Test Bank For Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 8th Edition

Name: Test Bank For Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 8th Edition
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Lewis: Medical-Surgical Nursing, 8th Edition
Chapter 1: Contemporary Nursing Practice
Test Bank
MULTIPLE CHOICE
1. The nurse has admitted a patient with a new diagnosis of pneumonia and explained
to the patient that together they will plan the patient’s care and set goals for discharge.
The patient says, “How is that different from what the doctor does?” Which response
by the nurse is most appropriate?
a. “The role of the nurse is to administer medications and other treatments prescribed by your
b. “The nurse’s job is to help the doctor by collecting data and communicating when there are
c.
“Nurses perform many of the procedures done by physicians, but nurses are here in the hos
time than doctors.”
d.
“In addition to caring for you while you are sick, the nurses will assist you to develop an in
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: Comprehension REF: 3
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. When providing patient care using evidence-based practice, the nurse uses
a. clinical judgment based on experience.
b. evidence from a clinical research study.
c. evidence-based guidelines in addition to clinical expertise.
d. evaluation of data showing that the patient outcomes are met.
ANS: C
Evidence-based practice (EBP) is the use of the best research-based evidence
combined with clinician expertise. Clinical judgment based on the nurse’s clinical
experience is part of EBP, but clinical decision making also should incorporate
current research and research-based guidelines. Evidence from one clinical research
study does not provide an adequate substantiation for interventions. Evaluation of

patient outcomes is important, but interventions should be based on research from
randomized control studies with a large number of subjects.
DIF: Cognitive Level: Comprehension REF: 6-8 TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
3. The nurse primarily uses the nursing process in the care of patients
a. to explain nursing interventions to other health care professionals
b. as a problem-solving tool to identify and treat patients’ health care needs
c. as a scientific-based process of diagnosing the patient’s health care problems
d. to establish 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: Comprehension REF: 10
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
4. The nurse plans an every 2-hour turning schedule to prevent skin breakdown for a
critically ill patient in the intensive care unit. In this case, the nursing action is
considered to be
a. dependent.
b. cooperative.
c. independent.
d. collaborative.
ANS: D
When implementing collaborative nursing actions, the nurse is responsible primarily
for monitoring for complications of acute illness or providing care to prevent or treat
complications. Independent nursing actions are focused on health promotion, illness
prevention, and patient advocacy. A dependent action would require a physician order
to implement. Cooperative nursing functions are not described as one of the formal
nursing functions.
DIF: Cognitive Level: Application REF: 10-11
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

5. A patient who has been admitted to the hospital for surgery tells the nurse, “I do not
feel right about leaving my children with my neighbor.” 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. Call the neighbor to determine whether adequate childcare is being provided.
d. Gather more data about the patient’s feelings about the childcare arrangements.
ANS: D
Since 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: Application REF: 11
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
6. A patient with a stroke is paralyzed on the left side of the body and has developed a
pressure ulcer on the left hip. The best nursing diagnosis for this patient is
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: Application REF: 11 TOP: Nursing Process: Diagnosis
MSC: NCLEX: Physiological Integrity

7. A patient with an infection has a nursing diagnosis of deficient fluid volume related
to excessive diaphoresis. An appropriate patient outcome identified by the nurse is
that the
a. patient has a balanced intake and output.
b. patient’s bedding is changed when it becomes damp.
c. patient understands the need for increased fluid intake.
d. patient’s skin remains cool and dry throughout hospitalization.
ANS: A
This statement gives measurable data showing resolution of the problem of deficient
fluid volume that was identified in the nursing diagnosis statement. The other
statements would not indicate that the problem of deficient fluid volume was resolved.
DIF: Cognitive Level: Application REF: 13 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
8. A nursing activity that is carried out during the evaluation phase of the nursing
process is
a. determining if interventions have been effective in meeting patient outcomes.
b. documenting the nursing care plan in the progress notes in the medical record.
c. deciding whether the patient’s health problems have been completely resolved.
d. asking the patient to evaluate whether the nursing care provided was satisfactory.
ANS: A
Evaluation consists of determining whether the desired patient outcomes have been
met and whether the nursing interventions were appropriate. The other responses do
not describe the evaluation phase.
DIF: Cognitive Level: Comprehension REF: 16 TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment
9. During the assessment phase of the nursing process, the nurse
a. obtains data with which to diagnose patient problems.
b. uses patient data to develop priority nursing diagnoses.
c. teaches interventions to relieve patient health problems.
d. helps the patient identify realistic outcomes to health problems.
ANS: A

During the assessment phase, the nurse gathers information about the patient. The
other responses are examples of the intervention, diagnosis, and planning phases of
the nursing process.
DIF: Cognitive Level: Knowledge REF: 11
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
10. An example of a correctly written nursing diagnosis statement is
a. altered tissue perfusion related to heart failure.
b. risk for impaired tissue integrity related to sacral redness.
c. ineffective coping related to response to biopsy test results.
d. altered urinary elimination related to urinary tract infection.
ANS: C
This diagnosis statement includes a NANDA nursing diagnosis and an etiology that
describes a patient’s response to a health problem that can be treated by nursing. The
use of a medical diagnosis (as in the responses beginning “Altered tissue perfusion”
and “Altered urinary elimination”) is not appropriate. The response beginning “Risk
for impaired tissue integrity” uses the defining characteristics as the etiology.
DIF: Cognitive Level: Comprehension REF: 11-13 TOP: Nursing Process: Diagnosis
MSC: NCLEX: Safe and Effective Care Environment
11. The nurse writes a complete nursing diagnosis statement by including
a. a problem and the suggested patient goals or outcomes.
b. a

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DIF: Cognitive Level: Application REF: 15-16 | eFig. 1-1
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
15. Which of these tasks is appropriate for the registered nurse to delegate to a
licensed practical/vocational nurse?
a. Perform a sterile dressing change for an infected wound.
b. Complete the initial admission assessment and plan of care.
c. Teach a patient about the effects of prescribed medications.
d. Document patient teaching about a routine surgical procedure.
ANS: A
The education and scope of practice of the LPN/LVN include activities such as sterile
dressing changes. Patient teaching and the initial assessment and development of the
plan of care are nursing actions that require RN-level education and scope of practice.
DIF: Cognitive Level: Comprehension REF: 15
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
Chapter 2: Health Disparities and
Culturally Competent Care
Lewis: Medical-Surgical Nursing, 8th Edition
Chapter 2: Health Disparities and Culturally Competent Care
Test Bank
MULTIPLE CHOICE
1. The nurse obtains information about all these areas during the health interview for a
new patient. Which area will be the focus of patient teaching?
a. Age and gender
b. Hispanic/Latino ethnicity
c.

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will be useful as the nurse develops an individualized plan for improving the patient’s
health, but will not be the focus of patient education.
DIF: Cognitive Level: Application REF: 20-21 TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
2. When developing strategies to decrease health care disparities, the nurse working in
a clinic located in a neighborhood with many Vietnamese individuals will include
a. improving public transportation.
b. obtaining low-cost medications.
c. updating equipment and supplies for the clinic.
d. educating staff about Vietnamese health beliefs.
ANS: D
Health care disparities are due to stereotyping, biases, and prejudice of health care
providers; the nurse can decrease these through staff education. The other strategies
also may be addressed by the nurse but will not impact health disparities.
DIF: Cognitive Level: Application REF: 21-23 | 32 TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
3. Which information will the nurse need to collect when assessing the health status of
a community?
a. Average income of community members
b. Morning traffic patterns in the community
c. Median life expectancy for the community
d. Occupations of individuals in the community

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a. avoid asking any questions unless the patient initiates conversation.
b. ask the patient whether it is important that cultural healers are contacted.
c. explain the usual hospital routines for meal times, care, and family visits.
d. obtain further information about the patient’s cultural beliefs from the daughter.
ANS: B
Because the patient has traditional health care beliefs, it is appropriate for the nurse to
ask whether the patient would like a visit by acurandero(a) or other cultural healers.
There is no cultural reason for the nurse to avoid asking the patient questions, and
questions may be necessary to obtain necessary health information. The patient (rather
than the daughter) should be consulted about personal cultural beliefs. The hospital
routines for meals, care, and visits should be adapted to the patient’s preferences
rather than expecting the patient to adapt to the hospital schedule.
DIF: Cognitive Level: Application REF: 26
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
5. When caring for a patient who is Native American, the best initial action by the
nurse is to
a. avoid all eye contact with the patient.
b. observe the patient’s use of eye contact.

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b. palpate the patient’s scalp.
c. call for a medical interpreter.
d. avoid eye contact with the patient.
ANS: B
Many people of Asian ethnicity believe that touching a person’s head is disrespectful;
the RN should ask permission before touching the patient’s head. The other actions
are appropriate.
DIF: Cognitive Level: Application REF: 29
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7. If an interpreter is not available when a patient speaks a language different from the
nurse’s language, it is appropriate for the nurse to
a. use specific

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interfere with Western therapies. It may be appropriate for the patient to continue
some culturally based treatments while he or she is hospitalized.
DIF: Cognitive Level: Comprehension REF: 30-31 TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
9. The best example of culturally appropriate nursing care when caring for a newly
admitted patient is
a. having family members provide most of the patient’s personal care.
b. maintaining a personal space of at least 2 feet when assessing the patient.
c. asking permission before touching a patient

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DIF: Cognitive Level: Application REF: 31
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
11. An 82-year-old Asian American patient tells the nurse that she has lived in the
United States for 50 years. The patient speaks English but lives in a predominantly
Asian neighborhood. The nurse will need to
a. include a folk healer when planning the patient’s care.
b. ask the patient about any special cultural beliefs or practices.
c. avoid making direct eye contact with the patient during care.
d. involve the patient’s oldest son in making health care decisions.
ANS: B
Further assessment of the patient’s health care preferences is needed before making
further plans for culturally appropriate care. The other responses indicate stereotyping
of the patient, based on ethnicity, and would not be appropriate initial actions.
DIF: Cognitive Level: Application REF: 25 | 32 TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
12. When planning health care for a community with a large number of recent
immigrants from China, the most important intervention for the nurse to include is
a. pregnancy testing.
b. tuberculosis screening.
c. contraceptive teaching.
d. colonoscopy information.

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b. wait for the patient to answer the questions.
c. ask the patient why the questions require so much time to answer.
d. give the patient an assessment form listing the questions and a pen.
ANS: B
Patients from some cultures take time to consider a question carefully before
answering. The nurse will show respect for the patient and help develop a trusting
relationship by allowing the patient time to give a thoughtful answer. Asking the
patient why the answers are taking so much time, stopping the assessment, and
handing the patient a form indicate that the nurse does not have time for the patient.

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Further assessment of the patient’s cultural beliefs is appropriate before implementing
any interventions for a culture-bound syndrome such as empacho. Although
medication, a visit by a curandero(a), or massage may be helpful, more information
about the patient’s beliefs is needed to determine which intervention(s) will be most
helpful.
DIF: Cognitive Level: Application REF: 25 | 31-32
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
16. When performing a cultural assessment with a patient of a different culture, the
nurse’s first action should be to
a. wait until a cultural healer is available to help with the assessment.
b. obtain a list of any cultural remedies that

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