Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
TEST BANK
Medical-Surgical Nursing in Canada
Assessment and Management of Clinical Problems
Sharon L. Lewis, Linda Bucher, Margaret M. Heitkemper
3rd Edition
,Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
Table of Contents
Section One – Concepts in Nursing Practice
1. Introduction to Medical-Surgical Nursing Practice In Canada
2. Cultural Competence and Health Equity in Nursing Care
3. Health History and Physical Examination
4. Patient and Caregiver Teaching
5. Chronic Illness
6. Community-Based Nursing and Home Care
7. Older Adults
8. Stress and Stress Management
9. Sleep and Sleep Disorders
10. Pain
11. Substance Abuse
12. Complementary and Alternative Therapies
13. Palliative Care at the End of Life
Section Two – Pathophysiologic Mechanisms of Disease
14. Inflammation and Wound Healing
15. Genetics
16. Altered Immune Responses and Transplantation
17. Infection and Human Immunodeficiency Virus Infection
18. Cancer
19. Fluid, Electrolyte, and Acid-Base Imbalances
Section Three – Perioperative Care
20. Nursing Management: Preoperative Care
21. Nursing Management: Intraoperative Care
22. Nursing Management: Postoperative Care
Section Four – Problems Related to Altered Sensory Input
23. Nursing Assessment: Visual and Auditory Systems
24. Nursing Management: Visual and Auditory Problems
25. Nursing Assessment: Integumentary System
26. Nursing Management: Integumentary Problems
27. Nursing Management: Burns
Section Five – Problems of Oxygenation: Ventilation
28. Nursing Assessment: Respiratory System
29. Nursing Management: Upper Respiratory Problems
30. Nursing Management: Lower Respiratory Problems
31. Nursing Management: Obstructive Pulmonary Diseases
Section Six – Problems of Oxygenation: Transport
32. Nursing Assessment: Hematological System
33. Nursing Management: Hematological Problems
Section Seven – Problems of Oxygenation: Perfusion
34. Nursing Assessment: Cardiovascular System
35. Nursing Management: Hypertension
36. Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome
37. Nursing Management: Heart Failure
38. Nursing Management: Dysrhythmias
39. Nursing Management: Inflammatory and Structural Heart Disorders
40. Nursing Management: Vascular Disorders
,Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
Section Eight – Problems of Ingestion, Digestion, Absorption, and Elimination
41. Nursing Assessment: Gastrointestinal System
42. Nursing Management: Nutritional Problems
43. Nursing Management: Obesity
44. Nursing Management: Upper Gastrointestinal Problems
45. Nursing Management: Lower Gastrointestinal Problems
46. Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Section Nine – Problems of Urinary Function
47. Nursing Assessment: Urinary System
48. Nursing Management: Renal and Urologic Problems
49. Nursing Management: Acute Kidney Injury and Chronic Kidney Disease
Section Ten – Problems Related to Regulatory and Reproductive Mechanisms
50.Nursing Assessment: Endocrine System
51. Nursing Management: Endocrine Problems
52. Nursing Management: Diabetes Mellitus
53. Nursing Assessment: Reproductive System
54. Nursing Management: Breast Disorders
55. Nursing Management: Sexually Transmitted Infections
56. Nursing Management: Female Reproductive Problems
57. Nursing Management: Male Reproductive Problems
Section Eleven – Problems Related to Movement and Coordination
58. Nursing Assessment: Nervous System
59. Nursing Management: Acute Intracranial Problems
60. Nursing Management: Stroke
61. Nursing Management: Chronic Neurologic Problems
62. Nursing Management: Delirium, Alzheimer’s Disease and Other Dementias
63. Nursing Management: Peripheral Nerve and Spinal Cord Problems
64. Nursing Assessment: Musculoskeletal System
65. Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery
66. Nursing Management: Musculoskeletal Problems
67. Nursing Management: Arthritis and Connective Tissue Diseases
Section Twelve – Nursing Care in Specialized Settings
68. Nursing Management: Critical Care Environment
69. Nursing Management: Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ
Dysfunction Syndrome
70. Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome
71. Nursing Management: Emergency Care Situations
72. Emergency Preparedness and Disaster Management
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada
Lewis et al.: Medical-Surgical Nursing in Canada, 3rd Edition
MULTIPLE CHOICE
1. The nurse explains to the patient that together they will plan the patient’s care and set goals to
achieve by discharge. The patient asks how this differs from what the physician does. Which
statement best describes the difference between the roles of nursing and medicine in planning
the patient’s care and setting goals to achieve discharge?
a. Medicine cures; nursing cares.
b. Nurses assist physicians to diagnose and treat patients with health care problems.
c. Very little role difference exists between medicine and nursing; nurses perform
many of the procedures done by physicians.
d. Medicine focuses on diagnosis and treatment of the health problem; nursing
focuses on diagnosis and treatment of the patient’s response to the health problem.
ANS: D
This response is consistent with the Canadian Nurses Association’s (CNA’s) definition of
registered nursing, which states that registered nurses enable individuals, families, groups,
communities, and populations to achieve their optimal level of 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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 4
OBJ: 2 TOP: Nursing Process: Implementation MSC: CRNE: PP-9
2. A woman with hypertension is concerned that if she sees the nurse practitioner (an advanced
practice nurse), only her hypertension will be assessed, and she is worried that another health
problem may not be diagnosed. What should the nurse tell the patient regarding nurse
practitioners’ scope of practice as it relates to diagnosis?
a. They diagnose and treat all major health problems.
b. They have the same role and scope of practice as physicians.
c. They write prescriptions for all classifications of medications.
d. They focus on primary care and health promotion, including diagnosis.
ANS: D
Advanced practice nurses (for example, nurse practitioners) focus on the management of
primary care and health promotion for a wide variety of health problems in various
specialties; roles include physical examination, diagnosis, treatment of health problems,
patient and family education, and counselling.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 9
OBJ: 2 TOP: Nursing Process: Implementation MSC: CRNE: PP-9
3. When asking a clinical question using the PICO format, which of the following would
represent the “C”?
a. Controlled diabetes in a woman aged 50 to 65 years
b. Conditioning and exercise program for one hour, three times weekly
c. Weekly blood glucose levels within normal range
d. Standard care for women with diabetes
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
ANS: D
The “C” in PICO stands for comparison of interest, which would be standard care, in this
case, for women with diabetes. Controlled diabetes in a woman aged 50 to 65 years is the “P,”
the population. Conditioning and exercise program for one hour, three times weekly is the “I,”
or intervention. Weekly blood glucose levels within normal range is the “O,” or outcome of
interest.
PTS: 1 DIF: Cognitive Level: Application REF: page 7
OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: CH-15
4. How does the nurse primarily use the nursing process in the care of patients?
a. As a science-based process of diagnosing the patient’s health care problems
b. To establish nursing theory that incorporates the bio-psycho-social nature of
humans
c. To promote the management of patient care in collaboration with other health care
providers
d. As a tool to organize the nurse’s thinking and clinical decision making about the
patient’s health care needs
ANS: D
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 providers.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 10
OBJ: 6 TOP: Nursing Process: All phases MSC: CRNE: CH-7
5. An emaciated older adult patient is admitted to the critical care unit. The nurse plans a
schedule of turning the patient every two hours to prevent skin breakdown. This is considered
to be what type of nursing action?
a. Dependent
b. Cooperative
c. Independent
d. Collaborative
ANS: D
When implementing collaborative nursing actions, the nurse is responsible primarily for
monitoring for complications or providing care to prevent or treat complications. Independent
nursing actions are focused on health promotion, illness prevention, and patient advocacy. A
dependent action would require a physician order to implement. Cooperative nursing
functions are not described as one of the formal nursing functions.
PTS: 1 DIF: Cognitive Level: Application REF: pages 11-12
OBJ: 6 TOP: Nursing Process: Implementation MSC: CRNE: CH-10
6. A woman who is a lone parent is about to undergo gallbladder surgery. She tells the nurse on
admission that she is uneasy about being in the hospital and leaving her two preschool
children with a neighbour. During the assessment phase, what is an appropriate nursing
action?
a. Reassure the patient that her children are fine.
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
b. Call the neighbour to determine whether she is an adequate care provider.
c. Have the patient call the children to reassure herself that they are doing well.
d. Gather more data about the patient’s feelings about the child care arrangements.
ANS: D
The assessment phase includes gathering multidimensional data about the patient. The other
nursing actions may be appropriate during the implementation phase (after the nurse
accomplishes further assessment of the patient’s concerns), but they are not part of the
assessment phase.
PTS: 1 DIF: Cognitive Level: Application REF: page 10
OBJ: 6 TOP: Nursing Process: Assessment MSC: CRNE: CH-3
7. A patient with a stroke is paralyzed on the left side of the body and is not responsive enough
to turn or move independently in bed. A pressure ulcer has developed on the patient’s left hip.
What is the most appropriate nursing diagnosis?
a. Impaired physical mobility related to paralysis
b. Impaired skin integrity related to altered circulation and pressure
c. Risk for impaired tissue integrity related to impaired physical mobility
d. Ineffective tissue perfusion related to inability to turn and move self in bed
ANS: B
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 impaired physical mobility is a problem for the
patient, the nurse cannot treat the paralysis. 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.
PTS: 1 DIF: Cognitive Level: Application REF: page 15
OBJ: 6 TOP: Nursing Process: Diagnosis MSC: CRNE: CH-20
8. A patient with an infection has a nursing diagnosis of fluid volume deficit related to excessive
diaphoresis. What is an appropriate patient outcome?
a. Balanced intake and output are achieved.
b. Patient verbalizes a need for increased fluid intake.
c. Bedding is changed when it becomes damp.
d. Skin remains cool and dry throughout hospitalization.
ANS: A
This statement gives measurable data showing resolution of the problem of fluid volume
deficit that was identified in the nursing diagnosis statement. The other statements would not
indicate that the problem of fluid volume deficit was resolved.
PTS: 1 DIF: Cognitive Level: Application REF: page 13
OBJ: 7 TOP: Nursing Process: Evaluation MSC: CRNE: CH-25
9. Which characteristic is consistent with critical thinking?
a. Do not use abstract ideas.
b. Think within alternative systems of thought.
c. Encourage cooperative relationships from positions of power and authority.
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
d. Use the trial-and-error method for effective problem-solving options.
ANS: B
Critical thinking is the art of analyzing and evaluating thinking with a view to improving it.
Characteristics of critical thinking include thinking open-mindedly within alternative systems
of thought, and recognizing and assessing their assumptions, implications, and practical
consequences.
PTS: 1 DIF: Cognitive Level: Analysis REF: page 6
OBJ: 4 TOP: Nursing Process: Assessment MSC: CRNE: PP-11
10. The nurse reads on the care plan that a patient is at risk for developing an infection. What does
the nurse recognize about this patient’s problem?
a. It is always a nursing diagnosis.
b. It is always a collaborative problem.
c. It may be either a nursing diagnosis or a collaborative problem, depending on the
etiology.
d. It should not be addressed as a special problem because all nursing measures
should protect patients from infection.
ANS: C
If the source of the risk for infection is something that can be treated by nursing, then the
problem is a nursing diagnosis. If it is one that requires treatment by other health care
providers, the problem is collaborative. In either case, the risk for infection should be included
in the care plan.
PTS: 1 DIF: Cognitive Level: Comprehension REF: pages 10-11
OBJ: 3 TOP: Nursing Process: Planning MSC: CRNE: PP-9
11. Which of the following is an example of the “P” in a SOAP progress note?
a. The patient stating that her right arm is numb
b. Encouragement of alternating rest and activity periods
c. Activity intolerance related to fatigue
d. Blood pressure 140/85 mm Hg
ANS: B
“P” stands for plan in the SOAP method of documentation; encouraging alternating rest and
activity periods is an example of a specific intervention related to a diagnostic problem. The
patient stating that the right arm is numb is an example of subjective data. Activity intolerance
is a nursing diagnosis and is an example of assessment. A blood pressure reading is an
objective assessment.
PTS: 1 DIF: Cognitive Level: Application REF: pages 1-16
OBJ: 10 TOP: Nursing Process: Implementation MSC: CRNE: CH-15
12. Which of the following refers to the use of communication and information technologies in
order to support the delivery and integration of clinical care?
a. e-Health
b. Nursing informatics
c. Electronic health record
d. ICT (information and communication technology)
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
ANS: A
e-Health refers to the use of communication and information technologies in order to support
the delivery and integration of clinical care. Nursing informatics refers to the integration of
nursing science, computer science, and information technology to manage and communicate
data, information, and knowledge in nursing practice. Electronic health record is an electronic
version of the patient health record. ICT consists of tools and applications that support the
management of clinical data, information, and knowledge.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 10
OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: CH-16
13. Which phase of the nursing process is too often not addressed sufficiently?
a. Planning
b. Diagnosis
c. Implementation
d. Evaluation
ANS: D
Evaluation is an extremely important part of the nursing process that is too often not
addressed sufficiently. The planning, diagnosis, and implementation phases are often
addressed sufficiently.
PTS: 1 DIF: Cognitive Level: Knowledge REF: page 10
OBJ: 9 TOP: Nursing Process: Evaluation MSC: CRNE: CH-25
14. Which of the following refers to a situation that results in unintended harm to the patient and
is related to the care or services provided rather than the patient’s medical condition?
a. Negligence
b. Adverse event
c. Incident report
d. Nonmaleficence
ANS: B
An adverse event is an event that results in unintended harm to the patient and is related to the
care or services provided rather than the patient’s medical condition. Negligence is an ethical
principle, not a situation that results in unintended harm to the patient, although it is related to
the care or services provided rather than the patient’s medical condition. An incident report
may be completed; however, it is not the event itself. Nonmaleficence is an ethical principle,
not a situation that results in unintended harm to the patient, although it is related to the care
or services provided rather than the patient’s medical condition.
PTS: 1 DIF: Cognitive Level: Knowledge REF: page 4
OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: PP-14
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
Chapter 02: Cultural Competence and Health Equity in Nursing Care
Lewis et al.: Medical-Surgical Nursing in Canada, 3rd Edition
MULTIPLE CHOICE
1. An Aboriginal patient tells the nurse that he thinks his abdominal pain is caused by eating too
much seal fat and that strong massage over the stomach will help it. What is this patient
describing?
a. Awareness and knowledge of his own culture
b. Encounters with cultures different from his own
c. Explanatory model of health and health practices
d. Knowledge about the differences in modern and folk health practices
ANS: C
Further assessment of the patient’s cultural beliefs is appropriate before implementing any
interventions. A massage may be helpful, but more information about the patient’s beliefs is
needed to determine which intervention(s) will be most helpful. This is eliciting the patient’s
explanatory model of health practices.
PTS: 1 DIF: Cognitive Level: Application REF: page 26
OBJ: 7 TOP: Nursing Process: Assessment MSC: CRNE: NCP-7
2. Which following term refers to characteristics of a group whose members share a common
social, cultural, linguistic, or religious heritage?
a. Diversity
b. Ethnicity
c. Ethnocentrism
d. Cultural imposition
ANS: B
Ethnicity refers to characteristics of a group whose members share a common social, cultural,
linguistic, or religious heritage. Diversity is differences or variations across individuals and
social groups. Ethnocentrism is a tendency for an individual to believe that their way of
viewing the world is the most correct. Cultural imposition is the situation in which one`s own
cultural beliefs are imposed on another, intentionally or unintentionally.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 25
OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: NCP-7
3. Having a commitment to the goal of inclusivity and equity is classified as which domain in
the ABCs of cultural competence?
a. Skills
b. Affective
c. Knowledge
d. Behavioural
ANS: B
Having a commitment to the goal of inclusivity and equity is classified as a component of the
affective domain. It is not an example of the skills domain, the knowledge domain, or the
behavioural domain.
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
PTS: 1 DIF: Cognitive Level: Application REF: page 27, Table 2-3
OBJ: 1 TOP: Nursing Process: Planning MSC: CRNE: NCP-7
4. Which of the following is a system factor that influences help-seeking behaviour for health
care?
a. Lack of health insurance
b. Association by patients of hospitals with death
c. Lack of ethnic-specific health care programs
d. Possible patient distrust of the dominant population and institutions
ANS: C
An example of a system factor that influences help-seeking behaviour for health care is a lack
of ethnic-specific health care programs. Lack of health insurance is an economic factor.
Patients associating hospitals with death is a belief and practice factor, as is patients’ distrust
of the dominant population and institutions.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 30, Table 2-7
OBJ: 7 TOP: Nursing Process: Assessment MSC: CRNE: HW-19
5. What is the most appropriate action when the patient constantly pauses before answering
questions about his or her health history on an admission assessment?
a. Stop the assessment and return later.
b. Wait for the patient to answer the questions.
c. Ask why the questions require so much time to answer.
d. Give the patient the assessment form listing the questions and a pen.
ANS: B
Although members of some groups may respond effectively to direct questions, members of
others will respond more comfortably in interactions that are less direct, in which information
is requested and presented in the third person, and more silence and reflection are allowed for;
therefore, the nurse should wait for the patient to answer the questions.
PTS: 1 DIF: Cognitive Level: Application REF: page 28
OBJ: 7 TOP: Nursing Process: Implementation MSC: CRNE: NCP-7
6. If an interpreter is not available when a patient speaks a language different from the nurse’s,
which action is most appropriate?
a. Use specific medical terms in the Latin form.
b. Talk loudly and slowly so that each word is clearly heard.
c. Repeat important words so that the patient recognizes their importance.
d. Use pantomime to demonstrate what is to be communicated to the patient.
ANS: D
The use of gestures will enable some information to be communicated to the patient. Using
specific medical terms in the Latin form is not appropriate, as one cannot assume that all
patients understand Latin. Talking loudly and slowly is not appropriate. Repeating important
words is not appropriate.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 29, Table 2-6
OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: NCP-2
TEST BANK
Medical-Surgical Nursing in Canada
Assessment and Management of Clinical Problems
Sharon L. Lewis, Linda Bucher, Margaret M. Heitkemper
3rd Edition
,Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
Table of Contents
Section One – Concepts in Nursing Practice
1. Introduction to Medical-Surgical Nursing Practice In Canada
2. Cultural Competence and Health Equity in Nursing Care
3. Health History and Physical Examination
4. Patient and Caregiver Teaching
5. Chronic Illness
6. Community-Based Nursing and Home Care
7. Older Adults
8. Stress and Stress Management
9. Sleep and Sleep Disorders
10. Pain
11. Substance Abuse
12. Complementary and Alternative Therapies
13. Palliative Care at the End of Life
Section Two – Pathophysiologic Mechanisms of Disease
14. Inflammation and Wound Healing
15. Genetics
16. Altered Immune Responses and Transplantation
17. Infection and Human Immunodeficiency Virus Infection
18. Cancer
19. Fluid, Electrolyte, and Acid-Base Imbalances
Section Three – Perioperative Care
20. Nursing Management: Preoperative Care
21. Nursing Management: Intraoperative Care
22. Nursing Management: Postoperative Care
Section Four – Problems Related to Altered Sensory Input
23. Nursing Assessment: Visual and Auditory Systems
24. Nursing Management: Visual and Auditory Problems
25. Nursing Assessment: Integumentary System
26. Nursing Management: Integumentary Problems
27. Nursing Management: Burns
Section Five – Problems of Oxygenation: Ventilation
28. Nursing Assessment: Respiratory System
29. Nursing Management: Upper Respiratory Problems
30. Nursing Management: Lower Respiratory Problems
31. Nursing Management: Obstructive Pulmonary Diseases
Section Six – Problems of Oxygenation: Transport
32. Nursing Assessment: Hematological System
33. Nursing Management: Hematological Problems
Section Seven – Problems of Oxygenation: Perfusion
34. Nursing Assessment: Cardiovascular System
35. Nursing Management: Hypertension
36. Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome
37. Nursing Management: Heart Failure
38. Nursing Management: Dysrhythmias
39. Nursing Management: Inflammatory and Structural Heart Disorders
40. Nursing Management: Vascular Disorders
,Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
Section Eight – Problems of Ingestion, Digestion, Absorption, and Elimination
41. Nursing Assessment: Gastrointestinal System
42. Nursing Management: Nutritional Problems
43. Nursing Management: Obesity
44. Nursing Management: Upper Gastrointestinal Problems
45. Nursing Management: Lower Gastrointestinal Problems
46. Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Section Nine – Problems of Urinary Function
47. Nursing Assessment: Urinary System
48. Nursing Management: Renal and Urologic Problems
49. Nursing Management: Acute Kidney Injury and Chronic Kidney Disease
Section Ten – Problems Related to Regulatory and Reproductive Mechanisms
50.Nursing Assessment: Endocrine System
51. Nursing Management: Endocrine Problems
52. Nursing Management: Diabetes Mellitus
53. Nursing Assessment: Reproductive System
54. Nursing Management: Breast Disorders
55. Nursing Management: Sexually Transmitted Infections
56. Nursing Management: Female Reproductive Problems
57. Nursing Management: Male Reproductive Problems
Section Eleven – Problems Related to Movement and Coordination
58. Nursing Assessment: Nervous System
59. Nursing Management: Acute Intracranial Problems
60. Nursing Management: Stroke
61. Nursing Management: Chronic Neurologic Problems
62. Nursing Management: Delirium, Alzheimer’s Disease and Other Dementias
63. Nursing Management: Peripheral Nerve and Spinal Cord Problems
64. Nursing Assessment: Musculoskeletal System
65. Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery
66. Nursing Management: Musculoskeletal Problems
67. Nursing Management: Arthritis and Connective Tissue Diseases
Section Twelve – Nursing Care in Specialized Settings
68. Nursing Management: Critical Care Environment
69. Nursing Management: Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ
Dysfunction Syndrome
70. Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome
71. Nursing Management: Emergency Care Situations
72. Emergency Preparedness and Disaster Management
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada
Lewis et al.: Medical-Surgical Nursing in Canada, 3rd Edition
MULTIPLE CHOICE
1. The nurse explains to the patient that together they will plan the patient’s care and set goals to
achieve by discharge. The patient asks how this differs from what the physician does. Which
statement best describes the difference between the roles of nursing and medicine in planning
the patient’s care and setting goals to achieve discharge?
a. Medicine cures; nursing cares.
b. Nurses assist physicians to diagnose and treat patients with health care problems.
c. Very little role difference exists between medicine and nursing; nurses perform
many of the procedures done by physicians.
d. Medicine focuses on diagnosis and treatment of the health problem; nursing
focuses on diagnosis and treatment of the patient’s response to the health problem.
ANS: D
This response is consistent with the Canadian Nurses Association’s (CNA’s) definition of
registered nursing, which states that registered nurses enable individuals, families, groups,
communities, and populations to achieve their optimal level of 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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 4
OBJ: 2 TOP: Nursing Process: Implementation MSC: CRNE: PP-9
2. A woman with hypertension is concerned that if she sees the nurse practitioner (an advanced
practice nurse), only her hypertension will be assessed, and she is worried that another health
problem may not be diagnosed. What should the nurse tell the patient regarding nurse
practitioners’ scope of practice as it relates to diagnosis?
a. They diagnose and treat all major health problems.
b. They have the same role and scope of practice as physicians.
c. They write prescriptions for all classifications of medications.
d. They focus on primary care and health promotion, including diagnosis.
ANS: D
Advanced practice nurses (for example, nurse practitioners) focus on the management of
primary care and health promotion for a wide variety of health problems in various
specialties; roles include physical examination, diagnosis, treatment of health problems,
patient and family education, and counselling.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 9
OBJ: 2 TOP: Nursing Process: Implementation MSC: CRNE: PP-9
3. When asking a clinical question using the PICO format, which of the following would
represent the “C”?
a. Controlled diabetes in a woman aged 50 to 65 years
b. Conditioning and exercise program for one hour, three times weekly
c. Weekly blood glucose levels within normal range
d. Standard care for women with diabetes
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
ANS: D
The “C” in PICO stands for comparison of interest, which would be standard care, in this
case, for women with diabetes. Controlled diabetes in a woman aged 50 to 65 years is the “P,”
the population. Conditioning and exercise program for one hour, three times weekly is the “I,”
or intervention. Weekly blood glucose levels within normal range is the “O,” or outcome of
interest.
PTS: 1 DIF: Cognitive Level: Application REF: page 7
OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: CH-15
4. How does the nurse primarily use the nursing process in the care of patients?
a. As a science-based process of diagnosing the patient’s health care problems
b. To establish nursing theory that incorporates the bio-psycho-social nature of
humans
c. To promote the management of patient care in collaboration with other health care
providers
d. As a tool to organize the nurse’s thinking and clinical decision making about the
patient’s health care needs
ANS: D
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 providers.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 10
OBJ: 6 TOP: Nursing Process: All phases MSC: CRNE: CH-7
5. An emaciated older adult patient is admitted to the critical care unit. The nurse plans a
schedule of turning the patient every two hours to prevent skin breakdown. This is considered
to be what type of nursing action?
a. Dependent
b. Cooperative
c. Independent
d. Collaborative
ANS: D
When implementing collaborative nursing actions, the nurse is responsible primarily for
monitoring for complications or providing care to prevent or treat complications. Independent
nursing actions are focused on health promotion, illness prevention, and patient advocacy. A
dependent action would require a physician order to implement. Cooperative nursing
functions are not described as one of the formal nursing functions.
PTS: 1 DIF: Cognitive Level: Application REF: pages 11-12
OBJ: 6 TOP: Nursing Process: Implementation MSC: CRNE: CH-10
6. A woman who is a lone parent is about to undergo gallbladder surgery. She tells the nurse on
admission that she is uneasy about being in the hospital and leaving her two preschool
children with a neighbour. During the assessment phase, what is an appropriate nursing
action?
a. Reassure the patient that her children are fine.
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
b. Call the neighbour to determine whether she is an adequate care provider.
c. Have the patient call the children to reassure herself that they are doing well.
d. Gather more data about the patient’s feelings about the child care arrangements.
ANS: D
The assessment phase includes gathering multidimensional data about the patient. The other
nursing actions may be appropriate during the implementation phase (after the nurse
accomplishes further assessment of the patient’s concerns), but they are not part of the
assessment phase.
PTS: 1 DIF: Cognitive Level: Application REF: page 10
OBJ: 6 TOP: Nursing Process: Assessment MSC: CRNE: CH-3
7. A patient with a stroke is paralyzed on the left side of the body and is not responsive enough
to turn or move independently in bed. A pressure ulcer has developed on the patient’s left hip.
What is the most appropriate nursing diagnosis?
a. Impaired physical mobility related to paralysis
b. Impaired skin integrity related to altered circulation and pressure
c. Risk for impaired tissue integrity related to impaired physical mobility
d. Ineffective tissue perfusion related to inability to turn and move self in bed
ANS: B
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 impaired physical mobility is a problem for the
patient, the nurse cannot treat the paralysis. 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.
PTS: 1 DIF: Cognitive Level: Application REF: page 15
OBJ: 6 TOP: Nursing Process: Diagnosis MSC: CRNE: CH-20
8. A patient with an infection has a nursing diagnosis of fluid volume deficit related to excessive
diaphoresis. What is an appropriate patient outcome?
a. Balanced intake and output are achieved.
b. Patient verbalizes a need for increased fluid intake.
c. Bedding is changed when it becomes damp.
d. Skin remains cool and dry throughout hospitalization.
ANS: A
This statement gives measurable data showing resolution of the problem of fluid volume
deficit that was identified in the nursing diagnosis statement. The other statements would not
indicate that the problem of fluid volume deficit was resolved.
PTS: 1 DIF: Cognitive Level: Application REF: page 13
OBJ: 7 TOP: Nursing Process: Evaluation MSC: CRNE: CH-25
9. Which characteristic is consistent with critical thinking?
a. Do not use abstract ideas.
b. Think within alternative systems of thought.
c. Encourage cooperative relationships from positions of power and authority.
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
d. Use the trial-and-error method for effective problem-solving options.
ANS: B
Critical thinking is the art of analyzing and evaluating thinking with a view to improving it.
Characteristics of critical thinking include thinking open-mindedly within alternative systems
of thought, and recognizing and assessing their assumptions, implications, and practical
consequences.
PTS: 1 DIF: Cognitive Level: Analysis REF: page 6
OBJ: 4 TOP: Nursing Process: Assessment MSC: CRNE: PP-11
10. The nurse reads on the care plan that a patient is at risk for developing an infection. What does
the nurse recognize about this patient’s problem?
a. It is always a nursing diagnosis.
b. It is always a collaborative problem.
c. It may be either a nursing diagnosis or a collaborative problem, depending on the
etiology.
d. It should not be addressed as a special problem because all nursing measures
should protect patients from infection.
ANS: C
If the source of the risk for infection is something that can be treated by nursing, then the
problem is a nursing diagnosis. If it is one that requires treatment by other health care
providers, the problem is collaborative. In either case, the risk for infection should be included
in the care plan.
PTS: 1 DIF: Cognitive Level: Comprehension REF: pages 10-11
OBJ: 3 TOP: Nursing Process: Planning MSC: CRNE: PP-9
11. Which of the following is an example of the “P” in a SOAP progress note?
a. The patient stating that her right arm is numb
b. Encouragement of alternating rest and activity periods
c. Activity intolerance related to fatigue
d. Blood pressure 140/85 mm Hg
ANS: B
“P” stands for plan in the SOAP method of documentation; encouraging alternating rest and
activity periods is an example of a specific intervention related to a diagnostic problem. The
patient stating that the right arm is numb is an example of subjective data. Activity intolerance
is a nursing diagnosis and is an example of assessment. A blood pressure reading is an
objective assessment.
PTS: 1 DIF: Cognitive Level: Application REF: pages 1-16
OBJ: 10 TOP: Nursing Process: Implementation MSC: CRNE: CH-15
12. Which of the following refers to the use of communication and information technologies in
order to support the delivery and integration of clinical care?
a. e-Health
b. Nursing informatics
c. Electronic health record
d. ICT (information and communication technology)
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
ANS: A
e-Health refers to the use of communication and information technologies in order to support
the delivery and integration of clinical care. Nursing informatics refers to the integration of
nursing science, computer science, and information technology to manage and communicate
data, information, and knowledge in nursing practice. Electronic health record is an electronic
version of the patient health record. ICT consists of tools and applications that support the
management of clinical data, information, and knowledge.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 10
OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: CH-16
13. Which phase of the nursing process is too often not addressed sufficiently?
a. Planning
b. Diagnosis
c. Implementation
d. Evaluation
ANS: D
Evaluation is an extremely important part of the nursing process that is too often not
addressed sufficiently. The planning, diagnosis, and implementation phases are often
addressed sufficiently.
PTS: 1 DIF: Cognitive Level: Knowledge REF: page 10
OBJ: 9 TOP: Nursing Process: Evaluation MSC: CRNE: CH-25
14. Which of the following refers to a situation that results in unintended harm to the patient and
is related to the care or services provided rather than the patient’s medical condition?
a. Negligence
b. Adverse event
c. Incident report
d. Nonmaleficence
ANS: B
An adverse event is an event that results in unintended harm to the patient and is related to the
care or services provided rather than the patient’s medical condition. Negligence is an ethical
principle, not a situation that results in unintended harm to the patient, although it is related to
the care or services provided rather than the patient’s medical condition. An incident report
may be completed; however, it is not the event itself. Nonmaleficence is an ethical principle,
not a situation that results in unintended harm to the patient, although it is related to the care
or services provided rather than the patient’s medical condition.
PTS: 1 DIF: Cognitive Level: Knowledge REF: page 4
OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: PP-14
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
Chapter 02: Cultural Competence and Health Equity in Nursing Care
Lewis et al.: Medical-Surgical Nursing in Canada, 3rd Edition
MULTIPLE CHOICE
1. An Aboriginal patient tells the nurse that he thinks his abdominal pain is caused by eating too
much seal fat and that strong massage over the stomach will help it. What is this patient
describing?
a. Awareness and knowledge of his own culture
b. Encounters with cultures different from his own
c. Explanatory model of health and health practices
d. Knowledge about the differences in modern and folk health practices
ANS: C
Further assessment of the patient’s cultural beliefs is appropriate before implementing any
interventions. A massage may be helpful, but more information about the patient’s beliefs is
needed to determine which intervention(s) will be most helpful. This is eliciting the patient’s
explanatory model of health practices.
PTS: 1 DIF: Cognitive Level: Application REF: page 26
OBJ: 7 TOP: Nursing Process: Assessment MSC: CRNE: NCP-7
2. Which following term refers to characteristics of a group whose members share a common
social, cultural, linguistic, or religious heritage?
a. Diversity
b. Ethnicity
c. Ethnocentrism
d. Cultural imposition
ANS: B
Ethnicity refers to characteristics of a group whose members share a common social, cultural,
linguistic, or religious heritage. Diversity is differences or variations across individuals and
social groups. Ethnocentrism is a tendency for an individual to believe that their way of
viewing the world is the most correct. Cultural imposition is the situation in which one`s own
cultural beliefs are imposed on another, intentionally or unintentionally.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 25
OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: NCP-7
3. Having a commitment to the goal of inclusivity and equity is classified as which domain in
the ABCs of cultural competence?
a. Skills
b. Affective
c. Knowledge
d. Behavioural
ANS: B
Having a commitment to the goal of inclusivity and equity is classified as a component of the
affective domain. It is not an example of the skills domain, the knowledge domain, or the
behavioural domain.
, Test Bank - Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems 3rd Edition (Lewis, 2019)
PTS: 1 DIF: Cognitive Level: Application REF: page 27, Table 2-3
OBJ: 1 TOP: Nursing Process: Planning MSC: CRNE: NCP-7
4. Which of the following is a system factor that influences help-seeking behaviour for health
care?
a. Lack of health insurance
b. Association by patients of hospitals with death
c. Lack of ethnic-specific health care programs
d. Possible patient distrust of the dominant population and institutions
ANS: C
An example of a system factor that influences help-seeking behaviour for health care is a lack
of ethnic-specific health care programs. Lack of health insurance is an economic factor.
Patients associating hospitals with death is a belief and practice factor, as is patients’ distrust
of the dominant population and institutions.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 30, Table 2-7
OBJ: 7 TOP: Nursing Process: Assessment MSC: CRNE: HW-19
5. What is the most appropriate action when the patient constantly pauses before answering
questions about his or her health history on an admission assessment?
a. Stop the assessment and return later.
b. Wait for the patient to answer the questions.
c. Ask why the questions require so much time to answer.
d. Give the patient the assessment form listing the questions and a pen.
ANS: B
Although members of some groups may respond effectively to direct questions, members of
others will respond more comfortably in interactions that are less direct, in which information
is requested and presented in the third person, and more silence and reflection are allowed for;
therefore, the nurse should wait for the patient to answer the questions.
PTS: 1 DIF: Cognitive Level: Application REF: page 28
OBJ: 7 TOP: Nursing Process: Implementation MSC: CRNE: NCP-7
6. If an interpreter is not available when a patient speaks a language different from the nurse’s,
which action is most appropriate?
a. Use specific medical terms in the Latin form.
b. Talk loudly and slowly so that each word is clearly heard.
c. Repeat important words so that the patient recognizes their importance.
d. Use pantomime to demonstrate what is to be communicated to the patient.
ANS: D
The use of gestures will enable some information to be communicated to the patient. Using
specific medical terms in the Latin form is not appropriate, as one cannot assume that all
patients understand Latin. Talking loudly and slowly is not appropriate. Repeating important
words is not appropriate.
PTS: 1 DIF: Cognitive Level: Comprehension REF: page 29, Table 2-6
OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: NCP-2
