(Test Bank) Lewis’s Medical Surgical Nursing

Harding, 11

Medicine

Test Bank

11th Edition

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Test Bank for Lewis’s Medical Surgical Nursing, The downloadable file consists of 901 pages, and the total size of the file is 5.29 MB. Purchase now only for highly discounted price.

Author(s): Harding

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Study Note Preview

Lewis’s Medical Surgical Nursing 11th Edition Harding Test Bank Table of Contents Chapter 01: Professional Nursing Table of Contents 1 3 Chapter 02: Health Equity and Culturally Competent Care Chapter 03: Health History and Physical Examination Chapter 04: Patient and Caregiver Teaching Chapter 05: Chronic Illness and Older Adults Chapter 06: Stress Management Chapter 07: Sleep and Sleep Disorders Chapter 08: Pain Chapter 09: Palliative and End of Life Care Chapter 10: Substance Use Disorders Chapter 11: Inflammation and Healing Chapter 12: Genetics Chapter 13: Immune Responses and Transplantation Chapter 14: Infection Chapter 15: Cancer Chapter 16: Fluid, Electrolyte, and Acid-Base Imbalances Chapter 17: Preoperative Care Chapter 18: Intraoperative Care Chapter 19: Postoperative Care Chapter 20: Assessment and Management: Visual Problems Chapter 21: Assessment and Management: Auditory Problems Chapter 22: Assessment: Integumentary System Chapter 23: Integumentary Problems Chapter 24: Burns Chapter 25: Assessment: Respiratory System Chapter 26: Upper Respiratory Problems Chapter 27: Lower Respiratory Problems Chapter 28: Obstructive Pulmonary Diseases Chapter 29: Assessment: Hematologic System Chapter 30: Hematologic Problems Chapter 31: Assessment: Cardiovascular System Chapter 32: Hypertension Chapter 33: Coronary Artery Disease and Acute Coronary Syndrome Chapter 34: Heart Failure Chapter 35: Dysrhythmias Chapter 36: Inflammatory and Structural Heart Disorders Chapter 37: Vascular Disorders Chapter 38: Assessment: Gastrointestinal System Chapter 39: Nutritional Problems Chapter 40: Obesity Chapter 41: Upper Gastrointestinal Problems Chapter 42: Lower Gastrointestinal Problems Chapter 43: Liver, Biliary Tract, and Pancreas Problems Chapter 44: Assessment: Urinary System Chapter 45: Renal and Urologic Problems Chapter 46: Acute Kidney Injury and Chronic Kidney Disease Chapter 47: Assessment: Endocrine System Chapter 48: Diabetes Mellitus Chapter 49: Endocrine Problems Chapter 50: Assessment: Reproductive System 13 21 28 38 48 54 59 71 79 91 101 105 117 129 148 165 175 184 196 216 227 233 245 259 270 282 305 325 332 353 364 375 394 406 420 435 450 458 469 478 499 523 543 553 573 590 600 622 642 Chapter 51: Breast Disorders Chapter 52: Sexually Transmitted Infections Chapter 53: Female Reproductive Problems Chapter 54: Male Reproductive Problems Chapter 55: Assessment: Nervous System Chapter 56: Acute Intracranial Problems Chapter 57: Stroke Chapter 58: Chronic Neurologic Problems Chapter 59: Dementia and Delirium Chapter 60: Spinal Cord and Peripheral Nerve Problems Chapter 61: Assessment: Musculoskeletal System Chapter 62: Musculoskeletal Trauma and Orthopedic Surgery Chapter 63: Musculoskeletal Problems Chapter 64: Arthritis and Connective Tissue Diseases Chapter 65: Critical Care Chapter 66: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome Chapter 67: Acute Respiratory Failure and Acute Respiratory Distress Syndrome Chapter 68: Emergency and Disaster Nursing 650 662 671 693 708 717 734 747 763 772 787 794 814 825 845 864 877 889 Chapter 01: Professional Nursing Test Bank MULTIPLE CHOICE 1. 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 patients health care problems. b. The nursing process is a problem -solving tool used to identify and treat patients health care needs. c. The nursing process is based on nursing theory that incorporates the biopsychosocial nature of humans. d. The nursing process is used primarily to explain nursing interventions to other health care professionals. 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) 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. Cl inical judgment based on the nurses 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) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 3. The nurse completes an admission database and explains that the plan of care and discharge goals will be developed with the patients 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 doctor. b. The nurses job is to help the doctor by collecting information and communicating any problems that occur. c. Nurses perform many of the same procedures as the doctor, but nurses are with the patients for a longer time than the doctor. d. In addition to caring for you while you are sick, the nurses will assist you to develop an individualized plan 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 nurses role in the health care system. DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment 4. 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 patients 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) TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity 5. 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 patients feelings about the child -care arrangements. d. Call the patients 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 nurses 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) OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial 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. Patients bedding is changed when it becomes damp. c. Patient understands the need for increased fluid intake. d. Patients 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) 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 patients 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) 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) 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 patients 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) 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) 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 patients 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) OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 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 patients 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) 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) 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. 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 patients 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) 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) 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? a. Assist the patient to choose appropriate foods. b. Help the patient with a daily bath and oral care. c. Check the patients 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) 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 nursings responsibility to monitor care 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 tha is considered preventable (e.g., acquiring a catheter -related urinary tract infection). DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment 18. The nurse documenting the patients progress in the care plan in the electronic health record before an interdisciplinary discharge conference is demonstrating competency in which QSEN category? 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) 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) OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 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 patients full name and date of birth before medication administration. Other actions that improve patient safety includ e 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) 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 The order of the nurses statements follows the SBAR format. DIF: Cognitive Level: Apply (application) OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment Chapter 02: Health Equity and Culturally Competent Care Test Bank MULTIPLE CHOICE 1. 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 communitys health status, they are not health measures. DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Assessment 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) TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 3. 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 patients 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 patients health, but will not be the focus of patient teaching. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning 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 most appropriate? 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 patients 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 a shaman 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 patie nts preferences rather than expecting the patient to adapt to the hospital schedule. DIF: Cognitive Level: Apply (application) 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? a. Avoid eye contact with the patient. b. Observe the patients use of eye contact. c. Look directly at the patient when interacting. d. Ask a family member about the patients cultural beliefs.