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 Practice — Definitions
of Nursing / Scope of Nursing Practice
Stem: A newly licensed RN is caring for an older adult admitted
with dehydration. The RN notes the UAP recorded minimal oral
intake and concentrated urine. Which action by the RN best
reflects professional scope and prioritizes patient safety while
practicing at the top of licensure?
,A. Ask the UAP to offer the patient additional fluid every 30
minutes and document completion.
B. Perform a focused assessment for dehydration, notify the
provider, and start prescribed IV fluids.
C. Delegate to the LPN to assess skin turgor and administer oral
rehydration solution.
D. Document the UAP’s findings and wait until the scheduled
RN oncoming shift to act.
Correct answer: B
Rationales — Correct (B): This choice reflects RN scope:
recognize (concentrated urine, low intake), analyze (risk for
hypovolemia), plan (need for IV fluids), intervene (initiate
prescribed IV fluids) and evaluate response. Lewis emphasizes
the RN’s responsibility for comprehensive assessment and
initiation of timely interventions for fluid imbalance to prevent
complications. This is highest priority for patient safety and
within RN licensure.
Rationales — Incorrect:
A. Delegating provision of fluids without RN assessment
overlooks clinical judgment and may miss need for IV therapy.
C. Delegating initial assessment to LPN delays RN’s required
comprehensive assessment; LPN cannot independently start IV
fluids.
D. Waiting delays necessary treatment and breaches standards
of care; unsafe when dehydration risk exists.
,Teaching point: RN must assess and initiate timely interventions
for dehydration to prevent hypovolemia.
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 Practice — Standards
of Professional Nursing Practice
Stem: While orienting to a new unit, the RN reviews the nursing
standards used to evaluate care quality. Which activity best
demonstrates adherence to professional nursing standards?
A. Completing only required documentation to save charting
time.
B. Following evidence-based protocols, accurately documenting
assessment findings, and participating in care audits.
C. Allowing experienced colleagues to make all care decisions
without input.
D. Delegating all patient teaching to the unit educator.
Correct answer: B
Rationales — Correct (B): This aligns with professional
standards: integrating evidence-based protocols, accurate
documentation, and quality improvement participation. Using
clinical judgment, the RN recognizes gaps, analyzes data, plans
and evaluates care quality—consistent with Lewis’s standards
for professional practice.
, Rationales — Incorrect:
A. Minimal documentation fails to meet standards and
jeopardizes continuity and legal record.
C. Abdicating decision-making neglects RN accountability and
compromises patient-centered care.
D. Delegating all teaching ignores RN’s role in patient education
and violates scope.
Teaching point: Follow standards by using evidence-based
protocols, accurate documentation, and QI participation.
Citation: Harding et al. (2023). Lewis’s Medical-Surgical Nursing.
Ch. 1.
3)
Reference: Ch. 1 — Professional Nursing Practice — Nursing’s
View of Humanity / Patient-Centered Care
Stem: A patient with multiple chronic illnesses expresses fear
about discharge and managing medications at home. Using a
patient-centered approach, what is the RN’s best initial action?
A. Provide the written discharge instructions and ask family to
review them later.
B. Assess the patient’s understanding, identify barriers, and
collaborate with the team to create a tailored plan.
C. Schedule a follow-up appointment in 2 weeks and assume
patient will manage.
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 Practice — Definitions
of Nursing / Scope of Nursing Practice
Stem: A newly licensed RN is caring for an older adult admitted
with dehydration. The RN notes the UAP recorded minimal oral
intake and concentrated urine. Which action by the RN best
reflects professional scope and prioritizes patient safety while
practicing at the top of licensure?
,A. Ask the UAP to offer the patient additional fluid every 30
minutes and document completion.
B. Perform a focused assessment for dehydration, notify the
provider, and start prescribed IV fluids.
C. Delegate to the LPN to assess skin turgor and administer oral
rehydration solution.
D. Document the UAP’s findings and wait until the scheduled
RN oncoming shift to act.
Correct answer: B
Rationales — Correct (B): This choice reflects RN scope:
recognize (concentrated urine, low intake), analyze (risk for
hypovolemia), plan (need for IV fluids), intervene (initiate
prescribed IV fluids) and evaluate response. Lewis emphasizes
the RN’s responsibility for comprehensive assessment and
initiation of timely interventions for fluid imbalance to prevent
complications. This is highest priority for patient safety and
within RN licensure.
Rationales — Incorrect:
A. Delegating provision of fluids without RN assessment
overlooks clinical judgment and may miss need for IV therapy.
C. Delegating initial assessment to LPN delays RN’s required
comprehensive assessment; LPN cannot independently start IV
fluids.
D. Waiting delays necessary treatment and breaches standards
of care; unsafe when dehydration risk exists.
,Teaching point: RN must assess and initiate timely interventions
for dehydration to prevent hypovolemia.
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 Practice — Standards
of Professional Nursing Practice
Stem: While orienting to a new unit, the RN reviews the nursing
standards used to evaluate care quality. Which activity best
demonstrates adherence to professional nursing standards?
A. Completing only required documentation to save charting
time.
B. Following evidence-based protocols, accurately documenting
assessment findings, and participating in care audits.
C. Allowing experienced colleagues to make all care decisions
without input.
D. Delegating all patient teaching to the unit educator.
Correct answer: B
Rationales — Correct (B): This aligns with professional
standards: integrating evidence-based protocols, accurate
documentation, and quality improvement participation. Using
clinical judgment, the RN recognizes gaps, analyzes data, plans
and evaluates care quality—consistent with Lewis’s standards
for professional practice.
, Rationales — Incorrect:
A. Minimal documentation fails to meet standards and
jeopardizes continuity and legal record.
C. Abdicating decision-making neglects RN accountability and
compromises patient-centered care.
D. Delegating all teaching ignores RN’s role in patient education
and violates scope.
Teaching point: Follow standards by using evidence-based
protocols, accurate documentation, and QI participation.
Citation: Harding et al. (2023). Lewis’s Medical-Surgical Nursing.
Ch. 1.
3)
Reference: Ch. 1 — Professional Nursing Practice — Nursing’s
View of Humanity / Patient-Centered Care
Stem: A patient with multiple chronic illnesses expresses fear
about discharge and managing medications at home. Using a
patient-centered approach, what is the RN’s best initial action?
A. Provide the written discharge instructions and ask family to
review them later.
B. Assess the patient’s understanding, identify barriers, and
collaborate with the team to create a tailored plan.
C. Schedule a follow-up appointment in 2 weeks and assume
patient will manage.
