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 — Patient-Centered Care / Clinical
Judgment
Stem
A 68-year-old patient with COPD is admitted for shortness of
breath. The nurse reviews the patient’s goals that prioritize
remaining independent at home. The interdisciplinary team
,recommends a change to the discharge plan that would
increase clinic visits but might limit independence. Which action
should the nurse take first?
A. Accept the team’s plan and notify the patient.
B. Discuss the proposed plan with the patient to clarify
preferences.
C. Advise the team to remove the increased visits due to cost
concerns.
D. Schedule home health without patient input to expedite
discharge.
Correct Answer: B
Rationale — Correct (B)
Lewis emphasizes patient-centered care and shared decision-
making; the nurse recognizes (CJM Recognize) a potential
mismatch between plan and patient goal, analyzes options, and
prioritizes clarifying patient preferences before planning.
Discussing the plan upholds autonomy and allows creating an
intervention that balances safety and independence.
Rationale — Incorrect
A: Accepting without discussion ignores patient preferences and
risks nonadherence.
C: Removing visits based on cost alone bypasses patient values
and team expertise.
D: Scheduling without consent violates patient-centered care
and informed decision-making.
,Teaching Point:
Always clarify patient goals before finalizing the care plan.
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 — Domain of Nursing Practice /
Scope of Practice
Stem
A new RN graduate is assigned a unit with an experienced LPN
and UAP. A postoperative patient requires wound assessment
and dressing change. Which assignment reflects appropriate
division of duties consistent with scope of practice?
A. RN delegates the wound dressing change to the UAP and
documents.
B. RN assigns the LPN to perform the dressing change and
complete assessment.
C. RN performs the wound assessment and delegates dressing
change technique to the LPN.
D. RN assigns the UAP to assess wound for infection and applies
dressing.
Correct Answer: C
, Rationale — Correct (C)
Lewis describes scope and delegation: assessment and complex
clinical judgment remain with the RN (Recognize/Analyze). The
RN should perform the wound assessment (detect signs of
infection) and may delegate routine dressing technique to LPN
if within LPN scope. This maintains patient safety and
appropriate skill mix.
Rationale — Incorrect
A: UAP cannot perform assessments or sterile dressing changes
beyond their training.
B: LPN can perform dressing changes but the RN must verify
assessment findings and plan.
D: UAP should not assess for infection or perform clinical
judgments.
Teaching Point:
RN retains assessment and judgment; delegate tasks, not
nursing judgment.
Citation:
Harding et al. (2023). Ch. 1.
3
Reference
Ch. 1 — Professional Nursing — Standards of Professional
Nursing Practice / Safety
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 — Patient-Centered Care / Clinical
Judgment
Stem
A 68-year-old patient with COPD is admitted for shortness of
breath. The nurse reviews the patient’s goals that prioritize
remaining independent at home. The interdisciplinary team
,recommends a change to the discharge plan that would
increase clinic visits but might limit independence. Which action
should the nurse take first?
A. Accept the team’s plan and notify the patient.
B. Discuss the proposed plan with the patient to clarify
preferences.
C. Advise the team to remove the increased visits due to cost
concerns.
D. Schedule home health without patient input to expedite
discharge.
Correct Answer: B
Rationale — Correct (B)
Lewis emphasizes patient-centered care and shared decision-
making; the nurse recognizes (CJM Recognize) a potential
mismatch between plan and patient goal, analyzes options, and
prioritizes clarifying patient preferences before planning.
Discussing the plan upholds autonomy and allows creating an
intervention that balances safety and independence.
Rationale — Incorrect
A: Accepting without discussion ignores patient preferences and
risks nonadherence.
C: Removing visits based on cost alone bypasses patient values
and team expertise.
D: Scheduling without consent violates patient-centered care
and informed decision-making.
,Teaching Point:
Always clarify patient goals before finalizing the care plan.
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 — Domain of Nursing Practice /
Scope of Practice
Stem
A new RN graduate is assigned a unit with an experienced LPN
and UAP. A postoperative patient requires wound assessment
and dressing change. Which assignment reflects appropriate
division of duties consistent with scope of practice?
A. RN delegates the wound dressing change to the UAP and
documents.
B. RN assigns the LPN to perform the dressing change and
complete assessment.
C. RN performs the wound assessment and delegates dressing
change technique to the LPN.
D. RN assigns the UAP to assess wound for infection and applies
dressing.
Correct Answer: C
, Rationale — Correct (C)
Lewis describes scope and delegation: assessment and complex
clinical judgment remain with the RN (Recognize/Analyze). The
RN should perform the wound assessment (detect signs of
infection) and may delegate routine dressing technique to LPN
if within LPN scope. This maintains patient safety and
appropriate skill mix.
Rationale — Incorrect
A: UAP cannot perform assessments or sterile dressing changes
beyond their training.
B: LPN can perform dressing changes but the RN must verify
assessment findings and plan.
D: UAP should not assess for infection or perform clinical
judgments.
Teaching Point:
RN retains assessment and judgment; delegate tasks, not
nursing judgment.
Citation:
Harding et al. (2023). Ch. 1.
3
Reference
Ch. 1 — Professional Nursing — Standards of Professional
Nursing Practice / Safety
