prevent, diagnose, and treat disease. Selecting a cancer
therapy based on the specific genetic characteristics of the
patient's tumor, rather than a one-size-fits-all approach, is a key
example of this paradigm. (Harrison’s Principles of Internal
Medicine, 22nd ed., Chapter 5: Precision Medicine and Clinical
Care)
5. Which of the following screening tests is most appropriate
for a nurse to recommend to a general, asymptomatic adult
population based on established guidelines for effectiveness?
A. Annual chest X-ray for lung cancer.
B. Annual CA-125 blood test for ovarian cancer.
C. Colonoscopy every 10 years starting at age 45.
D. Whole-body CT scan for overall health.
Answer: C. Colonoscopy every 10 years starting at age 45.
Rationale: Screening tests must meet criteria of proven benefit,
including reducing mortality for the target condition.
Colonoscopy for colorectal cancer screening in average-risk
adults starting at age 45-50 is a well-established, evidence-
based recommendation. Chest X-rays for lung cancer in the
general population and CA-125 for ovarian cancer are not
recommended due to lack of mortality benefit and high false-
positive rates. Whole-body CT is not a recommended screening
tool. (Harrison’s Principles of Internal Medicine, 22nd ed.,
Chapter 6: Screening and Prevention of Disease)
,6. During a hand-off report, a nurse emphasizes the
importance of using two patient identifiers before
administering medication. This practice directly addresses
which primary aim of the National Quality Strategy?
A. Improving patient safety.
B. Promoting effective communication.
C. Making care affordable.
D. Engaging patients and families.
Answer: A. Improving patient safety.
Rationale: Using two patient identifiers is a foundational
patient safety practice designed to prevent errors, such as
wrong-patient medication administration. While it involves
communication, its primary and direct purpose is to enhance
safety by ensuring the right patient receives the right
intervention. (Harrison’s Principles of Internal Medicine, 22nd
ed., Chapter 7: The Safety and Quality of Health Care)
7. A nurse is preparing to discharge a patient with heart
failure. Which component of the physical examination
provides the most reliable, objective, and immediate data for
assessing the patient's volume status?
A. Measuring body weight.
B. Asking about shortness of breath.
C. Auscultating heart sounds.
D. Inspecting for jugular venous distension (JVD).
Answer: A. Measuring body weight.
Rationale: Daily weight is a critical, quantitative, and nurse-
driven component of the physical assessment for patients with
,heart failure. A rapid weight gain (e.g., 2-3 lbs in 24 hours) is a
key indicator of fluid retention and worsening failure, often
preceding subjective symptoms. JVD is also important but
requires more skill to assess reliably. (Harrison’s Principles of
Internal Medicine, 22nd ed., Chapter 8: The Value of the
Physical Examination in Modern Medicine)
8. A nurse manager notices a staff nurse making repeated
minor errors and appearing fatigued and withdrawn. The
manager suspects burnout. Which initial action by the
manager is most aligned with a systems approach to clinician
well-being?
A. Document the errors for potential disciplinary action.
B. Privately ask the nurse, "How are you coping with your
workload?"
C. Mandate the nurse to take a week of vacation immediately.
D. Refer the nurse to the employee assistance program (EAP).
Answer: B. Privately ask the nurse, "How are you coping with
your workload?"
Rationale: Burnout is recognized as a systems issue, not an
individual failing. The first, most supportive step is a non-
punitive, confidential conversation to express concern and open
a dialogue. This approach fosters trust and allows for
collaborative problem-solving about workload or other systemic
factors, rather than immediately assigning blame or a
mandatory solution. (*Harrison’s Principles of Internal
Medicine, 22nd ed., Chapter 9: Physician Well-Being*)
,9. A nurse reviews a patient's chart and notices a "pending"
lab result that would typically rule out a key differential
diagnosis. The physician is ready to discharge the patient.
What is the nurse's most appropriate action?
A. Carry out the discharge order as written by the physician.
B. Ask the unit clerk to call the lab for a stat result.
C. Politely alert the physician to the pending critical result
before discharge.
D. Inform the patient that discharge is delayed due to a lab
issue.
Answer: C. Politely alert the physician to the pending critical
result before discharge.
Rationale: This action embodies the nurse's critical role in
preventing diagnostic error by serving as a safety check within
the healthcare team. It respects the physician's authority while
ensuring all necessary information is considered in the
diagnostic reasoning process before a final disposition decision
is made. (Harrison’s Principles of Internal Medicine, 22nd ed.,
Chapter 10: Diagnosis: Reducing Errors and Improving Quality)
10. To provide culturally competent care and help reduce
health disparities, a nurse's priority action should be to:
A. Assume patients from minority groups have low health
literacy.
B. Use medical jargon to establish professional authority.
C. Recognize their own implicit biases and how they may affect
care.
D. Apply all clinical practice guidelines uniformly to every
,patient.
Answer: C. Recognize their own implicit biases and how they
may affect care.
Rationale: A foundational step in addressing disparities is for
healthcare providers to engage in self-reflection to become
aware of their own unconscious biases, stereotypes, and
assumptions that can negatively influence clinical decisions,
patient interactions, and trust. This introspection must precede
effective patient-centered communication and tailored care.
(Harrison’s Principles of Internal Medicine, 22nd ed., Chapter 11:
Racial and Ethnic Disparities in Health Care)
11. A competent, alert patient with metastatic cancer refuses
a recommended blood transfusion based on personal beliefs.
The nursing team disagrees with the decision. What is the
overriding ethical principle that must guide the nurses'
actions?
A. Beneficence (doing good).
B. Non-maleficence (avoiding harm).
C. Justice (fairness in care).
D. Respect for autonomy.
Answer: D. Respect for autonomy.
Rationale: For a competent adult patient, the ethical principle
of autonomy grants them the right to make informed decisions
about their own body and care, even if the healthcare team
believes the decision is unwise or will lead to a worse outcome.
The nurse's role is to ensure the patient is informed and then to
respect and uphold that choice. (Harrison’s Principles of Internal
,Medicine, 22nd ed., Chapter 12: Ethical Issues in Clinical
Medicine)
12. A nurse is discussing a "Do Not Resuscitate" (DNR) order
with a patient's family. The family asks, "If we agree to this,
does it mean you will stop all care for him?" The nurse's best
response is based on the understanding that DNR means:
A. Care shifts entirely to comfort measures only.
B. Only cardiopulmonary resuscitation (CPR) is withheld in the
event of cardiac arrest.
C. All life-sustaining treatments, like antibiotics, must be
discontinued.
D. The patient will not be admitted to the intensive care unit.
Answer: B. Only cardiopulmonary resuscitation (CPR) is
withheld in the event of cardiac arrest.
Rationale: A common and critical misconception is that DNR
equals "no care." Clarifying that a DNR order applies solely to
the specific intervention of CPR is essential. Patients with a DNR
order can and should continue to receive all other appropriate
medical, nursing, and comfort treatments aimed at helping
them recover or improving their quality of life. (*Harrison’s
Principles of Internal Medicine, 22nd ed., Chapter 13: Palliative
and End-of-Life Care*)
13. During a health fair, a nurse emphasizes lifestyle
modifications. Which recommendation represents the most
impactful behavioral change for primary prevention of chronic
disease in the general population?
, A. Taking a daily multivitamin.
B. Avoiding smoking in all forms.
C. Drinking two glasses of red wine daily.
D. Following a gluten-free diet.
Answer: B. Avoiding smoking in all forms.
Rationale: Smoking cessation is the single most effective
lifestyle intervention for preventing a vast array of chronic
diseases, including cardiovascular disease, chronic obstructive
pulmonary disease (COPD), and multiple cancers. Its public
health impact far exceeds that of other dietary supplements or
unproven diet trends for the general population. (Harrison’s
Principles of Internal Medicine, 22nd ed., Chapter 2: Promoting
Good Health)
14. A patient recovering from surgery says to the nurse, "My
doctor explained the procedure, but I'm still not sure it was
the right choice." Which element of shared decision-making
does this statement highlight as potentially lacking?
A. Clinical evidence.
B. Integration of patient preferences.
C. The surgeon's technical skill.
D. Informed consent documentation.
Answer: B. Integration of patient preferences.
Rationale: Shared decision-making is a collaborative process
where clinicians and patients work together to make choices
that align with the best evidence AND the patient's specific
values, goals, and preferences. The patient's doubt suggests
their personal values or concerns may not have been fully
