EXAMINATION MASTER FILE:
COMPREHENSIVE TEST BANK FOR
TIMBY'S INTRODUCTORY
MEDICAL-SURGICAL NURSING,
13TH EDITION
SUBJECT MATTER: Introductory Medical-Surgical Nursing
SOURCE MATERIAL: Timby’s Introductory Medical-Surgical Nursing, 13th Edition Authors:
Loretta A. Donnelly-Moreno & Brigitte Moseley Publisher: Wolters Kluwer
SCOPE: Chapters 1 through 72
CONTENT DOMAINS: Nursing Roles and Responsibilities Client Care Concerns Foundations
of Medical-Surgical Nursing Multisystem Disorders Respiratory, Cardiovascular, Hematopoietic,
Lymphatic, and Immune Disorders Neurologic, Sensory, Gastrointestinal, Endocrine, and
Urinary Disorders Musculoskeletal, Integumentary, and Reproductive Disorders Psychobiologic
Disorders
TARGET AUDIENCE: Licensed Practical/Vocational Nursing Students (LPN/LVN) NCLEX-PN
Candidates Clinical Educators
DOCUMENT TYPE: Elite Comprehensive Examination & Clinical Rationale Report
INTRODUCTION: CLINICAL JUDGMENT IN
MEDICAL-SURGICAL NURSING
The thirteenth edition of Timby's Introductory Medical-Surgical Nursing represents a pivotal
resource in the education of Licensed Practical/Vocational Nurses (LPN/LVNs), emphasizing the
critical shift toward the Next Generation NCLEX (NGN) clinical judgment model. As the
healthcare landscape evolves, the LPN/LVN is increasingly tasked with caring for clients with
high-acuity, multisystem disorders across diverse settings, from acute care hospitals to
community-based environments. The following examination is designed not merely to assess
rote memorization but to rigorously evaluate the student's ability to synthesize complex
physiological data, prioritize interventions based on safety frameworks, and apply ethical
principles in high-pressure scenarios.
This report is structured into 55 detailed clinical case questions that traverse the entire textbook,
covering Chapters 1 through 72. Each question is accompanied by an exhaustive rationale that
dissects the pathophysiology, nursing process, and pharmacological implications of the
scenario. The analysis integrates core concepts such as the "Healthy People 2030" initiative,
Maslow’s Hierarchy of Needs, and safety competencies, ensuring a nuanced understanding of
the subject matter.
UNIT I: NURSING ROLES AND
,RESPONSIBILITIES (CHAPTERS 1-6)
The foundation of safe nursing practice lies in understanding the legal, ethical, and professional
frameworks that govern the LPN/LVN role. This unit examines the intersection of clinical care
with the regulations of the healthcare system.
Question 1: Legal Implications of Delegation
Clinical Scenario: A Licensed Practical Nurse (LPN) is functioning as a charge nurse in a
long-term care facility. The unit is short-staffed, and the LPN must delegate tasks to an
Unlicensed Assistive Personnel (UAP) for a client who is three days post-stroke (CVA) with
residual dysphagia. The client requires feeding assistance.
Examination Inquiry: Based on the frameworks of leadership and management discussed in
Chapter 6, determine the appropriateness of delegating feeding to the UAP for this specific
client. Provide a detailed analysis of the legal and safety principles guiding this decision.
Correct Clinical Response: Delegation is inappropriate. The LPN must retain the task of
feeding this specific client due to the high risk of aspiration associated with dysphagia.
Comprehensive Rationale and Clinical Analysis: The delegation of nursing tasks is a
complex function regulated by the State Nurse Practice Act and institutional policy. While
feeding is generally considered a standard skill within the UAP’s scope of practice, the
circumstances of the client dictate the safety of the delegation. In this scenario, the client has a
known physiological deficit—dysphagia (difficulty swallowing)—resulting from a Cerebrovascular
Accident (stroke). This condition transforms a routine activity into a high-risk intervention
requiring clinical judgment.
The LPN must apply the "Five Rights of Delegation": Right Task, Right Circumstance, Right
Person, Right Direction/Communication, and Right Supervision/Evaluation. Here, the "Right
Circumstance" is not met. Dysphagia necessitates skilled observation for signs of aspiration,
such as coughing, pocketing of food, or changes in voice quality (wet voice). A UAP is trained in
the mechanics of feeding but lacks the clinical depth to assess airway patency or immediate
swallowing reflex integrity during the meal. If the LPN were to delegate this task and the client
aspirated, leading to pneumonia or asphyxiation, the LPN could be held liable for malpractice
due to negligent delegation. The LPN must prioritize client safety over unit efficiency in this
instance, performing the feeding to simultaneously assess the client's nutritional intake and
airway safety.
Question 2: Ethical Dilemmas and Advance Directives
Clinical Scenario: A 78-year-old client is admitted to the medical-surgical unit with end-stage
Chronic Obstructive Pulmonary Disease (COPD) and pneumonia. The client presents a valid
"Do Not Resuscitate" (DNR) order. Two days later, the client develops acute respiratory distress.
The client's daughter arrives, visibly distraught, and demands that the medical team "do
everything" to save her father, including intubation.
Examination Inquiry: Referring to Chapter 5 (Legal and Ethical Issues), analyze the nurse’s
primary obligation in this conflict between the family's wishes and the client's advance directive.
What specific ethical principle supports the nurse's action?
Correct Clinical Response: The nurse’s primary obligation is to uphold the client's valid
DNR order. The ethical principle supporting this action is Autonomy.
, Comprehensive Rationale and Clinical Analysis: Ethical practice in nursing is grounded in
specific principles, with autonomy—the right of a competent individual to make decisions
regarding their own healthcare—being paramount. A valid DNR order represents the client’s
informed decision to refuse resuscitative measures (CPR, intubation) in the event of cardiac or
respiratory arrest. This document acts as the voice of the client when they are incapacitated or
unable to speak for themselves.
The conflict arises from the family member's distress, which is a common occurrence in
end-of-life care. However, legally and ethically, a family member cannot override a competent
client’s advance directive unless they hold a Durable Power of Attorney for Healthcare
(DPOA-HC) and the document grants them authority to override prior instructions (which is rare)
or the client revoked the DNR. The nurse must advocate for the client's stated wishes. Acceding
to the daughter's demand to "do everything" would constitute battery (unauthorized
touching/treatment) and a violation of the client's autonomy. The appropriate nursing action
involves therapeutic communication with the daughter, explaining that the team is providing
maximum medical treatment (antibiotics, oxygen, comfort measures) but will respect the father's
wish not to be resuscitated. This distinction between "care" and "resuscitation" is often where
confusion lies for families.
Question 3: The Nursing Process and Prioritization
Clinical Scenario: An LPN is receiving shift report on four clients.
1. A client with type 2 diabetes requesting a foot check.
2. A client with pneumonia who has an oxygen saturation of 89% on 2L nasal cannula.
3. A client with a broken femur in traction requesting pain medication (rated 6/10).
4. A client scheduled for discharge needing instructions on wound care.
Examination Inquiry: Applying the principles of the Nursing Process and Maslow’s Hierarchy of
Needs (Chapter 2), which client requires immediate assessment and intervention? Justify the
selection by categorizing the needs of all four clients.
Correct Clinical Response: The priority is Client 2 (Pneumonia with 89% O2 saturation).
Comprehensive Rationale and Clinical Analysis: The "ABCs" (Airway, Breathing, Circulation)
form the bedrock of acute care prioritization.
● Client 2 (Priority): An oxygen saturation of 89% indicates hypoxemia, a direct threat to
Physiological Integrity and Breathing. If left untreated, this can rapidly progress to
respiratory failure, tissue hypoxia, and organ damage. This is a life-threatening, unstable
condition requiring immediate escalation of care (e.g., increasing oxygen, suctioning,
notifying the provider).
● Client 3 (Secondary Priority): The client in pain (6/10) has a physiological need, but it is
not immediately life-threatening. Pain management is a high priority (often considered the
"fifth vital sign"), but strictly speaking, it follows the preservation of life (breathing).
● Client 1 (Tertiary Priority): The diabetic foot check represents a Safety and Prevention
need. While important to prevent future complications (ulcers/amputation), it is not an
acute emergency.
● Client 4 (Lowest Priority): Discharge education falls under Health Promotion and
Self-Actualization. This can be delayed until the physiological crises of the other clients
are managed.
The nurse must demonstrate the ability to distinguish between "acute" (hypoxia) and
"chronic/stable" (diabetes maintenance) and between "physiological survival" (oxygen) and
COMPREHENSIVE TEST BANK FOR
TIMBY'S INTRODUCTORY
MEDICAL-SURGICAL NURSING,
13TH EDITION
SUBJECT MATTER: Introductory Medical-Surgical Nursing
SOURCE MATERIAL: Timby’s Introductory Medical-Surgical Nursing, 13th Edition Authors:
Loretta A. Donnelly-Moreno & Brigitte Moseley Publisher: Wolters Kluwer
SCOPE: Chapters 1 through 72
CONTENT DOMAINS: Nursing Roles and Responsibilities Client Care Concerns Foundations
of Medical-Surgical Nursing Multisystem Disorders Respiratory, Cardiovascular, Hematopoietic,
Lymphatic, and Immune Disorders Neurologic, Sensory, Gastrointestinal, Endocrine, and
Urinary Disorders Musculoskeletal, Integumentary, and Reproductive Disorders Psychobiologic
Disorders
TARGET AUDIENCE: Licensed Practical/Vocational Nursing Students (LPN/LVN) NCLEX-PN
Candidates Clinical Educators
DOCUMENT TYPE: Elite Comprehensive Examination & Clinical Rationale Report
INTRODUCTION: CLINICAL JUDGMENT IN
MEDICAL-SURGICAL NURSING
The thirteenth edition of Timby's Introductory Medical-Surgical Nursing represents a pivotal
resource in the education of Licensed Practical/Vocational Nurses (LPN/LVNs), emphasizing the
critical shift toward the Next Generation NCLEX (NGN) clinical judgment model. As the
healthcare landscape evolves, the LPN/LVN is increasingly tasked with caring for clients with
high-acuity, multisystem disorders across diverse settings, from acute care hospitals to
community-based environments. The following examination is designed not merely to assess
rote memorization but to rigorously evaluate the student's ability to synthesize complex
physiological data, prioritize interventions based on safety frameworks, and apply ethical
principles in high-pressure scenarios.
This report is structured into 55 detailed clinical case questions that traverse the entire textbook,
covering Chapters 1 through 72. Each question is accompanied by an exhaustive rationale that
dissects the pathophysiology, nursing process, and pharmacological implications of the
scenario. The analysis integrates core concepts such as the "Healthy People 2030" initiative,
Maslow’s Hierarchy of Needs, and safety competencies, ensuring a nuanced understanding of
the subject matter.
UNIT I: NURSING ROLES AND
,RESPONSIBILITIES (CHAPTERS 1-6)
The foundation of safe nursing practice lies in understanding the legal, ethical, and professional
frameworks that govern the LPN/LVN role. This unit examines the intersection of clinical care
with the regulations of the healthcare system.
Question 1: Legal Implications of Delegation
Clinical Scenario: A Licensed Practical Nurse (LPN) is functioning as a charge nurse in a
long-term care facility. The unit is short-staffed, and the LPN must delegate tasks to an
Unlicensed Assistive Personnel (UAP) for a client who is three days post-stroke (CVA) with
residual dysphagia. The client requires feeding assistance.
Examination Inquiry: Based on the frameworks of leadership and management discussed in
Chapter 6, determine the appropriateness of delegating feeding to the UAP for this specific
client. Provide a detailed analysis of the legal and safety principles guiding this decision.
Correct Clinical Response: Delegation is inappropriate. The LPN must retain the task of
feeding this specific client due to the high risk of aspiration associated with dysphagia.
Comprehensive Rationale and Clinical Analysis: The delegation of nursing tasks is a
complex function regulated by the State Nurse Practice Act and institutional policy. While
feeding is generally considered a standard skill within the UAP’s scope of practice, the
circumstances of the client dictate the safety of the delegation. In this scenario, the client has a
known physiological deficit—dysphagia (difficulty swallowing)—resulting from a Cerebrovascular
Accident (stroke). This condition transforms a routine activity into a high-risk intervention
requiring clinical judgment.
The LPN must apply the "Five Rights of Delegation": Right Task, Right Circumstance, Right
Person, Right Direction/Communication, and Right Supervision/Evaluation. Here, the "Right
Circumstance" is not met. Dysphagia necessitates skilled observation for signs of aspiration,
such as coughing, pocketing of food, or changes in voice quality (wet voice). A UAP is trained in
the mechanics of feeding but lacks the clinical depth to assess airway patency or immediate
swallowing reflex integrity during the meal. If the LPN were to delegate this task and the client
aspirated, leading to pneumonia or asphyxiation, the LPN could be held liable for malpractice
due to negligent delegation. The LPN must prioritize client safety over unit efficiency in this
instance, performing the feeding to simultaneously assess the client's nutritional intake and
airway safety.
Question 2: Ethical Dilemmas and Advance Directives
Clinical Scenario: A 78-year-old client is admitted to the medical-surgical unit with end-stage
Chronic Obstructive Pulmonary Disease (COPD) and pneumonia. The client presents a valid
"Do Not Resuscitate" (DNR) order. Two days later, the client develops acute respiratory distress.
The client's daughter arrives, visibly distraught, and demands that the medical team "do
everything" to save her father, including intubation.
Examination Inquiry: Referring to Chapter 5 (Legal and Ethical Issues), analyze the nurse’s
primary obligation in this conflict between the family's wishes and the client's advance directive.
What specific ethical principle supports the nurse's action?
Correct Clinical Response: The nurse’s primary obligation is to uphold the client's valid
DNR order. The ethical principle supporting this action is Autonomy.
, Comprehensive Rationale and Clinical Analysis: Ethical practice in nursing is grounded in
specific principles, with autonomy—the right of a competent individual to make decisions
regarding their own healthcare—being paramount. A valid DNR order represents the client’s
informed decision to refuse resuscitative measures (CPR, intubation) in the event of cardiac or
respiratory arrest. This document acts as the voice of the client when they are incapacitated or
unable to speak for themselves.
The conflict arises from the family member's distress, which is a common occurrence in
end-of-life care. However, legally and ethically, a family member cannot override a competent
client’s advance directive unless they hold a Durable Power of Attorney for Healthcare
(DPOA-HC) and the document grants them authority to override prior instructions (which is rare)
or the client revoked the DNR. The nurse must advocate for the client's stated wishes. Acceding
to the daughter's demand to "do everything" would constitute battery (unauthorized
touching/treatment) and a violation of the client's autonomy. The appropriate nursing action
involves therapeutic communication with the daughter, explaining that the team is providing
maximum medical treatment (antibiotics, oxygen, comfort measures) but will respect the father's
wish not to be resuscitated. This distinction between "care" and "resuscitation" is often where
confusion lies for families.
Question 3: The Nursing Process and Prioritization
Clinical Scenario: An LPN is receiving shift report on four clients.
1. A client with type 2 diabetes requesting a foot check.
2. A client with pneumonia who has an oxygen saturation of 89% on 2L nasal cannula.
3. A client with a broken femur in traction requesting pain medication (rated 6/10).
4. A client scheduled for discharge needing instructions on wound care.
Examination Inquiry: Applying the principles of the Nursing Process and Maslow’s Hierarchy of
Needs (Chapter 2), which client requires immediate assessment and intervention? Justify the
selection by categorizing the needs of all four clients.
Correct Clinical Response: The priority is Client 2 (Pneumonia with 89% O2 saturation).
Comprehensive Rationale and Clinical Analysis: The "ABCs" (Airway, Breathing, Circulation)
form the bedrock of acute care prioritization.
● Client 2 (Priority): An oxygen saturation of 89% indicates hypoxemia, a direct threat to
Physiological Integrity and Breathing. If left untreated, this can rapidly progress to
respiratory failure, tissue hypoxia, and organ damage. This is a life-threatening, unstable
condition requiring immediate escalation of care (e.g., increasing oxygen, suctioning,
notifying the provider).
● Client 3 (Secondary Priority): The client in pain (6/10) has a physiological need, but it is
not immediately life-threatening. Pain management is a high priority (often considered the
"fifth vital sign"), but strictly speaking, it follows the preservation of life (breathing).
● Client 1 (Tertiary Priority): The diabetic foot check represents a Safety and Prevention
need. While important to prevent future complications (ulcers/amputation), it is not an
acute emergency.
● Client 4 (Lowest Priority): Discharge education falls under Health Promotion and
Self-Actualization. This can be delayed until the physiological crises of the other clients
are managed.
The nurse must demonstrate the ability to distinguish between "acute" (hypoxia) and
"chronic/stable" (diabetes maintenance) and between "physiological survival" (oxygen) and
