Test Bank For
Lewis\'s Medical-
Surgical Nursing,
12th Edition by
Mariann M.
Harding, Jeffrey
Kwong, Debra
Hagler
Chapter 1-69
,Chapter 01: Professional Nursing
Harding: Lewis’s Medical-Surgical Nursing, 12th 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 asks, “How is this different from
what the physician does?” Which response would the nurse provide?
a. “The role of the nurse is to administer medications and other treatments prescribed
by your physician.”
b. “In addition to caring for you while you are sick, the nurses will help you plan to
maintain your health.”
c. “The nurse‘s job is to collect information and communicate any problems that
occur to the physician.”
d. “Nurses perform many of the same procedures as the physician, but nurses are
with the patients for a longer time than the physician.”
ANS: B
The American Nurses Association (ANA) definition of nursing describes the role of nurses in
promoting health. The other responses describe dependent and collaborative functions of the
nursing role but do not accurately describe the nurse‘s unique role in the health care system.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. Which statement by the nurse accurately describes the use of evidence-based practice (EBP)?
a. “Patient care is based on clinical judgment, experience, and traditions.”
b. “Data are analyzed later to show that the patient outcomes are consistently met.”
c. “Research from all published articles are used as a guide for planning patient care.”
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 with
clinician expertise and consideration of patient preferences. 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 data analysis is not required to use EBP. All published articles do not provide
research evidence; interventions should be based on credible research, preferably randomized
controlled studies with a large number of subjects.
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
3. Which statement by the nurse provides a clear explanation of the nursing process?
a. “The nursing process is a research method of diagnosing the patient‘s health care
problems.”
b. “The nursing process is used primarily to explain nursing interventions to other
health care professionals.”
c. “The nursing process is a problem-solving tool used to identify and manage the
, patients‘ health care needs.”
d. “The nursing process is based on nursing theory that incorporates the
biopsychosocial nature of humans.”
ANS: C
The nursing process is a problem-solving approach to the identification and treatment of
patients‘ problems. Nursing process does not require research methods for diagnosis. 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) TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment
4. A patient admitted to the hospital for surgery tells the nurse, “I do not feel comfortable
leaving my children with my parents.” Which action would 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 information on the patient‘s concerns 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 intervention
can be chosen.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
5. A patient with a bacterial infection is hypovolemic due to a fever and excessive diaphoresis.
Which expected outcome would the nurse select for this patient?
a. Patient has a balanced intake and output.
b. Patient‘s bedding is kept clean and free of moisture.
c. Patient understands the need for increased fluid intake.
d. Patient‘s skin remains cool and dry throughout hospitalization.
ANS: A
Balanced intake and output gives measurable data showing resolution of the problem of
deficient fluid volume. The other statements would not indicate that the problem of
hypovolemia was resolved.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
6. Which statement describes the purpose of the evaluation phase of the nursing process?
a. To document the nursing care plan in the progress notes of the health record
b. To determine if interventions have been effective in meeting patient outcomes
c. To decide whether the patient‘s health problems have been completely resolved
d. To establish if the patient agrees that the nursing care provided was satisfactory
ANS: B
, Evaluation11consists11of11determining11whether11the11desired11patient11outcomes11have11be
en11met11and11whether11the11nursing11interventions11were11appropriate.11The11other11respons
es11do11not11describe11the11evaluation11phase.
DIF: Cognitive11Level:11Understand11(Comprehension)
TOP:1 1 Nursing11Process:11Evaluation11MSC:1 1 NCLEX:11Safe11and11Effective11Care11Enviro
nment
7. Which11statement11describes11the11purpose11of11the11assessment11phase11of11the11nursing11process?
a. To11teach11interventions11that11relieve11health11problems
b. To11use11patient11data11to11evaluate11patient11care11outcomes
c. To11obtain11data11to11diagnose11patient11strengths11and11problems
d. To11help11the11patient11identify11realistic11outcomes11for11health11problems
ANS:1 1 C
During11the11assessment11phase,11the11nurse11gathers11information11about11the11patient11to11di
agnose11patient11strengths11and11problems.11The11other11responses11are11examples11of11the11p
lanning,11intervention,11and11evaluation11phases11of11the11nursing11process.
DIF: Cognitive11Level:11Understand11(Comprehension)
TOP:1 1 Nursing11Process:11Assessment MSC:1 1 NCLEX:11Safe11and11Effective11Care11Environment
8. When11developing11the11plan11of11care,11which11components11would11the11nurse11include11in
11the11clinical11problem11statement?
a. The11problem11and11the11suggested11patient11goals11or11outcomes
b. The11problem,11its11causes,11and11the11signs11and11symptoms11of11the11problem
c. The11problem11with11the11possible11etiology11and11the11planned11interventions
d. The11problem,11its11pathophysiology,11and11the11expected11outcome
ANS:1 1 B
When11writing11clinical11problems11or11nursing11diagnoses,11the11subjective11as11well11as11ob
jective11data11to11support11the11problem‘s11existence11should11be11included.11Goals,11outcome
s,11and11interventions11are11not11included11in11the11problem11statement.
DIF: Cognitive11Level:11Understand11(Comprehension)
TOP:1 1 Nursing11Process:11Diagnosis11MSC:1 1 NCLEX:11Safe11and11Effective11Care11Enviro
nment
9. Which11patient11care11task11would11the11nurse11delegate11to11experienced11assistive11personnel11(AP
)?
a. Instruct11the11patient11about11the11need11to11alternate11activity11and11rest.
b. Monitor11level11of11shortness11of11breath11or11fatigue11after11ambulation.
c. Obtain11the11patient‘s11blood11pressure11and11pulse11rate11after11ambulation.
d. Determine11whether11the11patient11is11ready11to11increase11the11activity11level.
ANS:1 1 C
AP11education11includes11accurate11vital11sign11measurement.11Assessment11and11patient11tea
ching11require11registered11nurse11education11and11scope11of11practice11and11cannot11be11deleg
ated.
DIF: Cognitive11Level:11Apply11(Application)
TOP:1 1 Nursing11Process:11Planning11MSC:1 1 NCLEX:11Safe11and11Effective11Care11Enviro
nment
Lewis\'s Medical-
Surgical Nursing,
12th Edition by
Mariann M.
Harding, Jeffrey
Kwong, Debra
Hagler
Chapter 1-69
,Chapter 01: Professional Nursing
Harding: Lewis’s Medical-Surgical Nursing, 12th 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 asks, “How is this different from
what the physician does?” Which response would the nurse provide?
a. “The role of the nurse is to administer medications and other treatments prescribed
by your physician.”
b. “In addition to caring for you while you are sick, the nurses will help you plan to
maintain your health.”
c. “The nurse‘s job is to collect information and communicate any problems that
occur to the physician.”
d. “Nurses perform many of the same procedures as the physician, but nurses are
with the patients for a longer time than the physician.”
ANS: B
The American Nurses Association (ANA) definition of nursing describes the role of nurses in
promoting health. The other responses describe dependent and collaborative functions of the
nursing role but do not accurately describe the nurse‘s unique role in the health care system.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. Which statement by the nurse accurately describes the use of evidence-based practice (EBP)?
a. “Patient care is based on clinical judgment, experience, and traditions.”
b. “Data are analyzed later to show that the patient outcomes are consistently met.”
c. “Research from all published articles are used as a guide for planning patient care.”
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 with
clinician expertise and consideration of patient preferences. 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 data analysis is not required to use EBP. All published articles do not provide
research evidence; interventions should be based on credible research, preferably randomized
controlled studies with a large number of subjects.
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
3. Which statement by the nurse provides a clear explanation of the nursing process?
a. “The nursing process is a research method of diagnosing the patient‘s health care
problems.”
b. “The nursing process is used primarily to explain nursing interventions to other
health care professionals.”
c. “The nursing process is a problem-solving tool used to identify and manage the
, patients‘ health care needs.”
d. “The nursing process is based on nursing theory that incorporates the
biopsychosocial nature of humans.”
ANS: C
The nursing process is a problem-solving approach to the identification and treatment of
patients‘ problems. Nursing process does not require research methods for diagnosis. 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) TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment
4. A patient admitted to the hospital for surgery tells the nurse, “I do not feel comfortable
leaving my children with my parents.” Which action would 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 information on the patient‘s concerns 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 intervention
can be chosen.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
5. A patient with a bacterial infection is hypovolemic due to a fever and excessive diaphoresis.
Which expected outcome would the nurse select for this patient?
a. Patient has a balanced intake and output.
b. Patient‘s bedding is kept clean and free of moisture.
c. Patient understands the need for increased fluid intake.
d. Patient‘s skin remains cool and dry throughout hospitalization.
ANS: A
Balanced intake and output gives measurable data showing resolution of the problem of
deficient fluid volume. The other statements would not indicate that the problem of
hypovolemia was resolved.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
6. Which statement describes the purpose of the evaluation phase of the nursing process?
a. To document the nursing care plan in the progress notes of the health record
b. To determine if interventions have been effective in meeting patient outcomes
c. To decide whether the patient‘s health problems have been completely resolved
d. To establish if the patient agrees that the nursing care provided was satisfactory
ANS: B
, Evaluation11consists11of11determining11whether11the11desired11patient11outcomes11have11be
en11met11and11whether11the11nursing11interventions11were11appropriate.11The11other11respons
es11do11not11describe11the11evaluation11phase.
DIF: Cognitive11Level:11Understand11(Comprehension)
TOP:1 1 Nursing11Process:11Evaluation11MSC:1 1 NCLEX:11Safe11and11Effective11Care11Enviro
nment
7. Which11statement11describes11the11purpose11of11the11assessment11phase11of11the11nursing11process?
a. To11teach11interventions11that11relieve11health11problems
b. To11use11patient11data11to11evaluate11patient11care11outcomes
c. To11obtain11data11to11diagnose11patient11strengths11and11problems
d. To11help11the11patient11identify11realistic11outcomes11for11health11problems
ANS:1 1 C
During11the11assessment11phase,11the11nurse11gathers11information11about11the11patient11to11di
agnose11patient11strengths11and11problems.11The11other11responses11are11examples11of11the11p
lanning,11intervention,11and11evaluation11phases11of11the11nursing11process.
DIF: Cognitive11Level:11Understand11(Comprehension)
TOP:1 1 Nursing11Process:11Assessment MSC:1 1 NCLEX:11Safe11and11Effective11Care11Environment
8. When11developing11the11plan11of11care,11which11components11would11the11nurse11include11in
11the11clinical11problem11statement?
a. The11problem11and11the11suggested11patient11goals11or11outcomes
b. The11problem,11its11causes,11and11the11signs11and11symptoms11of11the11problem
c. The11problem11with11the11possible11etiology11and11the11planned11interventions
d. The11problem,11its11pathophysiology,11and11the11expected11outcome
ANS:1 1 B
When11writing11clinical11problems11or11nursing11diagnoses,11the11subjective11as11well11as11ob
jective11data11to11support11the11problem‘s11existence11should11be11included.11Goals,11outcome
s,11and11interventions11are11not11included11in11the11problem11statement.
DIF: Cognitive11Level:11Understand11(Comprehension)
TOP:1 1 Nursing11Process:11Diagnosis11MSC:1 1 NCLEX:11Safe11and11Effective11Care11Enviro
nment
9. Which11patient11care11task11would11the11nurse11delegate11to11experienced11assistive11personnel11(AP
)?
a. Instruct11the11patient11about11the11need11to11alternate11activity11and11rest.
b. Monitor11level11of11shortness11of11breath11or11fatigue11after11ambulation.
c. Obtain11the11patient‘s11blood11pressure11and11pulse11rate11after11ambulation.
d. Determine11whether11the11patient11is11ready11to11increase11the11activity11level.
ANS:1 1 C
AP11education11includes11accurate11vital11sign11measurement.11Assessment11and11patient11tea
ching11require11registered11nurse11education11and11scope11of11practice11and11cannot11be11deleg
ated.
DIF: Cognitive11Level:11Apply11(Application)
TOP:1 1 Nursing11Process:11Planning11MSC:1 1 NCLEX:11Safe11and11Effective11Care11Enviro
nment
