MEDSURGNURSING10THEDITION
, , , ,
,MEDSURGNURSING10THEDITION
, , , ,
Lewis: Medical-Surgical Nursing, 10th Edition
, , , ,
MULTIPLE , CHOICE
1. The ,nurse ,completes ,an ,admission ,database ,and ,explains ,that ,the ,plan ,of ,care ,and ,discharge
,goals ,will ,be ,developed ,with ,the ,patient’s ,input. ,The ,patient ,states, ,“How ,is ,this ,different
,fromwhat ,the ,doctor ,does?” ,Which ,response ,would ,be ,most ,appropriate ,for ,the ,nurse ,to
,make?
a. “The ,role ,of ,the ,nurse ,is ,to ,administer ,medications ,and ,other ,treatments
,prescribed,by , your ,doctor.”
b. “The ,nurse’s ,job ,is ,to ,help ,the ,doctor ,by ,collecting ,information
,andcommunicating ,any ,problems ,that ,occur.”
c. “Nurses ,perform ,many ,of ,the ,same ,procedures ,as ,the ,doctor, ,but ,nurses ,are
,withthe ,patients ,for ,a ,longer ,time ,than ,the ,doctor.”
d. “In ,addition ,to ,caring ,for ,you ,while ,you ,are ,sick, ,the ,nurses ,will ,assist ,you
,todevelop ,an ,individualized ,plan ,to ,maintain , your ,health.”
ANS: , D
This ,response ,is ,consistent ,with ,the ,American ,Nurses ,Association ,(ANA) ,definition ,of
,nursing, ,which ,describes ,the ,role ,of ,nurses ,in ,promoting ,health. ,The ,other ,responses
,describe,some ,of ,the ,dependent ,and ,collaborative ,functions ,of ,the ,nursing ,role ,but ,do ,not
,accurately ,describe ,the ,nurse’s ,role ,in ,the ,health ,care ,system.
DIF: Cognitive ,Level: , Understand ,(comprehension) REF: 3
TOP: Nursing ,Process: , Implementation , MSC: NCLEX: , Safe ,and , Effective , Care , Environment
2. The ,nurse ,describes ,to ,a ,student ,nurse ,how ,to ,use ,evidence-based ,practice ,guidelines
,whencaring ,for ,patients. ,Which ,statement, ,if ,made ,by ,the ,nurse, ,would ,be ,the ,most
,accurate?
a. “Inferences , from , clinical , research , studies , are ,used , as , a , guide.”
b. “Patient , care , is , based , on , clinical , judgment, , experience, , and , traditions.”
c. “Data , are , evaluated , to , show , that , the , patient , outcomes , are , consistently ,met.”
d. “Recommendations ,are ,based ,on ,research, ,clinical ,expertise, ,and
,patient,preferences.”
ANS: , D
Evidence-based ,practice ,(EBP) ,is ,the ,use ,of ,the ,best ,research-based ,evidence ,combined
,withclinician , expertise. ,Clinical , judgment , based , on , the ,nurse’s , clinical , experience , is
, part ,of ,EBP,but ,clinical ,decision ,making ,should ,also ,incorporate ,current ,research ,and
,research- ,based ,guidelines. ,Evaluation ,of ,patient ,outcomes ,is ,important, ,but ,interventions
,should ,be ,based ,onresearch ,from ,randomized ,control ,studies ,with ,a ,large ,number ,of
,subjects.
DIF: Cognitive ,Level: , Remember , (knowledge) REF: 15
TOP: Nursing ,Process: , Planning MSC: NCLEX: , Safe ,and , Effective , Care , Environment
3. The ,nurse ,teaches ,a ,student ,nurse ,about ,how ,to ,apply ,the ,nursing ,process ,when
,providing,patient ,care. ,Which ,statement, ,if ,made ,by ,the ,student ,nurse, ,indicates ,that
,teaching ,was ,successful?
a. “The ,nursing ,process ,is ,a ,scientific-based ,method ,of ,diagnosing ,the
,patient’shealth ,care ,problems.”
,MEDSURGNURSING10THEDITION
, , , ,
b. “The , nursing , process , is , a , problem-solving , tool , used , to , identify ,and , treat , patients’
, MEDSURGNURSING10THEDITION
, , , ,
health , care , needs.”
c. “The ,nursing ,process ,is ,used ,primarily ,to ,explain ,nursing ,interventions ,to
, otherhealth ,care ,professionals.”
d. “The ,nursing ,process ,is ,based ,on ,nursing ,theory ,that ,incorporates
, the,biopsychosocial ,nature ,of ,humans.”
ANS: , B
The ,nursing ,process ,is ,a ,problem-solving ,approach ,to ,the ,identification ,and ,treatment ,of
,patients’ ,problems. ,Diagnosis ,is ,only ,one ,phase ,of ,the ,nursing ,process. ,The ,primary ,use ,of
,the,nursing ,process ,is ,in ,patient ,care, ,not ,to ,establish ,nursing ,theory ,or ,explain ,nursing
,interventions ,to ,other ,health ,care ,professionals.
DIF: Cognitive ,Level: , Understand , (comprehension) REF: 5
TOP: Nursing ,Process: , Implementation , MSC: NCLEX: , Safe ,and , Effective , Care , Environment
4. A ,patient ,has ,been ,admitted ,to ,the ,hospital ,for ,surgery ,and ,tells ,the ,nurse, ,“I ,do ,not ,feel
,comfortable ,leaving ,my ,children ,with ,my ,parents.” ,Which ,action ,should ,the ,nurse ,take
,next?
a. Reassure ,the , patient , that , these , feelings , are , common , for , parents.
b. Have , the , patient , call , the , children , to , ensure ,that , they ,are , doing , well.
c. Gather ,more , data , about , the , patient’s , feelings , about , the , child-care , arrangements.
d. Call ,the ,patient’s ,parents ,to ,determine ,whether ,adequate ,child ,care ,is
,being,provided.
ANS: , C
Because ,a ,complete ,assessment ,is ,necessary ,in ,order ,to ,identify ,a ,problem ,and ,choose ,an
,appropriate ,intervention, ,the ,nurse’s ,first ,action ,should ,be ,to ,obtain ,more ,information. ,The
,other ,actions ,may ,be ,appropriate, ,but ,more ,assessment ,is ,needed ,before ,the ,best
,interventioncan ,be ,chosen.
DIF: Cognitive , Level: , Apply ,(application) REF: 6
OBJ: Special ,Questions: ,Prioritization TOP: Nursing ,Process:
,Assessment,MSC: NCLEX: ,Psychosocial ,Integrity
5. A ,patient ,who ,is ,paralyzed ,on ,the ,left ,side ,of ,the ,body ,after ,a ,stroke ,develops ,a ,pressure
,ulceron ,the ,left ,hip. ,Which ,nursing ,diagnosis ,is ,most ,appropriate?
a. Impaired , physical , mobility ,related , to , left-sided , paralysis
b. Risk , for , impaired , tissue , integrity ,related , to , left-sided , weakness
c. Impaired , skin , integrity ,related , to , altered , circulation , and , pressure
d. Ineffective , tissue , perfusion , related , to , inability ,to , move , independently
ANS: , C
The ,patient’s ,major ,problem ,is ,the ,impaired ,skin ,integrity ,as ,demonstrated ,by ,the ,presence ,of
, a , pressure , ulcer. , The ,nurse , is ,able ,to ,treat , the ,cause , of , altered , circulation , and , pressure ,by
,frequently ,repositioning ,the ,patient. ,Although ,left-sided ,weakness ,is ,a ,problem ,for ,the
,patient,the ,nurse ,cannot ,treat ,the ,weakness. ,The ,“risk ,for” ,diagnosis ,is ,not ,appropriate ,for
,this ,patient,who ,already ,has ,impaired ,tissue ,integrity. ,The ,patient ,does ,have ,ineffective ,tissue
,perfusion, ,but ,the ,impaired ,skin ,integrity ,diagnosis ,indicates ,more ,clearly ,what ,the ,health
,problem ,is.
DIF: Cognitive , Level: , Apply ,(application) REF: 7
TOP: Nursing , Process: , Diagnosis MSC: NCLEX: , Physiological , Integrity
, , , ,
,MEDSURGNURSING10THEDITION
, , , ,
Lewis: Medical-Surgical Nursing, 10th Edition
, , , ,
MULTIPLE , CHOICE
1. The ,nurse ,completes ,an ,admission ,database ,and ,explains ,that ,the ,plan ,of ,care ,and ,discharge
,goals ,will ,be ,developed ,with ,the ,patient’s ,input. ,The ,patient ,states, ,“How ,is ,this ,different
,fromwhat ,the ,doctor ,does?” ,Which ,response ,would ,be ,most ,appropriate ,for ,the ,nurse ,to
,make?
a. “The ,role ,of ,the ,nurse ,is ,to ,administer ,medications ,and ,other ,treatments
,prescribed,by , your ,doctor.”
b. “The ,nurse’s ,job ,is ,to ,help ,the ,doctor ,by ,collecting ,information
,andcommunicating ,any ,problems ,that ,occur.”
c. “Nurses ,perform ,many ,of ,the ,same ,procedures ,as ,the ,doctor, ,but ,nurses ,are
,withthe ,patients ,for ,a ,longer ,time ,than ,the ,doctor.”
d. “In ,addition ,to ,caring ,for ,you ,while ,you ,are ,sick, ,the ,nurses ,will ,assist ,you
,todevelop ,an ,individualized ,plan ,to ,maintain , your ,health.”
ANS: , D
This ,response ,is ,consistent ,with ,the ,American ,Nurses ,Association ,(ANA) ,definition ,of
,nursing, ,which ,describes ,the ,role ,of ,nurses ,in ,promoting ,health. ,The ,other ,responses
,describe,some ,of ,the ,dependent ,and ,collaborative ,functions ,of ,the ,nursing ,role ,but ,do ,not
,accurately ,describe ,the ,nurse’s ,role ,in ,the ,health ,care ,system.
DIF: Cognitive ,Level: , Understand ,(comprehension) REF: 3
TOP: Nursing ,Process: , Implementation , MSC: NCLEX: , Safe ,and , Effective , Care , Environment
2. The ,nurse ,describes ,to ,a ,student ,nurse ,how ,to ,use ,evidence-based ,practice ,guidelines
,whencaring ,for ,patients. ,Which ,statement, ,if ,made ,by ,the ,nurse, ,would ,be ,the ,most
,accurate?
a. “Inferences , from , clinical , research , studies , are ,used , as , a , guide.”
b. “Patient , care , is , based , on , clinical , judgment, , experience, , and , traditions.”
c. “Data , are , evaluated , to , show , that , the , patient , outcomes , are , consistently ,met.”
d. “Recommendations ,are ,based ,on ,research, ,clinical ,expertise, ,and
,patient,preferences.”
ANS: , D
Evidence-based ,practice ,(EBP) ,is ,the ,use ,of ,the ,best ,research-based ,evidence ,combined
,withclinician , expertise. ,Clinical , judgment , based , on , the ,nurse’s , clinical , experience , is
, part ,of ,EBP,but ,clinical ,decision ,making ,should ,also ,incorporate ,current ,research ,and
,research- ,based ,guidelines. ,Evaluation ,of ,patient ,outcomes ,is ,important, ,but ,interventions
,should ,be ,based ,onresearch ,from ,randomized ,control ,studies ,with ,a ,large ,number ,of
,subjects.
DIF: Cognitive ,Level: , Remember , (knowledge) REF: 15
TOP: Nursing ,Process: , Planning MSC: NCLEX: , Safe ,and , Effective , Care , Environment
3. The ,nurse ,teaches ,a ,student ,nurse ,about ,how ,to ,apply ,the ,nursing ,process ,when
,providing,patient ,care. ,Which ,statement, ,if ,made ,by ,the ,student ,nurse, ,indicates ,that
,teaching ,was ,successful?
a. “The ,nursing ,process ,is ,a ,scientific-based ,method ,of ,diagnosing ,the
,patient’shealth ,care ,problems.”
,MEDSURGNURSING10THEDITION
, , , ,
b. “The , nursing , process , is , a , problem-solving , tool , used , to , identify ,and , treat , patients’
, MEDSURGNURSING10THEDITION
, , , ,
health , care , needs.”
c. “The ,nursing ,process ,is ,used ,primarily ,to ,explain ,nursing ,interventions ,to
, otherhealth ,care ,professionals.”
d. “The ,nursing ,process ,is ,based ,on ,nursing ,theory ,that ,incorporates
, the,biopsychosocial ,nature ,of ,humans.”
ANS: , B
The ,nursing ,process ,is ,a ,problem-solving ,approach ,to ,the ,identification ,and ,treatment ,of
,patients’ ,problems. ,Diagnosis ,is ,only ,one ,phase ,of ,the ,nursing ,process. ,The ,primary ,use ,of
,the,nursing ,process ,is ,in ,patient ,care, ,not ,to ,establish ,nursing ,theory ,or ,explain ,nursing
,interventions ,to ,other ,health ,care ,professionals.
DIF: Cognitive ,Level: , Understand , (comprehension) REF: 5
TOP: Nursing ,Process: , Implementation , MSC: NCLEX: , Safe ,and , Effective , Care , Environment
4. A ,patient ,has ,been ,admitted ,to ,the ,hospital ,for ,surgery ,and ,tells ,the ,nurse, ,“I ,do ,not ,feel
,comfortable ,leaving ,my ,children ,with ,my ,parents.” ,Which ,action ,should ,the ,nurse ,take
,next?
a. Reassure ,the , patient , that , these , feelings , are , common , for , parents.
b. Have , the , patient , call , the , children , to , ensure ,that , they ,are , doing , well.
c. Gather ,more , data , about , the , patient’s , feelings , about , the , child-care , arrangements.
d. Call ,the ,patient’s ,parents ,to ,determine ,whether ,adequate ,child ,care ,is
,being,provided.
ANS: , C
Because ,a ,complete ,assessment ,is ,necessary ,in ,order ,to ,identify ,a ,problem ,and ,choose ,an
,appropriate ,intervention, ,the ,nurse’s ,first ,action ,should ,be ,to ,obtain ,more ,information. ,The
,other ,actions ,may ,be ,appropriate, ,but ,more ,assessment ,is ,needed ,before ,the ,best
,interventioncan ,be ,chosen.
DIF: Cognitive , Level: , Apply ,(application) REF: 6
OBJ: Special ,Questions: ,Prioritization TOP: Nursing ,Process:
,Assessment,MSC: NCLEX: ,Psychosocial ,Integrity
5. A ,patient ,who ,is ,paralyzed ,on ,the ,left ,side ,of ,the ,body ,after ,a ,stroke ,develops ,a ,pressure
,ulceron ,the ,left ,hip. ,Which ,nursing ,diagnosis ,is ,most ,appropriate?
a. Impaired , physical , mobility ,related , to , left-sided , paralysis
b. Risk , for , impaired , tissue , integrity ,related , to , left-sided , weakness
c. Impaired , skin , integrity ,related , to , altered , circulation , and , pressure
d. Ineffective , tissue , perfusion , related , to , inability ,to , move , independently
ANS: , C
The ,patient’s ,major ,problem ,is ,the ,impaired ,skin ,integrity ,as ,demonstrated ,by ,the ,presence ,of
, a , pressure , ulcer. , The ,nurse , is ,able ,to ,treat , the ,cause , of , altered , circulation , and , pressure ,by
,frequently ,repositioning ,the ,patient. ,Although ,left-sided ,weakness ,is ,a ,problem ,for ,the
,patient,the ,nurse ,cannot ,treat ,the ,weakness. ,The ,“risk ,for” ,diagnosis ,is ,not ,appropriate ,for
,this ,patient,who ,already ,has ,impaired ,tissue ,integrity. ,The ,patient ,does ,have ,ineffective ,tissue
,perfusion, ,but ,the ,impaired ,skin ,integrity ,diagnosis ,indicates ,more ,clearly ,what ,the ,health
,problem ,is.
DIF: Cognitive , Level: , Apply ,(application) REF: 7
TOP: Nursing , Process: , Diagnosis MSC: NCLEX: , Physiological , Integrity
