Medical Surgical
Nursing TEST BANK Assessment and
Management of clinical problems 10
Edition
Chapter 01: Professional Nursing Practice
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) REF: 7
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 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) REF: 11
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 longertime 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) REF: 3
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) REF: 7
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) REF: 6
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
Nursing TEST BANK Assessment and
Management of clinical problems 10
Edition
Chapter 01: Professional Nursing Practice
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) REF: 7
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 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) REF: 11
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 longertime 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) REF: 3
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) REF: 7
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) REF: 6
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
