Test Bank For Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 9th Edition
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Chapter 1: Professional Nursing Practice
Chapter 1: Professional Nursing Practice
Test Bank
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 states, “How is
this different from what the doctor does?” Which response would be most appropriate
for the nurse to make?
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 information and communicating any pro
occur.”
c.
“Nurses perform many of the same procedures as the doctor, but nurses are with the patien
time than the doctor.”
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: Understand (comprehension) REF: 3
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. The nurse describes to a student nurse how to use evidence-based practice
guidelines when caring for patients. Which statement, if made by the nurse, would be
the most accurate?
a. “Inferences from clinical research studies are used as a guide.”
b. “Patient care is based on clinical judgment, experience, and traditions.”
c. “Data are evaluated to show that the patient outcomes are consistently met.”
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. Clinical judgment based on the nurse’s clinical
experience is part of EBP, but clinical decision making should also incorporate
Chapter 1: Professional Nursing Practice
Test Bank
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 states, “How is
this different from what the doctor does?” Which response would be most appropriate
for the nurse to make?
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 information and communicating any pro
occur.”
c.
“Nurses perform many of the same procedures as the doctor, but nurses are with the patien
time than the doctor.”
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: Understand (comprehension) REF: 3
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. The nurse describes to a student nurse how to use evidence-based practice
guidelines when caring for patients. Which statement, if made by the nurse, would be
the most accurate?
a. “Inferences from clinical research studies are used as a guide.”
b. “Patient care is based on clinical judgment, experience, and traditions.”
c. “Data are evaluated to show that the patient outcomes are consistently met.”
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. Clinical judgment based on the nurse’s clinical
experience is part of EBP, but clinical decision making should also incorporate
Chapter 1: Professional Nursing Practice
Chapter 1: Professional Nursing Practice
Test Bank
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 states, “How is
this different from what the doctor does?” Which response would be most appropriate
for the nurse to make?
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 information and communicating any pro
occur.”
c.
“Nurses perform many of the same procedures as the doctor, but nurses are with the patien
time than the doctor.”
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: Understand (comprehension) REF: 3
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. The nurse describes to a student nurse how to use evidence-based practice
guidelines when caring for patients. Which statement, if made by the nurse, would be
the most accurate?
a. “Inferences from clinical research studies are used as a guide.”
b. “Patient care is based on clinical judgment, experience, and traditions.”
c. “Data are evaluated to show that the patient outcomes are consistently met.”
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. Clinical judgment based on the nurse’s clinical
experience is part of EBP, but clinical decision making should also incorporate
Chapter 1: Professional Nursing Practice
Test Bank
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 states, “How is
this different from what the doctor does?” Which response would be most appropriate
for the nurse to make?
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 information and communicating any pro
occur.”
c.
“Nurses perform many of the same procedures as the doctor, but nurses are with the patien
time than the doctor.”
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: Understand (comprehension) REF: 3
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. The nurse describes to a student nurse how to use evidence-based practice
guidelines when caring for patients. Which statement, if made by the nurse, would be
the most accurate?
a. “Inferences from clinical research studies are used as a guide.”
b. “Patient care is based on clinical judgment, experience, and traditions.”
c. “Data are evaluated to show that the patient outcomes are consistently met.”
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. 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 interventions should be based on research from randomized control
studies with a large number of subjects.
DIF: Cognitive Level: Remember (knowledge) REF: 11
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
3. The nurse teaches a student nurse about how to apply the nursing process when
providing patient care. Which statement, if made by the student nurse, indicates that
teaching was successful?
a. “The nursing process is a scientific-based method of diagnosing the patient’s health care pr
b. “The nursing process is a problem-solving tool used to identify and treat patients’ health ca
c. “The nursing process is based on nursing theory that incorporates the biopsychosocial natu
d. “The nursing process is used primarily to explain nursing interventions to other health care
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: Understand (comprehension) REF: 7
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
4. A patient has been admitted to the hospital for surgery and tells the nurse, “I do not
feel comfortable leaving my children with my parents.” 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. Gather more data about the patient’s feelings about the child-care arrangements.
d. Call the patient’s parents to determine whether adequate child care is being provided.
ANS: C
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: Apply (application) REF: 6-7
important, but interventions should be based on research from randomized control
studies with a large number of subjects.
DIF: Cognitive Level: Remember (knowledge) REF: 11
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
3. The nurse teaches a student nurse about how to apply the nursing process when
providing patient care. Which statement, if made by the student nurse, indicates that
teaching was successful?
a. “The nursing process is a scientific-based method of diagnosing the patient’s health care pr
b. “The nursing process is a problem-solving tool used to identify and treat patients’ health ca
c. “The nursing process is based on nursing theory that incorporates the biopsychosocial natu
d. “The nursing process is used primarily to explain nursing interventions to other health care
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: Understand (comprehension) REF: 7
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
4. A patient has been admitted to the hospital for surgery and tells the nurse, “I do not
feel comfortable leaving my children with my parents.” 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. Gather more data about the patient’s feelings about the child-care arrangements.
d. Call the patient’s parents to determine whether adequate child care is being provided.
ANS: C
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: Apply (application) REF: 6-7
current research and research-based guidelines. 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: Remember (knowledge) REF: 11
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
3. The nurse teaches a student nurse about how to apply the nursing process when
providing patient care. Which statement, if made by the student nurse, indicates that
teaching was successful?
a. “The nursing process is a scientific-based method of diagnosing the patient’s health care pr
b. “The nursing process is a problem-solving tool used to identify and treat patients’ health ca
c. “The nursing process is based on nursing theory that incorporates the biopsychosocial natu
d. “The nursing process is used primarily to explain nursing interventions to other health care
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: Understand (comprehension) REF: 7
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
4. A patient has been admitted to the hospital for surgery and tells the nurse, “I do not
feel comfortable leaving my children with my parents.” 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. Gather more data about the patient’s feelings about the child-care arrangements.
d. Call the patient’s parents to determine whether adequate child care is being provided.
ANS: C
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: Apply (application) REF: 6-7
important, but interventions should be based on research from randomized control
studies with a large number of subjects.
DIF: Cognitive Level: Remember (knowledge) REF: 11
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
3. The nurse teaches a student nurse about how to apply the nursing process when
providing patient care. Which statement, if made by the student nurse, indicates that
teaching was successful?
a. “The nursing process is a scientific-based method of diagnosing the patient’s health care pr
b. “The nursing process is a problem-solving tool used to identify and treat patients’ health ca
c. “The nursing process is based on nursing theory that incorporates the biopsychosocial natu
d. “The nursing process is used primarily to explain nursing interventions to other health care
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: Understand (comprehension) REF: 7
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
4. A patient has been admitted to the hospital for surgery and tells the nurse, “I do not
feel comfortable leaving my children with my parents.” 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. Gather more data about the patient’s feelings about the child-care arrangements.
d. Call the patient’s parents to determine whether adequate child care is being provided.
ANS: C
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: Apply (application) REF: 6-7
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
5. A patient who is paralyzed on the left side of the body after a stroke develops a
pressure ulcer on the left hip. Which nursing diagnosis is most appropriate?
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: Apply (application) REF: 7-9
TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity
6. A patient with a bacterial infection has a nursing diagnosis of deficient fluid volume
related to excessive diaphoresis. Which outcome would the nurse recognize as
most appropriate for this patient?
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: Apply (application) REF: 7-9
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
MSC: NCLEX: Psychosocial Integrity
5. A patient who is paralyzed on the left side of the body after a stroke develops a
pressure ulcer on the left hip. Which nursing diagnosis is most appropriate?
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: Apply (application) REF: 7-9
TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity
6. A patient with a bacterial infection has a nursing diagnosis of deficient fluid volume
related to excessive diaphoresis. Which outcome would the nurse recognize as
most appropriate for this patient?
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: Apply (application) REF: 7-9
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
7. A nurse asks the patient if pain was relieved after receiving medication. What is the
purpose of the evaluation phase of the nursing process?
a. To determine if interventions have been effective in meeting patient outcomes
b. To document the nursing care plan in the progress notes of the medical record
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: 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: Understand (comprehension) REF: 7-9
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe and Effective Care Environment
8. The nurse interviews a patient while completing the health history and physical
examination. What is the purpose of the assessment phase of the nursing process?
a. To teach interventions that relieve health problems
b. To use patient data to evaluate patient care outcomes
c. To obtain data with which to diagnose patient problems
d. To help the patient identify realistic outcomes for health problems
ANS: C
During the assessment phase, the nurse gathers information about the patient to
diagnose patient problems. The other responses are examples of the planning,
intervention, and evaluation phases of the nursing process.
DIF: Cognitive Level: Understand (comprehension) REF: 7-9
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
9. Which nursing diagnosis statement is written correctly?
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
purpose of the evaluation phase of the nursing process?
a. To determine if interventions have been effective in meeting patient outcomes
b. To document the nursing care plan in the progress notes of the medical record
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: 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: Understand (comprehension) REF: 7-9
TOP: Nursing Process: Evaluation MSC: NCLEX: Safe and Effective Care Environment
8. The nurse interviews a patient while completing the health history and physical
examination. What is the purpose of the assessment phase of the nursing process?
a. To teach interventions that relieve health problems
b. To use patient data to evaluate patient care outcomes
c. To obtain data with which to diagnose patient problems
d. To help the patient identify realistic outcomes for health problems
ANS: C
During the assessment phase, the nurse gathers information about the patient to
diagnose patient problems. The other responses are examples of the planning,
intervention, and evaluation phases of the nursing process.
DIF: Cognitive Level: Understand (comprehension) REF: 7-9
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
9. Which nursing diagnosis statement is written correctly?
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 an etiology (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 characteristic as the
etiology.
DIF: Cognitive Level: Understand (comprehension) REF: 7
TOP: Nursing Process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment
10. The nurse admits a patient to the hospital and develops a plan of care. What
components should the nurse include in the nursing diagnosis statement?
a. The problem and the suggested patient goals or outcomes
b. The problem with possible causes and the planned interventions
c. The problem, its cause, and objective data that support the problem
d. The problem with an etiology and the signs and symptoms of the problem
ANS: D
When writing nursing diagnoses, this format should be used: problem, etiology, and
signs and symptoms. The subjective, as well as objective, data should be included in
the defining characteristics. Interventions and outcomes are not included in the
nursing diagnosis statement.
DIF: Cognitive Level: Remember (knowledge) REF: 8-9
TOP: Nursing Process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment
11. A nurse is caring for a patient with heart failure. Which task is appropriate for the
nurse to delegate to experienced unlicensed assistive personnel (UAP)?
a. Monitor for shortness of breath or fatigue after ambulation.
b. Instruct the patient about the need to alternate activity and rest.
c. Obtain the patient’s blood pressure and pulse rate after ambulation.
d. Determine whether the patient is ready to increase the activity level.
ANS: C
UAP education includes accurate vital sign measurement. Assessment and patient
teaching require registered nurse education and scope of practice and cannot be
delegated.
DIF: Cognitive Level: Apply (application) REF: 15
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
tissue perfusion” and “Altered urinary elimination”) is not appropriate. The response
beginning “Risk for impaired tissue integrity” uses the defining characteristic as the
etiology.
DIF: Cognitive Level: Understand (comprehension) REF: 7
TOP: Nursing Process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment
10. The nurse admits a patient to the hospital and develops a plan of care. What
components should the nurse include in the nursing diagnosis statement?
a. The problem and the suggested patient goals or outcomes
b. The problem with possible causes and the planned interventions
c. The problem, its cause, and objective data that support the problem
d. The problem with an etiology and the signs and symptoms of the problem
ANS: D
When writing nursing diagnoses, this format should be used: problem, etiology, and
signs and symptoms. The subjective, as well as objective, data should be included in
the defining characteristics. Interventions and outcomes are not included in the
nursing diagnosis statement.
DIF: Cognitive Level: Remember (knowledge) REF: 8-9
TOP: Nursing Process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment
11. A nurse is caring for a patient with heart failure. Which task is appropriate for the
nurse to delegate to experienced unlicensed assistive personnel (UAP)?
a. Monitor for shortness of breath or fatigue after ambulation.
b. Instruct the patient about the need to alternate activity and rest.
c. Obtain the patient’s blood pressure and pulse rate after ambulation.
d. Determine whether the patient is ready to increase the activity level.
ANS: C
UAP education includes accurate vital sign measurement. Assessment and patient
teaching require registered nurse education and scope of practice and cannot be
delegated.
DIF: Cognitive Level: Apply (application) REF: 15
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
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12. A nurse is caring for a group of patients on the medical-surgical unit with the help
of one float registered nurse (RN), one unlicensed assistive personnel (UAP), and one
licensed practical/vocational nurse (LPN/LVN). Which assignment, if delegated by
the nurse, would be inappropriate?
a. Measurement of a patient’s urine output by UAP
b. Administration of oral medications by LPN/LVN
c. Check for the presence of bowel sounds and flatulence by UAP
d. Care of a patient with diabetes by RN who usually works on the pediatric unit
ANS: C
Assessment requires RN education and scope of practice and cannot be delegated to
an LPN/LVN or UAP. The other assignments made by the RN are appropriate.
DIF: Cognitive Level: Apply (application) REF: 15-16
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
13. Which task is appropriate for the nurse to delegate to a licensed
practical/vocational nurse (LPN/LVN)?
a. Complete the initial admission assessment and plan of care.
b. Document teaching completed before a diagnostic procedure.
c. Instruct a patient about low-fat, reduced sodium dietary restrictions.
d. Obtain bedside blood glucose on a patient before insulin administration.
ANS: D
The education and scope of practice of the LPN/LVN include activities such as
obtaining glucose testing using a finger stick. Patient teaching and the initial
assessment and development of the plan of care are nursing actions that require
registered nurse education and scope of practice.
DIF: Cognitive Level: Apply (application) REF: 15-16
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
14. A nurse is assigned as a case manager for a hospitalized patient with a spinal cord
injury. The patient can expect the nurse functioning in this role to perform which
activity?
a. Care for the patient during hospitalization for the injuries.
of one float registered nurse (RN), one unlicensed assistive personnel (UAP), and one
licensed practical/vocational nurse (LPN/LVN). Which assignment, if delegated by
the nurse, would be inappropriate?
a. Measurement of a patient’s urine output by UAP
b. Administration of oral medications by LPN/LVN
c. Check for the presence of bowel sounds and flatulence by UAP
d. Care of a patient with diabetes by RN who usually works on the pediatric unit
ANS: C
Assessment requires RN education and scope of practice and cannot be delegated to
an LPN/LVN or UAP. The other assignments made by the RN are appropriate.
DIF: Cognitive Level: Apply (application) REF: 15-16
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
13. Which task is appropriate for the nurse to delegate to a licensed
practical/vocational nurse (LPN/LVN)?
a. Complete the initial admission assessment and plan of care.
b. Document teaching completed before a diagnostic procedure.
c. Instruct a patient about low-fat, reduced sodium dietary restrictions.
d. Obtain bedside blood glucose on a patient before insulin administration.
ANS: D
The education and scope of practice of the LPN/LVN include activities such as
obtaining glucose testing using a finger stick. Patient teaching and the initial
assessment and development of the plan of care are nursing actions that require
registered nurse education and scope of practice.
DIF: Cognitive Level: Apply (application) REF: 15-16
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
14. A nurse is assigned as a case manager for a hospitalized patient with a spinal cord
injury. The patient can expect the nurse functioning in this role to perform which
activity?
a. Care for the patient during hospitalization for the injuries.
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b. Assist the patient with home care activities during recovery.
c. Determine what medical care the patient needs for optimal rehabilitation.
d. Coordinate the services that the patient receives in the hospital and at home.
ANS: D
The role of the case manager is to coordinate the patient’s care through multiple
settings and levels of care to allow the maximal patient benefit at the least cost. The
case manager does not provide direct care in either the acute or home setting. The case
manager coordinates and advocates for care but does not determine what medical care
is needed; that would be completed by the health care provider or other provider.
DIF: Cognitive Level: Apply (application) REF: 15
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
15. The nurse is caring for an older adult patient who had surgery to repair a fractured
hip. The patient needs continued nursing care and physical therapy to improve
mobility before returning home. The nurse will help to arrange for transfer of this
patient to which facility?
a. A skilled care facility
b. A residential care facility
c. A transitional care facility
d. An intermediate care facility
ANS: C
Transitional care settings are appropriate for patients who need continued
rehabilitation before discharge to home or to long-term care settings. The patient is no
longer in need of the more continuous assessment and care given in acute care
settings. There is no indication that the patient will need the permanent and ongoing
medical and nursing services available in intermediate or skilled care. The patient is
not yet independent enough to transfer to a residential care facility.
DIF: Cognitive Level: Apply (application)
REF: eTable 1-1 | eTable 1-2 | eTable 1-3 TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
16. A home care nurse is planning care for a patient who has just been diagnosed with
type 2 diabetes mellitus. Which task is appropriate for the nurse to delegate to the
home health aide?
c. Determine what medical care the patient needs for optimal rehabilitation.
d. Coordinate the services that the patient receives in the hospital and at home.
ANS: D
The role of the case manager is to coordinate the patient’s care through multiple
settings and levels of care to allow the maximal patient benefit at the least cost. The
case manager does not provide direct care in either the acute or home setting. The case
manager coordinates and advocates for care but does not determine what medical care
is needed; that would be completed by the health care provider or other provider.
DIF: Cognitive Level: Apply (application) REF: 15
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
15. The nurse is caring for an older adult patient who had surgery to repair a fractured
hip. The patient needs continued nursing care and physical therapy to improve
mobility before returning home. The nurse will help to arrange for transfer of this
patient to which facility?
a. A skilled care facility
b. A residential care facility
c. A transitional care facility
d. An intermediate care facility
ANS: C
Transitional care settings are appropriate for patients who need continued
rehabilitation before discharge to home or to long-term care settings. The patient is no
longer in need of the more continuous assessment and care given in acute care
settings. There is no indication that the patient will need the permanent and ongoing
medical and nursing services available in intermediate or skilled care. The patient is
not yet independent enough to transfer to a residential care facility.
DIF: Cognitive Level: Apply (application)
REF: eTable 1-1 | eTable 1-2 | eTable 1-3 TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
16. A home care nurse is planning care for a patient who has just been diagnosed with
type 2 diabetes mellitus. Which task is appropriate for the nurse to delegate to the
home health aide?
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a. Assist the patient to choose appropriate foods.
b. Help the patient with a daily bath and oral care.
c. Check the patient’s feet for signs of breakdown.
d. Teach the patient how to monitor blood glucose.
ANS: B
Assisting with patient hygiene is included in home health-aide education and scope of
practice. Assessment of the patient and instructing the patient in new skills, such as
diet and blood glucose monitoring, are complex skills that are included in registered
nurse education and scope of practice.
DIF: Cognitive Level: Apply (application) REF: 14
OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
17. The nurse is providing education to nursing staff on quality care initiatives. Which
statement would be the most accurate description of the impact of health care
financing on quality care?
a. “Hospitals are reimbursed for all costs incurred if care is documented electronically.”
b. “Payment for patient care is primarily based on clinical outcomes and patient satisfaction.”
c. “If a patient develops a catheter-related infection, the hospital receives additional funding.”
d.
“Because hospitals are accountable for overall care, it is not nursing’s responsibility to mon
delivered by others.”
ANS: B
Payment for health care services programs reimburses hospitals for their performance
on overall quality-of-care measures. These measures include clinical outcomes and
patient satisfaction. Nurses are responsible for coordinating complex aspects of
patient care, including the care delivered by others, and identifying issues that are
associated with poor quality care. Payment for care can be withheld if something
happens to the patient that is considered preventable (e.g., acquiring a catheter-related
urinary tract infection).
DIF: Cognitive Level: Apply (application) REF: 4-5
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
18. The nurse documenting the patient’s progress in the care plan in the electronic
health record before an interdisciplinary discharge conference is demonstrating
competency in which QSEN category?
b. Help the patient with a daily bath and oral care.
c. Check the patient’s feet for signs of breakdown.
d. Teach the patient how to monitor blood glucose.
ANS: B
Assisting with patient hygiene is included in home health-aide education and scope of
practice. Assessment of the patient and instructing the patient in new skills, such as
diet and blood glucose monitoring, are complex skills that are included in registered
nurse education and scope of practice.
DIF: Cognitive Level: Apply (application) REF: 14
OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
17. The nurse is providing education to nursing staff on quality care initiatives. Which
statement would be the most accurate description of the impact of health care
financing on quality care?
a. “Hospitals are reimbursed for all costs incurred if care is documented electronically.”
b. “Payment for patient care is primarily based on clinical outcomes and patient satisfaction.”
c. “If a patient develops a catheter-related infection, the hospital receives additional funding.”
d.
“Because hospitals are accountable for overall care, it is not nursing’s responsibility to mon
delivered by others.”
ANS: B
Payment for health care services programs reimburses hospitals for their performance
on overall quality-of-care measures. These measures include clinical outcomes and
patient satisfaction. Nurses are responsible for coordinating complex aspects of
patient care, including the care delivered by others, and identifying issues that are
associated with poor quality care. Payment for care can be withheld if something
happens to the patient that is considered preventable (e.g., acquiring a catheter-related
urinary tract infection).
DIF: Cognitive Level: Apply (application) REF: 4-5
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
18. The nurse documenting the patient’s progress in the care plan in the electronic
health record before an interdisciplinary discharge conference is demonstrating
competency in which QSEN category?
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a. Patient-centered care
b. Quality improvement
c. Evidence-based practice
d. Informatics and technology
ANS: D
The nurse is displaying competency in the QSEN area of informatics and technology.
Using a computerized information system to document patient needs and progress and
communicate vital information regarding the patient with health care team members
provides evidence that nursing practice standards related to the nursing process have
been maintained during the care of the patient.
DIF: Cognitive Level: Apply (application) REF: 5 | 10-11
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. Which information will the nurse consider when deciding what nursing actions to
delegate to a licensed practical/vocational nurse (LPN/LVN) who is working on a
medical-surgical unit (select all that apply)?
a. Institutional policies
b. Stability of the patient
c. State nurse practice act
d. LPN/LVN teaching abilities
e. Experience of the LPN/LVN
ANS: A, B, C, E
The nurse should assess the experience of LPN/LVNs when delegating. In addition,
state nurse practice acts and institutional policies must be considered. In general,
LPN/LVN scope of practice includes caring for patients who are stable, while
registered nurses should provide most of the care for unstable patients. Since
LPN/LVN scope of practice does not include patient education, this will not be part of
the delegation process.
DIF: Cognitive Level: Apply (application) REF: 14
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
b. Quality improvement
c. Evidence-based practice
d. Informatics and technology
ANS: D
The nurse is displaying competency in the QSEN area of informatics and technology.
Using a computerized information system to document patient needs and progress and
communicate vital information regarding the patient with health care team members
provides evidence that nursing practice standards related to the nursing process have
been maintained during the care of the patient.
DIF: Cognitive Level: Apply (application) REF: 5 | 10-11
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. Which information will the nurse consider when deciding what nursing actions to
delegate to a licensed practical/vocational nurse (LPN/LVN) who is working on a
medical-surgical unit (select all that apply)?
a. Institutional policies
b. Stability of the patient
c. State nurse practice act
d. LPN/LVN teaching abilities
e. Experience of the LPN/LVN
ANS: A, B, C, E
The nurse should assess the experience of LPN/LVNs when delegating. In addition,
state nurse practice acts and institutional policies must be considered. In general,
LPN/LVN scope of practice includes caring for patients who are stable, while
registered nurses should provide most of the care for unstable patients. Since
LPN/LVN scope of practice does not include patient education, this will not be part of
the delegation process.
DIF: Cognitive Level: Apply (application) REF: 14
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
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2. The nurse is administering medications to a patient. Which actions by the nurse
during this process are consistent with promoting safe delivery of care (select all that
apply)?
a. Throws away a medication that is not labeled
b. Uses a hand sanitizer before preparing a medication
c. Identifies the patient by the room number on the door
d. Checks lab test results before administering a diuretic
e. Gives the patient a list of current medications upon discharge
ANS: A, B, D, E
National Patient Safety Goals have been established to promote safe delivery of care.
The nurse should use at least two reliable ways to identify the patient such as asking
the patient’s full name and date of birth before medication administration. Other
actions that improve patient safety include performing hand hygiene, disposing of
unlabeled medications, completing appropriate assessments before administering
medications, and giving a list of the current medicines to the patient and caregiver
before discharge.
DIF: Cognitive Level: Apply (application) REF: 15-16
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
OTHER
1. The nurse uses the Situation-Background-Assessment-Recommendation (SBAR)
format to communicate a change in patient status to a health care provider. In which
order should the nurse make the following statements? (Put a comma and a space
between each answer choice [A, B, C, D].)
a. “The patient needs to be evaluated immediately and may need intubation and
mechanical ventilation.”
b. “The patient was admitted yesterday with heart failure and has been receiving
furosemide (Lasix) for diuresis, but urine output has been low.”
c. “The patient has crackles audible throughout the posterior chest and the most recent
oxygen saturation is 89%. Her condition is very unstable.”
d. “This is the nurse on the surgical unit. After assessing the patient, I am very
concerned about increased shortness of breath over the past hour.”
ANS:
D, B, C, A
during this process are consistent with promoting safe delivery of care (select all that
apply)?
a. Throws away a medication that is not labeled
b. Uses a hand sanitizer before preparing a medication
c. Identifies the patient by the room number on the door
d. Checks lab test results before administering a diuretic
e. Gives the patient a list of current medications upon discharge
ANS: A, B, D, E
National Patient Safety Goals have been established to promote safe delivery of care.
The nurse should use at least two reliable ways to identify the patient such as asking
the patient’s full name and date of birth before medication administration. Other
actions that improve patient safety include performing hand hygiene, disposing of
unlabeled medications, completing appropriate assessments before administering
medications, and giving a list of the current medicines to the patient and caregiver
before discharge.
DIF: Cognitive Level: Apply (application) REF: 15-16
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
OTHER
1. The nurse uses the Situation-Background-Assessment-Recommendation (SBAR)
format to communicate a change in patient status to a health care provider. In which
order should the nurse make the following statements? (Put a comma and a space
between each answer choice [A, B, C, D].)
a. “The patient needs to be evaluated immediately and may need intubation and
mechanical ventilation.”
b. “The patient was admitted yesterday with heart failure and has been receiving
furosemide (Lasix) for diuresis, but urine output has been low.”
c. “The patient has crackles audible throughout the posterior chest and the most recent
oxygen saturation is 89%. Her condition is very unstable.”
d. “This is the nurse on the surgical unit. After assessing the patient, I am very
concerned about increased shortness of breath over the past hour.”
ANS:
D, B, C, A
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The order of the nurse’s statements follows the SBAR format.
DIF: Cognitive Level: Apply (application) REF: 15
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
DIF: Cognitive Level: Apply (application) REF: 15
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
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Chapter 2: Health Disparities and Culturally
Competent Care
Chapter 2: Health Disparities and Culturally Competent Care
Test Bank
MULTIPLE CHOICE
1. The nurse is obtaining a health history from a new patient. Which data will be the
focus of patient teaching?
a. Age and gender
b. Saturated fat intake
c. Hispanic/Latino ethnicity
d. Family history of diabetes
ANS: B
Behaviors are strongly linked to many health care problems. The patient’s saturated
fat intake is a behavior that the patient can change. The other information will be
useful as the nurse develops an individualized plan for improving the patient’s health,
but will not be the focus of patient teaching.
DIF: Cognitive Level: Apply (application) REF: 31
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
2. The nurse works in a clinic located in a community with many Hispanics. Which
strategy, if implemented by the nurse, would decrease health care disparities for the
Hispanic patients?
a. Improve public transportation to the clinic.
b. Update equipment and supplies at the clinic.
c. Obtain low-cost medications for clinic patients.
d. Teach clinic staff about Hispanic 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 directly impact health disparities.
DIF: Cognitive Level: Apply (application) REF: 24-25
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
Competent Care
Chapter 2: Health Disparities and Culturally Competent Care
Test Bank
MULTIPLE CHOICE
1. The nurse is obtaining a health history from a new patient. Which data will be the
focus of patient teaching?
a. Age and gender
b. Saturated fat intake
c. Hispanic/Latino ethnicity
d. Family history of diabetes
ANS: B
Behaviors are strongly linked to many health care problems. The patient’s saturated
fat intake is a behavior that the patient can change. The other information will be
useful as the nurse develops an individualized plan for improving the patient’s health,
but will not be the focus of patient teaching.
DIF: Cognitive Level: Apply (application) REF: 31
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
2. The nurse works in a clinic located in a community with many Hispanics. Which
strategy, if implemented by the nurse, would decrease health care disparities for the
Hispanic patients?
a. Improve public transportation to the clinic.
b. Update equipment and supplies at the clinic.
c. Obtain low-cost medications for clinic patients.
d. Teach clinic staff about Hispanic 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 directly impact health disparities.
DIF: Cognitive Level: Apply (application) REF: 24-25
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
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3. What information should the nurse collect when assessing the health status of a
community?
a. Air pollution levels
b. Number of health food stores
c. Most common causes of death
d. Education level of the individuals
ANS: C
Health status measures of a community include birth and death rates, life expectancy,
access to care, and morbidity and mortality rates related to disease and injury.
Although air pollution, access to health food stores, and education level are factors
that affect a community’s health status, they are not health measures.
DIF: Cognitive Level: Understand (comprehension) REF: 19
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
4. The nurse is caring for a Native American patient who has traditional beliefs about
health and illness. Which action by nurse is mostappropriate?
a. Avoid asking questions unless the patient initiates the 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 a family member.
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 ashaman or other cultural healer. There is
no cultural reason for the nurse to avoid asking the patient questions because they are
necessary to obtain health information. The patient (rather than the family) 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: Apply (application) REF: 26
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
5. The nurse is caring for an Asian patient who is being admitted to the hospital.
Which action would be most appropriate for the nurse to take when interviewing this
patient?
community?
a. Air pollution levels
b. Number of health food stores
c. Most common causes of death
d. Education level of the individuals
ANS: C
Health status measures of a community include birth and death rates, life expectancy,
access to care, and morbidity and mortality rates related to disease and injury.
Although air pollution, access to health food stores, and education level are factors
that affect a community’s health status, they are not health measures.
DIF: Cognitive Level: Understand (comprehension) REF: 19
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
4. The nurse is caring for a Native American patient who has traditional beliefs about
health and illness. Which action by nurse is mostappropriate?
a. Avoid asking questions unless the patient initiates the 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 a family member.
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 ashaman or other cultural healer. There is
no cultural reason for the nurse to avoid asking the patient questions because they are
necessary to obtain health information. The patient (rather than the family) 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: Apply (application) REF: 26
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
5. The nurse is caring for an Asian patient who is being admitted to the hospital.
Which action would be most appropriate for the nurse to take when interviewing this
patient?
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a. Avoid eye contact with the patient.
b. Observe the patient’s use of eye contact.
c. Look directly at the patient when interacting.
d. Ask a family member about the patient’s cultural beliefs.
ANS: B
Observation of the patient’s use of eye contact will be most useful in determining the
best way to communicate effectively with the patient. Looking directly at the patient
or avoiding eye contact may be appropriate, depending on the patient’s individual
cultural beliefs. The nurse should assess the patient, rather than asking family
members about the patient’s beliefs.
DIF: Cognitive Level: Apply (application) REF: 28 | 31
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
6. A female staff nurse is assessing a male patient of Arab descent who is admitted
with complaints of severe headaches. It is most important for the charge nurse to
intervene if the nurse takes which action?
a. The nurse explains the 0 to 10 intensity pain scale.
b. The nurse asks the patient when the headaches started.
c. The nurse sits down at the bedside and closes the privacy curtain.
d. The nurse calls for a male nurse to bring a hospital gown to the room.
ANS: C
Many males of Arab ethnicity do not believe it is appropriate to be alone with any
female except for their spouse. The other actions are appropriate.
DIF: Cognitive Level: Apply (application) REF: 28
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7. The nurse cares for a patient who speaks a different language. If an interpreter is not
available, which action by the nurse is mostappropriate?
a. Talk slowly so that each word is clearly heard.
b. Speak loudly in close proximity to the patient’s ears.
c. Repeat important words so that the patient recognizes their significance.
d. Use simple gestures to demonstrate meaning while talking to the patient.
ANS: D
b. Observe the patient’s use of eye contact.
c. Look directly at the patient when interacting.
d. Ask a family member about the patient’s cultural beliefs.
ANS: B
Observation of the patient’s use of eye contact will be most useful in determining the
best way to communicate effectively with the patient. Looking directly at the patient
or avoiding eye contact may be appropriate, depending on the patient’s individual
cultural beliefs. The nurse should assess the patient, rather than asking family
members about the patient’s beliefs.
DIF: Cognitive Level: Apply (application) REF: 28 | 31
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
6. A female staff nurse is assessing a male patient of Arab descent who is admitted
with complaints of severe headaches. It is most important for the charge nurse to
intervene if the nurse takes which action?
a. The nurse explains the 0 to 10 intensity pain scale.
b. The nurse asks the patient when the headaches started.
c. The nurse sits down at the bedside and closes the privacy curtain.
d. The nurse calls for a male nurse to bring a hospital gown to the room.
ANS: C
Many males of Arab ethnicity do not believe it is appropriate to be alone with any
female except for their spouse. The other actions are appropriate.
DIF: Cognitive Level: Apply (application) REF: 28
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7. The nurse cares for a patient who speaks a different language. If an interpreter is not
available, which action by the nurse is mostappropriate?
a. Talk slowly so that each word is clearly heard.
b. Speak loudly in close proximity to the patient’s ears.
c. Repeat important words so that the patient recognizes their significance.
d. Use simple gestures to demonstrate meaning while talking to the patient.
ANS: D
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The use of gestures will enable some information to be communicated to the patient.
The other actions will not improve communication with the patient.
DIF: Cognitive Level: Understand (comprehension) REF: 32
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
8. The nurse plans care for a hospitalized patient who uses culturally based treatments.
Which action by the nurse is best?
a. Encourage the use of diagnostic procedures.
b. Coordinate the use of folk treatments with ordered medical therapies.
c. Ask the patient to discontinue the cultural treatments during hospitalization.
d. Teach the patient that folk remedies will interfere with orders by the health care provider.
ANS: B
Many culturally based therapies can be accommodated along with the use of Western
treatments and medications. The nurse should attempt to use both traditional folk
treatments and the ordered Western therapies as much as possible. Some culturally
based treatments can be effective in treating “Western” diseases. Not all folk remedies
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: Apply (application) REF: 26
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
9. The nurse is caring for a newly admitted patient. Which intervention is
the best example of a culturally appropriate nursing intervention?
a. Insist family members provide most of the patient’s personal care.
b. Maintain a personal space of at least 2 feet when assessing the patient.
c. Ask permission before touching a patient during the physical assessment.
d. Consider the patient’s ethnicity as the most important factor in planning care.
ANS: C
Many cultures consider it disrespectful to touch a patient without asking permission,
so asking a patient for permission is always culturally appropriate. The other actions
may be appropriate for some patients but are not appropriate across all cultural groups
or for all individual patients. Ethnicity may not be the most important factor in
planning care, especially if the patient has urgent physiologic problems.
DIF: Cognitive Level: Understand (comprehension) REF: 28
The other actions will not improve communication with the patient.
DIF: Cognitive Level: Understand (comprehension) REF: 32
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
8. The nurse plans care for a hospitalized patient who uses culturally based treatments.
Which action by the nurse is best?
a. Encourage the use of diagnostic procedures.
b. Coordinate the use of folk treatments with ordered medical therapies.
c. Ask the patient to discontinue the cultural treatments during hospitalization.
d. Teach the patient that folk remedies will interfere with orders by the health care provider.
ANS: B
Many culturally based therapies can be accommodated along with the use of Western
treatments and medications. The nurse should attempt to use both traditional folk
treatments and the ordered Western therapies as much as possible. Some culturally
based treatments can be effective in treating “Western” diseases. Not all folk remedies
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: Apply (application) REF: 26
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
9. The nurse is caring for a newly admitted patient. Which intervention is
the best example of a culturally appropriate nursing intervention?
a. Insist family members provide most of the patient’s personal care.
b. Maintain a personal space of at least 2 feet when assessing the patient.
c. Ask permission before touching a patient during the physical assessment.
d. Consider the patient’s ethnicity as the most important factor in planning care.
ANS: C
Many cultures consider it disrespectful to touch a patient without asking permission,
so asking a patient for permission is always culturally appropriate. The other actions
may be appropriate for some patients but are not appropriate across all cultural groups
or for all individual patients. Ethnicity may not be the most important factor in
planning care, especially if the patient has urgent physiologic problems.
DIF: Cognitive Level: Understand (comprehension) REF: 28
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TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
10. A staff nurse expresses frustration that a Native American patient always has
several family members at the bedside. Which action by the charge nurse
is most appropriate?
a. Remind the nurse that family support is important to this family and patient.
b. Have the nurse explain to the family that too many visitors will tire the patient.
c. Suggest that the nurse ask family members to leave the room during patient care.
d. Ask about the nurse’s personal beliefs about family support during hospitalization.
ANS: D
The first step in providing culturally competent care is to understand one’s own
beliefs and values related to health and health care. Asking the nurse about personal
beliefs will help achieve this step. Reminding the nurse that this cultural practice is
important to the family and patient will not decrease the nurse’s frustration. The
remaining responses (suggest that the nurse ask family members to leave the room,
and have the nurse explain to family that too many visitors will tire the patient) are not
culturally appropriate for this patient.
DIF: Cognitive Level: Apply (application) REF: 30-31
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
11. An older Asian American patient tells the nurse that she has lived in the United
States for 50 years. The patient speaks English and lives in a predominantly Asian
neighborhood. Which action by the nurse is most appropriate?
a. Include a shaman when planning the patient’s care.
b. Avoid direct eye contact with the patient during care.
c. Ask the patient about any special cultural beliefs or practices.
d. Involve the patient’s oldest son to assist with health care decisions.
ANS: C
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: Apply (application) REF: 31
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
10. A staff nurse expresses frustration that a Native American patient always has
several family members at the bedside. Which action by the charge nurse
is most appropriate?
a. Remind the nurse that family support is important to this family and patient.
b. Have the nurse explain to the family that too many visitors will tire the patient.
c. Suggest that the nurse ask family members to leave the room during patient care.
d. Ask about the nurse’s personal beliefs about family support during hospitalization.
ANS: D
The first step in providing culturally competent care is to understand one’s own
beliefs and values related to health and health care. Asking the nurse about personal
beliefs will help achieve this step. Reminding the nurse that this cultural practice is
important to the family and patient will not decrease the nurse’s frustration. The
remaining responses (suggest that the nurse ask family members to leave the room,
and have the nurse explain to family that too many visitors will tire the patient) are not
culturally appropriate for this patient.
DIF: Cognitive Level: Apply (application) REF: 30-31
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
11. An older Asian American patient tells the nurse that she has lived in the United
States for 50 years. The patient speaks English and lives in a predominantly Asian
neighborhood. Which action by the nurse is most appropriate?
a. Include a shaman when planning the patient’s care.
b. Avoid direct eye contact with the patient during care.
c. Ask the patient about any special cultural beliefs or practices.
d. Involve the patient’s oldest son to assist with health care decisions.
ANS: C
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: Apply (application) REF: 31
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
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12. The nurse plans health care for a community with a large number of recent
immigrants from Vietnam. Which intervention is the mostimportant for the nurse to
implement?
a. Hepatitis testing
b. Tuberculosis screening
c. Contraceptive teaching
d. Colonoscopy information
ANS: B
Tuberculosis (TB) is endemic in many parts of Asia, and the incidence of TB is much
higher in immigrants from Vietnam than in the general U.S. population. Teaching
about contraceptive use, colonoscopy, and testing for hepatitis may also be
appropriate for some patients but is not generally indicated for all members of this
community.
DIF: Cognitive Level: Apply (application) REF: 29
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
13. When doing an admission assessment for a patient, the nurse notices that the
patient pauses before answering questions about the health history. Which action by
the nurse is most appropriate?
a. Interview a family member instead.
b. Wait for the patient to answer the questions.
c. Remind the patient that you have other patients who need care.
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.
DIF: Cognitive Level: Apply (application) REF: 28
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
14. Which strategy should be a priority when the nurse is planning care for a diabetic
patient who is uninsured?
immigrants from Vietnam. Which intervention is the mostimportant for the nurse to
implement?
a. Hepatitis testing
b. Tuberculosis screening
c. Contraceptive teaching
d. Colonoscopy information
ANS: B
Tuberculosis (TB) is endemic in many parts of Asia, and the incidence of TB is much
higher in immigrants from Vietnam than in the general U.S. population. Teaching
about contraceptive use, colonoscopy, and testing for hepatitis may also be
appropriate for some patients but is not generally indicated for all members of this
community.
DIF: Cognitive Level: Apply (application) REF: 29
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
13. When doing an admission assessment for a patient, the nurse notices that the
patient pauses before answering questions about the health history. Which action by
the nurse is most appropriate?
a. Interview a family member instead.
b. Wait for the patient to answer the questions.
c. Remind the patient that you have other patients who need care.
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.
DIF: Cognitive Level: Apply (application) REF: 28
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
14. Which strategy should be a priority when the nurse is planning care for a diabetic
patient who is uninsured?
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a. Obtain less expensive medications.
b. Follow evidence-based practice guidelines.
c. Assist with dietary changes as the first action.
d. Teach about the impact of exercise on diabetes.
ANS: B
The use of standardized evidence-based guidelines will reduce the incidence of health
care disparities among various socioeconomic groups. The other strategies may also
be appropriate, but the priority concern should be that the patient receives care that
meets the accepted standard.
DIF: Cognitive Level: Apply (application) REF: 23 | 31
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
15. A Hispanic patient complains of abdominal cramping caused by empacho. Which
action should the nurse take first?
a. Ask the patient what treatments are likely to help.
b. Massage the patient’s abdomen until the pain is gone.
c. Administer prescribed medications to decrease the cramping.
d. Offer to contact a curandero(a) to make a visit to the patient.
ANS: A
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: Apply (application) REF: 26 | 30
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
16. The nurse performs a cultural assessment with a patient from a different culture.
Which action by the nurse should be taken first?
a. Request an interpreter before interviewing the patient.
b. Wait until a family member is available to help with the assessment.
c. Ask the patient about any affiliation with a particular cultural group.
b. Follow evidence-based practice guidelines.
c. Assist with dietary changes as the first action.
d. Teach about the impact of exercise on diabetes.
ANS: B
The use of standardized evidence-based guidelines will reduce the incidence of health
care disparities among various socioeconomic groups. The other strategies may also
be appropriate, but the priority concern should be that the patient receives care that
meets the accepted standard.
DIF: Cognitive Level: Apply (application) REF: 23 | 31
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
15. A Hispanic patient complains of abdominal cramping caused by empacho. Which
action should the nurse take first?
a. Ask the patient what treatments are likely to help.
b. Massage the patient’s abdomen until the pain is gone.
c. Administer prescribed medications to decrease the cramping.
d. Offer to contact a curandero(a) to make a visit to the patient.
ANS: A
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: Apply (application) REF: 26 | 30
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
16. The nurse performs a cultural assessment with a patient from a different culture.
Which action by the nurse should be taken first?
a. Request an interpreter before interviewing the patient.
b. Wait until a family member is available to help with the assessment.
c. Ask the patient about any affiliation with a particular cultural group.
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d. Tell the patient what the nurse already knows about the patient’s culture.
ANS: C
An early step in performing a cultural assessment is to determine whether the patient
feels an affiliation with any cultural group. The other actions may be appropriate if the
patient does identify with a particular culture.
DIF: Cognitive Level: Apply (application) REF: 30-31
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
17. The nurse working in a clinic in a primarily African American community notes a
higher incidence of uncontrolled hypertension in the patients. To correct this health
disparity, which action should the nurse take first?
a. Initiate a regular home-visit program by nurses working at the clinic.
b. Schedule teaching sessions about low-salt diets at community events.
c. Assess the perceptions of community members about the care at the clinic.
d. Obtain low-cost antihypertensive drugs using funding from government grants.
ANS: C
Before other actions are taken, additional assessment data are needed to determine the
reason for the disparity. The other actions also may be appropriate, but additional
assessment is needed before the next action is selected.
DIF: Cognitive Level: Apply (application) REF: 30-31
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. The nurse is performing an admission assessment for a non-English speaking
patient who is from China. Which actions could the nurse take to enhance
communication (select all that apply)?
a. Use an electronic translation application.
b. Use a telephone-based medical interpreter.
c. Wait until an agency interpreter is available.
d. Ask the patient’s teenage daughter to interpret.
e. Use exaggerated gestures to convey information.
ANS: A, B, C
ANS: C
An early step in performing a cultural assessment is to determine whether the patient
feels an affiliation with any cultural group. The other actions may be appropriate if the
patient does identify with a particular culture.
DIF: Cognitive Level: Apply (application) REF: 30-31
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
17. The nurse working in a clinic in a primarily African American community notes a
higher incidence of uncontrolled hypertension in the patients. To correct this health
disparity, which action should the nurse take first?
a. Initiate a regular home-visit program by nurses working at the clinic.
b. Schedule teaching sessions about low-salt diets at community events.
c. Assess the perceptions of community members about the care at the clinic.
d. Obtain low-cost antihypertensive drugs using funding from government grants.
ANS: C
Before other actions are taken, additional assessment data are needed to determine the
reason for the disparity. The other actions also may be appropriate, but additional
assessment is needed before the next action is selected.
DIF: Cognitive Level: Apply (application) REF: 30-31
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. The nurse is performing an admission assessment for a non-English speaking
patient who is from China. Which actions could the nurse take to enhance
communication (select all that apply)?
a. Use an electronic translation application.
b. Use a telephone-based medical interpreter.
c. Wait until an agency interpreter is available.
d. Ask the patient’s teenage daughter to interpret.
e. Use exaggerated gestures to convey information.
ANS: A, B, C
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Electronic translation applications, telephone-based interpreters, and agency
interpreters are all appropriate to use to communicate with non–English-speaking
patients. When no interpreter is available, family members may be considered, but
some information that will be needed in an admission assessment may be
misunderstood or not shared if a child is used as the interpreter. Gestures are
appropriate to use, but exaggeration of the gestures is not needed.
DIF: Cognitive Level: Apply (application) REF: 32-33
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
interpreters are all appropriate to use to communicate with non–English-speaking
patients. When no interpreter is available, family members may be considered, but
some information that will be needed in an admission assessment may be
misunderstood or not shared if a child is used as the interpreter. Gestures are
appropriate to use, but exaggeration of the gestures is not needed.
DIF: Cognitive Level: Apply (application) REF: 32-33
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
Loading page 21...
Chapter 3: Health History and Physical
Examination
Chapter 3: Health History and Physical Examination
Test Bank
MULTIPLE CHOICE
1. A patient who is actively bleeding is admitted to the emergency department. Which
approach is best for the nurse to use to obtain a health history?
a. Briefly interview the patient while obtaining vital signs.
b. Obtain subjective data about the patient from family members.
c. Omit subjective data collection and obtain the physical examination.
d. Use the health care provider’s medical history to obtain subjective data.
ANS: A
In an emergency situation the nurse may need to ask only the most pertinent questions
for a specific problem and obtain more information later. A complete health history
will include subjective information that is not available in the health care provider’s
medical history. Family members may be able to provide some subjective data, but
only the patient will be able to give subjective information about the bleeding.
Because the subjective data about the cause of the patient’s bleeding will be essential,
obtaining the physical examination alone will not provide sufficient information.
DIF: Cognitive Level: Apply (application) REF: 45
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
2. Immediate surgery is planned for a patient with acute abdominal pain. Which
question by the nurse will elicit the most complete information about the patient’s
coping-stress tolerance pattern?
a. “Can you rate your pain on a 0 to 10 scale?”
b. “What do you think caused this abdominal pain?”
c. “How do you feel about yourself and your hospitalization?”
d. “Are there other major problems that are a concern right now?”
ANS: D
The coping-stress tolerance pattern includes information about other major stressors
confronting the patient. The health perception–health management pattern includes
information about the patient’s ideas about risk factors. Feelings about self and the
Examination
Chapter 3: Health History and Physical Examination
Test Bank
MULTIPLE CHOICE
1. A patient who is actively bleeding is admitted to the emergency department. Which
approach is best for the nurse to use to obtain a health history?
a. Briefly interview the patient while obtaining vital signs.
b. Obtain subjective data about the patient from family members.
c. Omit subjective data collection and obtain the physical examination.
d. Use the health care provider’s medical history to obtain subjective data.
ANS: A
In an emergency situation the nurse may need to ask only the most pertinent questions
for a specific problem and obtain more information later. A complete health history
will include subjective information that is not available in the health care provider’s
medical history. Family members may be able to provide some subjective data, but
only the patient will be able to give subjective information about the bleeding.
Because the subjective data about the cause of the patient’s bleeding will be essential,
obtaining the physical examination alone will not provide sufficient information.
DIF: Cognitive Level: Apply (application) REF: 45
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
2. Immediate surgery is planned for a patient with acute abdominal pain. Which
question by the nurse will elicit the most complete information about the patient’s
coping-stress tolerance pattern?
a. “Can you rate your pain on a 0 to 10 scale?”
b. “What do you think caused this abdominal pain?”
c. “How do you feel about yourself and your hospitalization?”
d. “Are there other major problems that are a concern right now?”
ANS: D
The coping-stress tolerance pattern includes information about other major stressors
confronting the patient. The health perception–health management pattern includes
information about the patient’s ideas about risk factors. Feelings about self and the
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hospitalization are assessed in the self-perception–self-concept pattern. Intensity of
pain is part of the cognitive-perceptual pattern.
DIF: Cognitive Level: Apply (application) REF: 41
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
3. During the health history interview, a patient tells the nurse about periodic fainting
spells. Which question by the nurse will best elicit any associated clinical
manifestations?
a. “How frequently do you have the fainting spells?”
b. “Where are you when you have the fainting spells?”
c. “Do the spells tend to occur at any special time of day?”
d. “Do you have any other symptoms along with the spells?”
ANS: D
Asking about other associated symptoms will provide the nurse more information
about all the clinical manifestations related to the fainting spells. Information about
the setting is obtained by asking where the patient was and what the patient was doing
when the symptom occurred. The other questions from the nurse are appropriate for
obtaining information about chronology and frequency.
DIF: Cognitive Level: Apply (application) REF: 42
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
4. The nurse records the following general survey of a patient: “The patient is a 50-
year-old Asian female attended by her husband and two daughters. Alert and oriented.
Does not make eye contact with the nurse and responds slowly, but appropriately, to
questions. No apparent disabilities or distinguishing features.” What additional
information should the nurse add to this general survey?
a. Nutritional status
b. Intake and output
c. Reasons for contact with the health care system
d. Comments of family members about his condition
ANS: A
The general survey also describes the patient’s general nutritional status. The other
information will be obtained when doing the complete nursing history and
examination but is not obtained through the initial scanning of a patient.
pain is part of the cognitive-perceptual pattern.
DIF: Cognitive Level: Apply (application) REF: 41
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
3. During the health history interview, a patient tells the nurse about periodic fainting
spells. Which question by the nurse will best elicit any associated clinical
manifestations?
a. “How frequently do you have the fainting spells?”
b. “Where are you when you have the fainting spells?”
c. “Do the spells tend to occur at any special time of day?”
d. “Do you have any other symptoms along with the spells?”
ANS: D
Asking about other associated symptoms will provide the nurse more information
about all the clinical manifestations related to the fainting spells. Information about
the setting is obtained by asking where the patient was and what the patient was doing
when the symptom occurred. The other questions from the nurse are appropriate for
obtaining information about chronology and frequency.
DIF: Cognitive Level: Apply (application) REF: 42
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
4. The nurse records the following general survey of a patient: “The patient is a 50-
year-old Asian female attended by her husband and two daughters. Alert and oriented.
Does not make eye contact with the nurse and responds slowly, but appropriately, to
questions. No apparent disabilities or distinguishing features.” What additional
information should the nurse add to this general survey?
a. Nutritional status
b. Intake and output
c. Reasons for contact with the health care system
d. Comments of family members about his condition
ANS: A
The general survey also describes the patient’s general nutritional status. The other
information will be obtained when doing the complete nursing history and
examination but is not obtained through the initial scanning of a patient.
Loading page 23...
DIF: Cognitive Level: Understand (comprehension) REF: 39-41
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
5. A nurse performs a health history and physical examination with a patient who has
a right leg fracture. Which assessment would be a pertinent negative finding?
a. Patient has several bruised and swollen areas on the right leg.
b. Patient states that there have been no other recent health problems.
c. Patient refuses to bend the right knee because of the associated pain.
d. Patient denies having pain when the area over the fracture is palpated.
ANS: D
The nurse expects that a patient with a leg fracture will have pain over the fractured
area. The bruising and swelling and pain with bending are positive findings. No other
recent health problems is neither a positive nor a negative finding with regard to a leg
fracture.
DIF: Cognitive Level: Apply (application) REF: 41
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
6. The nurse who is assessing an older adult with rectal bleeding asks, “Have you ever
had a colonoscopy?” The nurse is performing what type of assessment?
a. Focused assessment
b. Emergency assessment
c. Detailed health assessment
d. Comprehensive assessment
ANS: A
A focused assessment is an abbreviated assessment used to evaluate the status of
previously identified problems and monitor for signs of new problems. It can be done
when a specific problem is identified. An emergency assessment is done when the
nurse needs to obtain information about life-threatening problems quickly while
simultaneously taking action to maintain vital function. A comprehensive assessment
includes a detailed health history and physical examination of one body system or
many body systems. It is typically done on admission to the hospital or onset of care
in a primary care setting.
DIF: Cognitive Level: Understand (comprehension) REF: 42
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
5. A nurse performs a health history and physical examination with a patient who has
a right leg fracture. Which assessment would be a pertinent negative finding?
a. Patient has several bruised and swollen areas on the right leg.
b. Patient states that there have been no other recent health problems.
c. Patient refuses to bend the right knee because of the associated pain.
d. Patient denies having pain when the area over the fracture is palpated.
ANS: D
The nurse expects that a patient with a leg fracture will have pain over the fractured
area. The bruising and swelling and pain with bending are positive findings. No other
recent health problems is neither a positive nor a negative finding with regard to a leg
fracture.
DIF: Cognitive Level: Apply (application) REF: 41
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
6. The nurse who is assessing an older adult with rectal bleeding asks, “Have you ever
had a colonoscopy?” The nurse is performing what type of assessment?
a. Focused assessment
b. Emergency assessment
c. Detailed health assessment
d. Comprehensive assessment
ANS: A
A focused assessment is an abbreviated assessment used to evaluate the status of
previously identified problems and monitor for signs of new problems. It can be done
when a specific problem is identified. An emergency assessment is done when the
nurse needs to obtain information about life-threatening problems quickly while
simultaneously taking action to maintain vital function. A comprehensive assessment
includes a detailed health history and physical examination of one body system or
many body systems. It is typically done on admission to the hospital or onset of care
in a primary care setting.
DIF: Cognitive Level: Understand (comprehension) REF: 42
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
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7. The nurse is preparing to perform a focused assessment for a patient complaining of
shortness of breath. Which equipment will be needed?
a. Flashlight
b. Stethoscope
c. Tongue blades
d. Percussion hammer
ANS: B
A stethoscope is used to auscultate breath sounds. The other equipment may be used
for a comprehensive assessment but will not be needed for a focused respiratory
assessment.
DIF: Cognitive Level: Understand (comprehension) REF: 42
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
8. The nurse plans to complete a physical examination of an alert, older patient. Which
adaptations to the examination technique should the nurse include?
a. Avoid the use of touch as much as possible.
b. Use slightly more pressure for palpation of the liver.
c. Speak softly and slowly when talking with the patient.
d. Organize the sequence to minimize the position changes.
ANS: D
Older patients may have age-related changes in mobility that make it more difficult to
change position. There is no need to avoid the use of touch when examining older
patients. Less pressure should be used over the liver. Because the patient is alert, there
is no indication that there is any age-related difficulty in understanding directions
from the nurse.
DIF: Cognitive Level: Apply (application) REF: 42
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
9. While the nurse is taking the health history, a patient states, “My mother and sister
both had double mastectomies and were unable to be very active for weeks.” Which
functional health pattern is represented by this patient’s statement?
a. Activity-exercise
b. Cognitive-perceptual
c. Coping-stress tolerance
shortness of breath. Which equipment will be needed?
a. Flashlight
b. Stethoscope
c. Tongue blades
d. Percussion hammer
ANS: B
A stethoscope is used to auscultate breath sounds. The other equipment may be used
for a comprehensive assessment but will not be needed for a focused respiratory
assessment.
DIF: Cognitive Level: Understand (comprehension) REF: 42
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
8. The nurse plans to complete a physical examination of an alert, older patient. Which
adaptations to the examination technique should the nurse include?
a. Avoid the use of touch as much as possible.
b. Use slightly more pressure for palpation of the liver.
c. Speak softly and slowly when talking with the patient.
d. Organize the sequence to minimize the position changes.
ANS: D
Older patients may have age-related changes in mobility that make it more difficult to
change position. There is no need to avoid the use of touch when examining older
patients. Less pressure should be used over the liver. Because the patient is alert, there
is no indication that there is any age-related difficulty in understanding directions
from the nurse.
DIF: Cognitive Level: Apply (application) REF: 42
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
9. While the nurse is taking the health history, a patient states, “My mother and sister
both had double mastectomies and were unable to be very active for weeks.” Which
functional health pattern is represented by this patient’s statement?
a. Activity-exercise
b. Cognitive-perceptual
c. Coping-stress tolerance
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d. Health perception–health management
ANS: D
The information in the patient statement relates to risk factors and important
information about the family history. Identification of risk factors falls into the health
perception–health maintenance pattern.
DIF: Cognitive Level: Understand (comprehension) REF: 39-40
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
10. A patient is seen in the emergency department with severe abdominal pain and
hypotension. Which type of assessment should the nurse do at this time?
a. Focused assessment
b. Subjective assessment
c. Emergency assessment
d. Comprehensive assessment
ANS: C
Because the patient is hemodynamically unstable, an emergency assessment is
needed. Comprehensive and focused assessments may be needed after the patient is
stabilized. Subjective information is needed, but objective data such as vital signs are
essential for the unstable patient.
DIF: Cognitive Level: Understand (comprehension) REF: 42 | 45
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
11. The registered nurse (RN) cares for a patient who was admitted a few hours
previously with back pain after falling. Which action can the RN delegate to
unlicensed assistive personnel (UAP)?
a. Finish documenting the admission assessment.
b. Determine the patient’s priority nursing diagnoses.
c. Obtain the health history from the patient’s caregiver.
d. Take the patient’s temperature, pulse, and blood pressure.
ANS: D
The RN may delegate vital signs to the UAP. Obtaining the health history,
documentation of the admission assessment, and determining nursing diagnoses
require the education and scope of practice of the RN.
DIF: Cognitive Level: Apply (application) REF: 38
ANS: D
The information in the patient statement relates to risk factors and important
information about the family history. Identification of risk factors falls into the health
perception–health maintenance pattern.
DIF: Cognitive Level: Understand (comprehension) REF: 39-40
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
10. A patient is seen in the emergency department with severe abdominal pain and
hypotension. Which type of assessment should the nurse do at this time?
a. Focused assessment
b. Subjective assessment
c. Emergency assessment
d. Comprehensive assessment
ANS: C
Because the patient is hemodynamically unstable, an emergency assessment is
needed. Comprehensive and focused assessments may be needed after the patient is
stabilized. Subjective information is needed, but objective data such as vital signs are
essential for the unstable patient.
DIF: Cognitive Level: Understand (comprehension) REF: 42 | 45
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
11. The registered nurse (RN) cares for a patient who was admitted a few hours
previously with back pain after falling. Which action can the RN delegate to
unlicensed assistive personnel (UAP)?
a. Finish documenting the admission assessment.
b. Determine the patient’s priority nursing diagnoses.
c. Obtain the health history from the patient’s caregiver.
d. Take the patient’s temperature, pulse, and blood pressure.
ANS: D
The RN may delegate vital signs to the UAP. Obtaining the health history,
documentation of the admission assessment, and determining nursing diagnoses
require the education and scope of practice of the RN.
DIF: Cognitive Level: Apply (application) REF: 38
Loading page 26...
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
12. When assessing for formation of a possible blood clot in the lower leg of a patient,
which action should the nurse take first?
a. Visually inspect the leg.
b. Feel for the temperature of the leg.
c. Check the patient’s pedal pulses using the fingertips.
d. Compress the nail beds to determine capillary refill time.
ANS: A
Inspection is the first of the major techniques used in the physical examination.
Palpation and auscultation are then used later in the examination.
DIF: Cognitive Level: Apply (application) REF: 41
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
13. When assessing a patient’s abdomen during the admission assessment, which
action should the nurse take first?
a. Feel for any masses.
b. Palpate the abdomen.
c. Listen for bowel sounds.
d. Percuss the liver borders.
ANS: C
When assessing the abdomen, auscultation is done before palpation or percussion
because palpation and percussion can cause changes in bowel sounds and alter the
findings. All of the techniques are appropriate, but auscultation should be done first.
DIF: Cognitive Level: Understand (comprehension) REF: 41
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
14. When admitting a patient who has just arrived on the unit with a severe headache,
what should the nurse do first?
a. Complete only basic demographic data before addressing the patient’s pain.
b. Medicate the patient for the headache before doing the health history and examination.
c. Take the initial vital signs and then address the headache before completing the health histo
MSC: NCLEX: Safe and Effective Care Environment
12. When assessing for formation of a possible blood clot in the lower leg of a patient,
which action should the nurse take first?
a. Visually inspect the leg.
b. Feel for the temperature of the leg.
c. Check the patient’s pedal pulses using the fingertips.
d. Compress the nail beds to determine capillary refill time.
ANS: A
Inspection is the first of the major techniques used in the physical examination.
Palpation and auscultation are then used later in the examination.
DIF: Cognitive Level: Apply (application) REF: 41
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
13. When assessing a patient’s abdomen during the admission assessment, which
action should the nurse take first?
a. Feel for any masses.
b. Palpate the abdomen.
c. Listen for bowel sounds.
d. Percuss the liver borders.
ANS: C
When assessing the abdomen, auscultation is done before palpation or percussion
because palpation and percussion can cause changes in bowel sounds and alter the
findings. All of the techniques are appropriate, but auscultation should be done first.
DIF: Cognitive Level: Understand (comprehension) REF: 41
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
14. When admitting a patient who has just arrived on the unit with a severe headache,
what should the nurse do first?
a. Complete only basic demographic data before addressing the patient’s pain.
b. Medicate the patient for the headache before doing the health history and examination.
c. Take the initial vital signs and then address the headache before completing the health histo
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d. Inform the patient that the headache will be treated as soon as the health history is complet
ANS: C
The patient priority in this situation will be to decrease the pain level because the
patient will be unlikely to cooperate in providing demographic data or the health
history until the nurse addresses the pain. However, obtaining information about vital
signs is essential before using either pharmacologic or nonpharmacologic therapies for
pain control. The vital signs may indicate hemodynamic instability that would need to
be addressed immediately.
DIF: Cognitive Level: Apply (application) REF: 37
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
OTHER
1. In what order will the nurse perform these actions when doing a physical
assessment for a patient admitted with abdominal pain? (Put a comma and a space
between each answer choice [A, B, C, D].)
a. Percuss the abdomen to locate any areas of dullness.
b. Palpate the abdomen to check for tenderness or masses.
c. Inspect the abdomen for distention or other abnormalities.
d. Auscultate the abdomen for the presence of bowel sounds.
ANS:
C, D, A, B
When assessing the abdomen, the initial action is to inspect the abdomen.
Auscultation is done next because percussion and palpation can alter bowel sounds
and produce misleading findings.
DIF: Cognitive Level: Understand (comprehension) REF: 41
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
ANS: C
The patient priority in this situation will be to decrease the pain level because the
patient will be unlikely to cooperate in providing demographic data or the health
history until the nurse addresses the pain. However, obtaining information about vital
signs is essential before using either pharmacologic or nonpharmacologic therapies for
pain control. The vital signs may indicate hemodynamic instability that would need to
be addressed immediately.
DIF: Cognitive Level: Apply (application) REF: 37
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
OTHER
1. In what order will the nurse perform these actions when doing a physical
assessment for a patient admitted with abdominal pain? (Put a comma and a space
between each answer choice [A, B, C, D].)
a. Percuss the abdomen to locate any areas of dullness.
b. Palpate the abdomen to check for tenderness or masses.
c. Inspect the abdomen for distention or other abnormalities.
d. Auscultate the abdomen for the presence of bowel sounds.
ANS:
C, D, A, B
When assessing the abdomen, the initial action is to inspect the abdomen.
Auscultation is done next because percussion and palpation can alter bowel sounds
and produce misleading findings.
DIF: Cognitive Level: Understand (comprehension) REF: 41
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
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Chapter 4: Patient and Caregiver Teaching
Chapter 4: Patient and Caregiver Teaching
Test Bank
MULTIPLE CHOICE
1. A patient with newly diagnosed colon cancer has a nursing diagnosis of deficient
knowledge about colon cancer. The nurse should initially focus on which learning
goal for this patient?
a. The patient will select the most appropriate colon cancer therapy.
b. The patient will state ways of preventing the recurrence of the cancer.
c. The patient will demonstrate coping skills needed to manage the disease.
d. The patient will choose methods to minimize adverse effects of treatment.
ANS: A
Adults learn best when given information that can be used immediately. The first
action the patient will need to take after a cancer diagnosis is to choose a treatment
option. The other goals may be appropriate as treatment progresses.
DIF: Cognitive Level: Apply (application) REF: 48
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
2. After the nurse provides dietary instructions for a patient with diabetes, the patient
can explain the information but fails to make the recommended dietary changes. How
would the nurse evaluate the patient’s situation?
a. Learning did not occur because the patient’s behavior did not change.
b. Choosing not to follow the diet is the behavior that resulted from learning.
c. The nursing responsibility for helping the patient make dietary changes has been fulfilled.
d. The teaching methods were ineffective in helping the patient learn the dietary instructions.
ANS: B
Although the patient behavior has not changed, the patient’s ability to explain the
information indicates that learning has occurred and the patient is choosing at this
time not to change the diet. The patient may be in the contemplation or preparation
stage in the Transtheoretical Model. The nurse should reinforce the need for change
and continue to provide information and assistance with planning for change.
DIF: Cognitive Level: Apply (application) REF: 49
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance
Chapter 4: Patient and Caregiver Teaching
Test Bank
MULTIPLE CHOICE
1. A patient with newly diagnosed colon cancer has a nursing diagnosis of deficient
knowledge about colon cancer. The nurse should initially focus on which learning
goal for this patient?
a. The patient will select the most appropriate colon cancer therapy.
b. The patient will state ways of preventing the recurrence of the cancer.
c. The patient will demonstrate coping skills needed to manage the disease.
d. The patient will choose methods to minimize adverse effects of treatment.
ANS: A
Adults learn best when given information that can be used immediately. The first
action the patient will need to take after a cancer diagnosis is to choose a treatment
option. The other goals may be appropriate as treatment progresses.
DIF: Cognitive Level: Apply (application) REF: 48
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
2. After the nurse provides dietary instructions for a patient with diabetes, the patient
can explain the information but fails to make the recommended dietary changes. How
would the nurse evaluate the patient’s situation?
a. Learning did not occur because the patient’s behavior did not change.
b. Choosing not to follow the diet is the behavior that resulted from learning.
c. The nursing responsibility for helping the patient make dietary changes has been fulfilled.
d. The teaching methods were ineffective in helping the patient learn the dietary instructions.
ANS: B
Although the patient behavior has not changed, the patient’s ability to explain the
information indicates that learning has occurred and the patient is choosing at this
time not to change the diet. The patient may be in the contemplation or preparation
stage in the Transtheoretical Model. The nurse should reinforce the need for change
and continue to provide information and assistance with planning for change.
DIF: Cognitive Level: Apply (application) REF: 49
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance
Loading page 29...
3. A patient is diagnosed with heart failure after being admitted to the hospital for
shortness of breath and fatigue. Which teaching strategy, if implemented by the nurse,
is most likely to be effective?
a. Assure the patient that the nurse is an expert on management of heart failure.
b. Teach the patient at each meal about the amounts of sodium in various foods.
c. Discuss the importance of medication control in maintenance of long-term health.
d. Refer the patient to a home health nurse for instructions on diet and fluid restrictions.
ANS: B
Principles of adult education indicate that readiness and motivation to learn are high
when facing new tasks (such as learning about the sodium amounts in various food
items) and when demonstration and practice of skills are available. Although a home
health referral may be needed for this patient, teaching should not be postponed until
discharge. Adult learners are independent. The nurse should act as a facilitator for
learning, rather than as the expert. Adults learn best when the topic is of immediate
usefulness. Long-term goals may not be very motivating.
DIF: Cognitive Level: Apply (application) REF: 48
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
4. A patient who was admitted to the hospital with hyperglycemia and newly
diagnosed diabetes mellitus is scheduled for discharge the second day after admission.
When implementing patient teaching, what is the priority action for the nurse?
a. Instruct about the increased risk for cardiovascular disease.
b. Provide detailed information about dietary control of glucose.
c. Teach glucose self-monitoring and medication administration.
d. Give information about the effects of exercise on glucose control.
ANS: C
When time is limited, the nurse should focus on the priorities of teaching. In this
situation, the patient should know how to test blood glucose and administer
medications to control glucose levels. The patient will need further teaching about the
role of diet, exercise, various medications, and the many potential complications of
diabetes, but these topics can be addressed through planning for appropriate referrals.
DIF: Cognitive Level: Apply (application) REF: 50
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
shortness of breath and fatigue. Which teaching strategy, if implemented by the nurse,
is most likely to be effective?
a. Assure the patient that the nurse is an expert on management of heart failure.
b. Teach the patient at each meal about the amounts of sodium in various foods.
c. Discuss the importance of medication control in maintenance of long-term health.
d. Refer the patient to a home health nurse for instructions on diet and fluid restrictions.
ANS: B
Principles of adult education indicate that readiness and motivation to learn are high
when facing new tasks (such as learning about the sodium amounts in various food
items) and when demonstration and practice of skills are available. Although a home
health referral may be needed for this patient, teaching should not be postponed until
discharge. Adult learners are independent. The nurse should act as a facilitator for
learning, rather than as the expert. Adults learn best when the topic is of immediate
usefulness. Long-term goals may not be very motivating.
DIF: Cognitive Level: Apply (application) REF: 48
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
4. A patient who was admitted to the hospital with hyperglycemia and newly
diagnosed diabetes mellitus is scheduled for discharge the second day after admission.
When implementing patient teaching, what is the priority action for the nurse?
a. Instruct about the increased risk for cardiovascular disease.
b. Provide detailed information about dietary control of glucose.
c. Teach glucose self-monitoring and medication administration.
d. Give information about the effects of exercise on glucose control.
ANS: C
When time is limited, the nurse should focus on the priorities of teaching. In this
situation, the patient should know how to test blood glucose and administer
medications to control glucose levels. The patient will need further teaching about the
role of diet, exercise, various medications, and the many potential complications of
diabetes, but these topics can be addressed through planning for appropriate referrals.
DIF: Cognitive Level: Apply (application) REF: 50
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
Loading page 30...
5. A patient states, “I told my husband I wouldn’t buy as much prepared food snacks,
so I will go the grocery store to buy fresh fruit, vegetables, and whole grains.” When
using the Transtheoretical Model of Health Behavior Change, the nurse identifies that
this patient is in which stage of change?
a. Preparation
b. Termination
c. Maintenance
d. Contemplation
ANS: A
The patient’s statement indicating that the plan for change is being shared with
someone else indicates that the preparation stage has been achieved. Contemplation of
a change would be indicated by a statement like “I know I should exercise.”
Maintenance of a change occurs when the patient practices the behavior regularly.
Termination would be indicated when the change is a permanent part of the lifestyle.
DIF: Cognitive Level: Understand (comprehension) REF: 49
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
6. While admitting a patient to the medical unit, the nurse determines that the patient
is hard of hearing. How should the nurse use this information to plan teaching and
learning strategies?
a. Motivation and readiness to learn will be affected.
b. The family must be included in the teaching process.
c. The patient will have problems understanding information.
d. Written materials should be provided with verbal instructions.
ANS: D
The information that the patient is hard of hearing indicates that the nurse should use
written and verbal materials in teaching along with other strategies. The patient does
not indicate a lack of motivation or an inability to understand new information. The
patient’s decreased hearing does not necessarily imply that the family must be
included in the teaching process.
DIF: Cognitive Level: Understand (comprehension) REF: 52
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
so I will go the grocery store to buy fresh fruit, vegetables, and whole grains.” When
using the Transtheoretical Model of Health Behavior Change, the nurse identifies that
this patient is in which stage of change?
a. Preparation
b. Termination
c. Maintenance
d. Contemplation
ANS: A
The patient’s statement indicating that the plan for change is being shared with
someone else indicates that the preparation stage has been achieved. Contemplation of
a change would be indicated by a statement like “I know I should exercise.”
Maintenance of a change occurs when the patient practices the behavior regularly.
Termination would be indicated when the change is a permanent part of the lifestyle.
DIF: Cognitive Level: Understand (comprehension) REF: 49
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
6. While admitting a patient to the medical unit, the nurse determines that the patient
is hard of hearing. How should the nurse use this information to plan teaching and
learning strategies?
a. Motivation and readiness to learn will be affected.
b. The family must be included in the teaching process.
c. The patient will have problems understanding information.
d. Written materials should be provided with verbal instructions.
ANS: D
The information that the patient is hard of hearing indicates that the nurse should use
written and verbal materials in teaching along with other strategies. The patient does
not indicate a lack of motivation or an inability to understand new information. The
patient’s decreased hearing does not necessarily imply that the family must be
included in the teaching process.
DIF: Cognitive Level: Understand (comprehension) REF: 52
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
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