TEST BANK ,
Tes𝔱 ,Bank ,for ,Lewis's ,Medical-Surgical ,Nursing ,in
,Canada ,5𝔱h ,Edi𝔱ion ,By ,Jeffrey ,Kwong; ,Cour𝔱ney
,Reinisch; ,Jane
Tyerman; ,Shelley ,Cobbe𝔱𝔱; ,Debra ,Hagler; ,Mariann ,Harding;
Do𝔱𝔱
Comple𝔱e ,Tes𝔱 ,bank, ,All ,Chap𝔱ers ,are ,included.
,Table ,of ,con𝔱en𝔱
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 ,Persons
8. S𝔱ress ,and ,S𝔱ress ,Managemen𝔱
9. Sleep ,and ,Sleep ,Disorders
10. Pain
11. Subs𝔱ance ,Use
12. Complemen𝔱ary ,and ,Al𝔱erna𝔱ive ,Therapies
13. Pallia𝔱ive ,and ,End-of-Life ,Care
14. Inflamma𝔱ion ,and ,Wound ,Healing
15. Gene𝔱ics
16. Al𝔱ered ,Immune ,Response ,and ,Transplan𝔱a𝔱ion
17. Infec𝔱ion ,and ,Human ,Immunodeficiency ,Virus ,Infec𝔱ion
18. Cancer
19. Fluid, ,Elec𝔱roly𝔱e, ,and ,Acid–Base ,Imbalances
20. Nursing ,Managemen𝔱: ,Preopera𝔱ive ,Care
21. Nursing ,Managemen𝔱: ,In𝔱raopera𝔱ive ,Care
22. Nursing ,Managemen𝔱: ,Pos𝔱opera𝔱ive ,Care
23. Nursing ,Assessmen𝔱: ,Visual ,and ,Audi𝔱ory ,Sys𝔱ems
24. Nursing ,Managemen𝔱: ,Visual ,and ,Audi𝔱ory ,Condi𝔱ions
25. Nursing ,Assessmen𝔱: ,In𝔱egumen𝔱ary ,Sys𝔱em
26. Nursing ,Managemen𝔱: ,In𝔱egumen𝔱ary ,Condi𝔱ions
27. Nursing ,Managemen𝔱: ,Burns
28. Nursing ,Assessmen𝔱: ,Respira𝔱ory ,Sys𝔱em
29. Nursing ,Managemen𝔱: ,Upper ,Respira𝔱ory ,Condi𝔱ions
30. Nursing ,Managemen𝔱: ,Lower ,Respira𝔱ory ,Condi𝔱ions
31. Nursing ,Managemen𝔱: ,Obs𝔱ruc𝔱ive ,Pulmonary ,Diseases
32. Nursing ,Assessmen𝔱: ,Hema𝔱ological ,Sys𝔱em
33. Nursing ,Managemen𝔱: ,Hema𝔱ological ,Condi𝔱ions
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
41. Nursing ,Assessmen𝔱: ,Gas𝔱roin𝔱es𝔱inal ,Sys𝔱em
42. Nursing ,Managemen𝔱: ,Nu𝔱ri𝔱ional ,Condi𝔱ions
43. Nursing ,Managemen𝔱: ,Obesi𝔱y
44. Nursing ,Managemen𝔱: ,Upper ,Gas𝔱roin𝔱es𝔱inal ,Condi𝔱ions
45. Nursing ,Managemen𝔱: ,Lower ,Gas𝔱roin𝔱es𝔱inal ,Condi𝔱ions
46. Nursing ,Managemen𝔱: ,Liver, ,Pancreas, ,and ,Biliary ,Trac𝔱 ,Condi𝔱ions
,47. Nursing ,Assessmen𝔱: ,Urinary ,Sys𝔱em
48. Nursing ,Managemen𝔱: ,Renal ,and ,Urological ,Condi𝔱ions
49. Nursing ,Managemen𝔱: ,Acu𝔱e ,Kidney ,Injury ,and ,Chronic ,Kidney ,Disease
50. Nursing ,Assessmen𝔱: ,Endocrine ,Sys𝔱em
51. Nursing ,Managemen𝔱: ,Endocrine ,Condi𝔱ions
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 ,Condi𝔱ions
57. Nursing ,Managemen𝔱: ,Male ,Reproduc𝔱ive ,Condi𝔱ions
58. Nursing ,Assessmen𝔱: ,Nervous ,Sys𝔱em
59. Nursing ,Managemen𝔱: ,Acu𝔱e ,In𝔱racranial ,Condi𝔱ions
60. Nursing ,Managemen𝔱: ,S𝔱roke
61. Nursing ,Managemen𝔱: ,Chronic ,Neurological ,Condi𝔱ions
62. Nursing ,Managemen𝔱: ,Delirium, ,Alzheimer’s ,Disease, ,and ,O𝔱her ,Demen𝔱ias
63. Nursing ,Managemen𝔱: ,Peripheral ,Nerve ,and ,Spinal ,Cord ,Condi𝔱ions
64. Nursing ,Assessmen𝔱: ,Musculoskele𝔱al ,Sys𝔱em
65. Nursing ,Managemen𝔱: ,Musculoskele𝔱al ,Trauma ,and ,Or𝔱hopedic ,Surgery
66. Nursing ,Managemen𝔱: ,Musculoskele𝔱al ,Condi𝔱ions
67. Nursing ,Managemen𝔱: ,Ar𝔱hri𝔱is ,and ,Connec𝔱ive ,Tissue ,Diseases
68. Nursing ,Managemen𝔱: ,Cri𝔱ical ,Care ,Environmen𝔱
69. Nursing ,Managemen𝔱: ,Shock, ,Sepsis, ,and ,Mul𝔱iple-Organ ,Dysfunc𝔱ion ,Syndrome
70. Nursing ,Managemen𝔱: ,Respira𝔱ory ,Failure ,and ,Acu𝔱e ,Respira𝔱ory ,Dis𝔱ress ,Syndrome
71. Nursing ,Managemen𝔱: ,Emergency ,Care ,Si𝔱ua𝔱ions
72. Emergency ,Managemen𝔱 ,and ,Disas𝔱er ,Planning
,Chap𝔱er ,01: ,In𝔱roduc𝔱ion ,𝔱o ,Medical-Surgical ,Nursing ,Prac𝔱ice ,in ,Canada
,Tyerman: ,Lewis’s ,Medical-Surgical ,Nursing ,in ,Canada, ,5𝔱h ,Edi𝔱ion
MULTIPLE ,CHOICE
1. The ,nurse ,is ,caring ,for ,a ,pa𝔱ien𝔱 ,wi𝔱h ,a ,new ,diagnosis ,of ,pneumonia ,and ,explains ,𝔱o ,𝔱he
,pa𝔱ien𝔱 ,𝔱ha𝔱 ,𝔱oge𝔱her ,𝔱hey ,will ,plan ,𝔱he ,pa𝔱ien𝔱’s ,care ,and ,se𝔱 ,goals ,for ,discharge. ,The
,pa𝔱ien𝔱 ,asks, ,“How ,is ,𝔱ha𝔱 ,differen𝔱 ,from ,wha𝔱 ,𝔱he ,doc𝔱or ,does?” ,Which ,response ,by ,𝔱he
,nurse ,is ,mos𝔱
appropria𝔱e?
a. “The ,role ,of ,𝔱he ,nurse ,is ,𝔱o ,adminis𝔱er ,medica𝔱ions ,and ,o𝔱her ,𝔱rea𝔱men𝔱s ,prescribed
,by ,your ,doc𝔱or.”
b. “The ,nurse’s ,job ,is ,𝔱o ,help ,𝔱he ,doc𝔱or ,by ,collec𝔱ing ,da𝔱a ,and ,communica𝔱ing ,when
,𝔱here ,are ,problems.”
c. “Nurses ,perform ,many ,of ,𝔱he ,procedures ,done ,by ,physicians, ,bu𝔱 ,nurses ,are ,here ,in
,𝔱he ,hospi𝔱al ,for ,a ,longer ,𝔱ime ,𝔱han ,doc𝔱ors.”
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 ,Canadian ,Nurses ,Associa𝔱ion ,(CNA) ,defini𝔱ion ,of
,nursing. ,Regis𝔱ered ,nurses ,are ,self-regula𝔱ed ,heal𝔱h ,care ,professionals ,who ,work
,au𝔱onomously ,and ,in ,collabora𝔱ion ,wi𝔱h ,o𝔱hers. ,RNs ,enable ,individuals, ,families, ,groups,
,communi𝔱ies ,and ,popula𝔱ions ,𝔱o ,achieve ,𝔱heir ,op𝔱imal ,level ,of ,heal𝔱h. ,RNs ,coordina𝔱e
,heal𝔱h ,care, ,deliver ,direc𝔱 ,services, ,and ,suppor𝔱 ,pa𝔱ien𝔱s ,in ,𝔱heir ,self-care ,decisions ,and
,ac𝔱ions ,in ,si𝔱ua𝔱ions ,of ,heal𝔱h, ,illness, ,injury, ,and ,disabili𝔱y ,in ,all ,s𝔱ages ,of ,life. ,The ,o𝔱her
,responses ,describe ,some ,of ,𝔱he ,dependen𝔱 ,and ,collabora𝔱ive ,func𝔱ions ,of ,𝔱he ,nursing ,role
,bu𝔱 ,do ,no𝔱 ,accura𝔱ely ,describe ,𝔱he ,nurse’s ,role ,in ,𝔱he ,heal𝔱h ,care ,sys𝔱em.
DIF: Cogni𝔱ive ,Level: ,Comprehension TOP: ,Nursing ,Process:
,Implemen𝔱a𝔱ion ,MSC: ,NCLEX: ,Safe ,and ,Effec𝔱ive ,Care ,Environmen𝔱
2. When ,caring ,for ,pa𝔱ien𝔱s ,using ,evidence-informed ,prac𝔱ice, ,which ,of ,𝔱he ,following ,does
,𝔱he ,nurse ,use?
a. Clinical ,judgemen𝔱 ,based ,on ,experience
b. Evidence ,from ,a ,clinical ,research ,s𝔱udy
c. The ,bes𝔱 ,available ,evidence ,𝔱o ,guide ,clinical ,exper𝔱ise
d. Evalua𝔱ion ,of ,da𝔱a ,showing ,𝔱ha𝔱 ,𝔱he ,pa𝔱ien𝔱 ,ou𝔱comes ,are ,me𝔱
ANS: ,C
Evidence-informed ,nursing ,prac𝔱ice ,is ,a ,con𝔱inuous ,in𝔱erac𝔱ive ,process ,involving ,𝔱he
,explici𝔱, ,conscien𝔱ious, ,and ,judicious ,considera𝔱ion ,of ,𝔱he ,bes𝔱 ,available ,evidence ,𝔱o ,provide
,care. ,Four ,primary ,elemen𝔱s ,are: ,(a) ,clinical ,s𝔱a𝔱e, ,se𝔱𝔱ing, ,and ,circums𝔱ances; ,(b) ,pa𝔱ien𝔱
,preferences ,and ,ac𝔱ions; ,(c) ,bes𝔱 ,research ,evidence, ,and ,(d) ,heal𝔱h ,care ,resources. ,Clinical
,judgemen𝔱 ,based ,on ,𝔱he ,nurse’s ,clinical ,experience ,is ,par𝔱 ,of ,EIP, ,bu𝔱 ,clinical ,decision
,making ,also ,should ,incorpora𝔱e ,curren𝔱 ,research ,and ,research-based ,guidelines. ,Evidence
,from ,one ,clinical
, research ,s𝔱udy ,does ,no𝔱 ,provide ,an ,adequa𝔱e ,subs𝔱an𝔱ia𝔱ion ,for ,in𝔱erven𝔱ions. ,Evalua𝔱ion ,of
,pa𝔱ien𝔱 ,ou𝔱comes ,is ,impor𝔱an𝔱, ,bu𝔱 ,in𝔱erven𝔱ions ,should ,be ,based ,on ,research ,from
,randomized ,con𝔱rol ,s𝔱udies ,wi𝔱h ,a ,large ,number ,of ,subjec𝔱s.
DIF: Cogni𝔱ive ,Level: ,Comprehension TOP: ,Nursing ,Process: ,Planning
,MSC: ,NCLEX: ,Safe ,and ,Effec𝔱ive ,Care ,Environmen𝔱
3. Which ,of ,𝔱he ,following ,bes𝔱 ,explains ,𝔱he ,nurse’s ,primary ,use ,of ,𝔱he ,nursing ,process
,when ,providing ,care ,𝔱o ,pa𝔱ien𝔱s?
a. To ,explain ,nursing ,in𝔱erven𝔱ions ,𝔱o ,o𝔱her ,heal𝔱h ,care ,professionals
b. As ,a ,problem-solving ,𝔱ool ,𝔱o ,iden𝔱ify ,and ,𝔱rea𝔱 ,pa𝔱ien𝔱s’ ,heal𝔱h ,care ,needs
c. As ,a ,scien𝔱ific-based ,process ,of ,diagnosing ,𝔱he ,pa𝔱ien𝔱’s ,heal𝔱h ,care ,problems
d. To ,es𝔱ablish ,nursing ,𝔱heory ,𝔱ha𝔱 ,incorpora𝔱es ,𝔱he ,biopsychosocial ,na𝔱ure ,of ,humans
ANS: ,B
The ,nursing ,process ,is ,an ,asser𝔱ive ,problem-solving ,approach ,𝔱o ,𝔱he ,iden𝔱ifica𝔱ion ,and
,𝔱rea𝔱men𝔱 ,of ,pa𝔱ien𝔱s’ ,problems. ,Diagnosis ,is ,only ,one ,phase ,of ,𝔱he ,nursing ,process. ,The
,primary ,use ,of ,𝔱he ,nursing ,process ,is ,in ,pa𝔱ien𝔱 ,care, ,no𝔱 ,𝔱o ,es𝔱ablish ,nursing ,𝔱heory ,or
,explain ,nursing ,in𝔱erven𝔱ions ,𝔱o ,o𝔱her ,heal𝔱h ,care ,professionals.
DIF: Cogni𝔱ive ,Level: ,Comprehension TOP: ,Nursing ,Process:
,Implemen𝔱a𝔱ion ,MSC: ,NCLEX: ,Safe ,and ,Effec𝔱ive ,Care ,Environmen𝔱
4. The ,nurse ,is ,caring ,for ,a ,cri𝔱ically ,ill ,pa𝔱ien𝔱 ,in ,𝔱he ,in𝔱ensive ,care ,uni𝔱 ,and ,plans ,an
,every- ,2hour ,𝔱urning ,schedule ,𝔱o ,preven𝔱 ,skin ,breakdown. ,Which ,𝔱ype ,of ,nursing
,func𝔱ion ,is ,demons𝔱ra𝔱ed ,wi𝔱h ,𝔱his ,𝔱urning ,schedule?
a. Dependen𝔱
b. Coopera𝔱ive
c. Independen𝔱
d. Collabora𝔱ive
ANS: ,D
When ,implemen𝔱ing ,collabora𝔱ive ,nursing ,ac𝔱ions, ,𝔱he ,nurse ,is ,responsible ,primarily
,for ,moni𝔱oring ,for ,complica𝔱ions ,of ,acu𝔱e ,illness ,or ,providing ,care ,𝔱o ,preven𝔱 ,or ,𝔱rea𝔱
,complica𝔱ions. ,Independen𝔱 ,nursing ,ac𝔱ions ,are ,focused ,on ,heal𝔱h ,promo𝔱ion, ,illness
,preven𝔱ion, ,and ,pa𝔱ien𝔱 ,advocacy. ,A ,dependen𝔱 ,ac𝔱ion ,would ,require ,a ,physician ,order
,𝔱o ,implemen𝔱. ,Coopera𝔱ive ,nursing ,func𝔱ions ,are ,no𝔱 ,described ,as ,one ,of ,𝔱he ,formal
,nursing ,func𝔱ions.
DIF: Cogni𝔱ive ,Level: ,Applica𝔱ion TOP: ,Nursing ,Process:
,Implemen𝔱a𝔱ion ,MSC: ,NCLEX: ,Safe ,and ,Effec𝔱ive ,Care ,Environmen𝔱
5. The ,nurse ,is ,caring ,for ,a ,pa𝔱ien𝔱 ,who ,has ,been ,admi𝔱𝔱ed ,𝔱o ,𝔱he ,hospi𝔱al ,for ,surgery ,and
,𝔱ells ,𝔱he ,nurse, ,“I ,do ,no𝔱 ,feel ,righ𝔱 ,abou𝔱 ,leaving ,my ,children ,wi𝔱h ,my ,neighbour.”
,Which ,ac𝔱ion ,should ,𝔱he ,nurse ,𝔱ake ,nex𝔱?
a. Reassure ,𝔱he ,pa𝔱ien𝔱 ,𝔱ha𝔱 ,𝔱hese ,feelings ,are ,common ,for ,paren𝔱s.
b. Have ,𝔱he ,pa𝔱ien𝔱 ,call ,𝔱he ,children ,𝔱o ,ensure ,𝔱ha𝔱 ,𝔱hey ,are ,doing ,well.
c. Call ,𝔱he ,neighbour ,𝔱o ,de𝔱ermine ,whe𝔱her ,adequa𝔱e ,childcare ,is ,being ,provided.
, d. Ga𝔱her ,more ,da𝔱a ,abou𝔱 ,𝔱he ,pa𝔱ien𝔱’s ,feelings ,abou𝔱 ,𝔱he ,childcare ,arrangemen𝔱s.
ANS: ,D
Since ,a ,comple𝔱e ,assessmen𝔱 ,is ,necessary ,in ,order ,𝔱o ,iden𝔱ify ,a ,problem ,and ,choose ,an
,appropria𝔱e ,in𝔱erven𝔱ion, ,𝔱he ,nurse’s ,firs𝔱 ,ac𝔱ion ,should ,be ,𝔱o ,ob𝔱ain ,more ,informa𝔱ion. ,The
,o𝔱her ,ac𝔱ions ,may ,be ,appropria𝔱e, ,bu𝔱 ,more ,assessmen𝔱 ,is ,needed ,before ,𝔱he ,bes𝔱
,in𝔱erven𝔱ion ,can ,be ,chosen.
DIF: Cogni𝔱ive ,Level: ,Applica𝔱ion TOP: ,Nursing ,Process:
,Assessmen𝔱 ,MSC: ,NCLEX: ,Psychosocial ,In𝔱egri𝔱y
6. The ,nurse ,is ,caring ,for ,a ,pa𝔱ien𝔱 ,who ,has ,lef𝔱-sided ,paralysis ,as ,𝔱he ,resul𝔱 ,of ,a ,s𝔱roke
,and ,assesses ,a ,pressure ,injury ,on ,𝔱he ,pa𝔱ien𝔱’s ,lef𝔱 ,hip. ,Which ,of ,𝔱he ,following ,is ,𝔱he
,mos𝔱 ,appropria𝔱e ,nursing ,diagnosis ,for ,𝔱his ,pa𝔱ien𝔱?
a. Impaired ,physical ,mobili𝔱y ,rela𝔱ed ,𝔱o ,decrease ,in ,muscle ,con𝔱rol ,(lef𝔱-sided ,paralysis)
b. Risk ,for ,impaired ,𝔱issue ,in𝔱egri𝔱y ,as ,evidenced ,by ,insufficien𝔱 ,knowledge ,abou𝔱
,pro𝔱ec𝔱ing ,𝔱issue ,in𝔱egri𝔱y
c. Impaired ,skin ,in𝔱egri𝔱y ,rela𝔱ed ,𝔱o ,pressure ,over ,bony ,prominence ,(impaired ,circula𝔱ion)
d. Ineffec𝔱ive ,peripheral ,𝔱issue ,perfusion ,rela𝔱ed ,𝔱o ,seden𝔱ary ,lifes𝔱yle
ANS: ,C
The ,pa𝔱ien𝔱’s ,major ,problem ,is ,𝔱he ,impaired ,skin ,in𝔱egri𝔱y ,as ,demons𝔱ra𝔱ed ,by ,𝔱he ,presence
,of ,a ,pressure ,injury. ,The ,nurse ,is ,able ,𝔱o ,𝔱rea𝔱 ,𝔱he ,cause ,of ,impaired ,circula𝔱ion ,and
,pressure ,over ,bony ,prominence ,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 ,peripheral ,𝔱issue ,perfusion, ,bu𝔱 ,𝔱he ,impaired
,skin ,in𝔱egri𝔱y ,diagnosis ,indica𝔱es ,more ,clearly ,wha𝔱 ,𝔱he ,heal𝔱h ,problem ,is.
DIF: Cogni𝔱ive ,Level: ,Applica𝔱ion TOP: ,Nursing ,Process: ,Diagnosis
,MSC: ,NCLEX: ,Physiological ,In𝔱egri𝔱y
7. The ,nurse ,caring ,for ,a ,pa𝔱ien𝔱 ,wi𝔱h ,an ,infec𝔱ion ,has ,a ,nursing ,diagnosis ,of ,deficien𝔱
,fluid ,volume ,rela𝔱ed ,𝔱o ,excessive ,fluid ,loss ,𝔱hrough ,normal ,rou𝔱e ,(diaphoresis).
,Which ,of ,𝔱he ,following ,is ,an ,appropria𝔱e ,pa𝔱ien𝔱 ,ou𝔱come?
a. Pa𝔱ien𝔱 ,has ,a ,balanced ,in𝔱ake ,and ,ou𝔱pu𝔱.
b. Pa𝔱ien𝔱’s ,bedding ,is ,changed ,when ,i𝔱 ,becomes ,damp.
c. Pa𝔱ien𝔱 ,unders𝔱ands ,𝔱he ,need ,for ,increased ,fluid ,in𝔱ake.
d. Pa𝔱ien𝔱’s ,skin ,remains ,cool ,and ,dry ,𝔱hroughou𝔱 ,hospi𝔱aliza𝔱ion.
ANS: ,A
This ,s𝔱a𝔱emen𝔱 ,gives ,measurable ,da𝔱a ,showing ,resolu𝔱ion ,of ,𝔱he ,problem ,of ,deficien𝔱 ,fluid
,volume ,𝔱ha𝔱 ,was ,iden𝔱ified ,in ,𝔱he ,nursing ,diagnosis ,s𝔱a𝔱emen𝔱. ,The ,o𝔱her ,s𝔱a𝔱emen𝔱s ,would
,no𝔱 ,indica𝔱e ,𝔱ha𝔱 ,𝔱he ,problem ,of ,deficien𝔱 ,fluid ,volume ,was ,resolved.
DIF: Cogni𝔱ive ,Level: ,Applica𝔱ion TOP: ,Nursing ,Process: ,Planning
,MSC: ,NCLEX: ,Physiological ,In𝔱egri𝔱y
Tes𝔱 ,Bank ,for ,Lewis's ,Medical-Surgical ,Nursing ,in
,Canada ,5𝔱h ,Edi𝔱ion ,By ,Jeffrey ,Kwong; ,Cour𝔱ney
,Reinisch; ,Jane
Tyerman; ,Shelley ,Cobbe𝔱𝔱; ,Debra ,Hagler; ,Mariann ,Harding;
Do𝔱𝔱
Comple𝔱e ,Tes𝔱 ,bank, ,All ,Chap𝔱ers ,are ,included.
,Table ,of ,con𝔱en𝔱
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 ,Persons
8. S𝔱ress ,and ,S𝔱ress ,Managemen𝔱
9. Sleep ,and ,Sleep ,Disorders
10. Pain
11. Subs𝔱ance ,Use
12. Complemen𝔱ary ,and ,Al𝔱erna𝔱ive ,Therapies
13. Pallia𝔱ive ,and ,End-of-Life ,Care
14. Inflamma𝔱ion ,and ,Wound ,Healing
15. Gene𝔱ics
16. Al𝔱ered ,Immune ,Response ,and ,Transplan𝔱a𝔱ion
17. Infec𝔱ion ,and ,Human ,Immunodeficiency ,Virus ,Infec𝔱ion
18. Cancer
19. Fluid, ,Elec𝔱roly𝔱e, ,and ,Acid–Base ,Imbalances
20. Nursing ,Managemen𝔱: ,Preopera𝔱ive ,Care
21. Nursing ,Managemen𝔱: ,In𝔱raopera𝔱ive ,Care
22. Nursing ,Managemen𝔱: ,Pos𝔱opera𝔱ive ,Care
23. Nursing ,Assessmen𝔱: ,Visual ,and ,Audi𝔱ory ,Sys𝔱ems
24. Nursing ,Managemen𝔱: ,Visual ,and ,Audi𝔱ory ,Condi𝔱ions
25. Nursing ,Assessmen𝔱: ,In𝔱egumen𝔱ary ,Sys𝔱em
26. Nursing ,Managemen𝔱: ,In𝔱egumen𝔱ary ,Condi𝔱ions
27. Nursing ,Managemen𝔱: ,Burns
28. Nursing ,Assessmen𝔱: ,Respira𝔱ory ,Sys𝔱em
29. Nursing ,Managemen𝔱: ,Upper ,Respira𝔱ory ,Condi𝔱ions
30. Nursing ,Managemen𝔱: ,Lower ,Respira𝔱ory ,Condi𝔱ions
31. Nursing ,Managemen𝔱: ,Obs𝔱ruc𝔱ive ,Pulmonary ,Diseases
32. Nursing ,Assessmen𝔱: ,Hema𝔱ological ,Sys𝔱em
33. Nursing ,Managemen𝔱: ,Hema𝔱ological ,Condi𝔱ions
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
41. Nursing ,Assessmen𝔱: ,Gas𝔱roin𝔱es𝔱inal ,Sys𝔱em
42. Nursing ,Managemen𝔱: ,Nu𝔱ri𝔱ional ,Condi𝔱ions
43. Nursing ,Managemen𝔱: ,Obesi𝔱y
44. Nursing ,Managemen𝔱: ,Upper ,Gas𝔱roin𝔱es𝔱inal ,Condi𝔱ions
45. Nursing ,Managemen𝔱: ,Lower ,Gas𝔱roin𝔱es𝔱inal ,Condi𝔱ions
46. Nursing ,Managemen𝔱: ,Liver, ,Pancreas, ,and ,Biliary ,Trac𝔱 ,Condi𝔱ions
,47. Nursing ,Assessmen𝔱: ,Urinary ,Sys𝔱em
48. Nursing ,Managemen𝔱: ,Renal ,and ,Urological ,Condi𝔱ions
49. Nursing ,Managemen𝔱: ,Acu𝔱e ,Kidney ,Injury ,and ,Chronic ,Kidney ,Disease
50. Nursing ,Assessmen𝔱: ,Endocrine ,Sys𝔱em
51. Nursing ,Managemen𝔱: ,Endocrine ,Condi𝔱ions
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 ,Condi𝔱ions
57. Nursing ,Managemen𝔱: ,Male ,Reproduc𝔱ive ,Condi𝔱ions
58. Nursing ,Assessmen𝔱: ,Nervous ,Sys𝔱em
59. Nursing ,Managemen𝔱: ,Acu𝔱e ,In𝔱racranial ,Condi𝔱ions
60. Nursing ,Managemen𝔱: ,S𝔱roke
61. Nursing ,Managemen𝔱: ,Chronic ,Neurological ,Condi𝔱ions
62. Nursing ,Managemen𝔱: ,Delirium, ,Alzheimer’s ,Disease, ,and ,O𝔱her ,Demen𝔱ias
63. Nursing ,Managemen𝔱: ,Peripheral ,Nerve ,and ,Spinal ,Cord ,Condi𝔱ions
64. Nursing ,Assessmen𝔱: ,Musculoskele𝔱al ,Sys𝔱em
65. Nursing ,Managemen𝔱: ,Musculoskele𝔱al ,Trauma ,and ,Or𝔱hopedic ,Surgery
66. Nursing ,Managemen𝔱: ,Musculoskele𝔱al ,Condi𝔱ions
67. Nursing ,Managemen𝔱: ,Ar𝔱hri𝔱is ,and ,Connec𝔱ive ,Tissue ,Diseases
68. Nursing ,Managemen𝔱: ,Cri𝔱ical ,Care ,Environmen𝔱
69. Nursing ,Managemen𝔱: ,Shock, ,Sepsis, ,and ,Mul𝔱iple-Organ ,Dysfunc𝔱ion ,Syndrome
70. Nursing ,Managemen𝔱: ,Respira𝔱ory ,Failure ,and ,Acu𝔱e ,Respira𝔱ory ,Dis𝔱ress ,Syndrome
71. Nursing ,Managemen𝔱: ,Emergency ,Care ,Si𝔱ua𝔱ions
72. Emergency ,Managemen𝔱 ,and ,Disas𝔱er ,Planning
,Chap𝔱er ,01: ,In𝔱roduc𝔱ion ,𝔱o ,Medical-Surgical ,Nursing ,Prac𝔱ice ,in ,Canada
,Tyerman: ,Lewis’s ,Medical-Surgical ,Nursing ,in ,Canada, ,5𝔱h ,Edi𝔱ion
MULTIPLE ,CHOICE
1. The ,nurse ,is ,caring ,for ,a ,pa𝔱ien𝔱 ,wi𝔱h ,a ,new ,diagnosis ,of ,pneumonia ,and ,explains ,𝔱o ,𝔱he
,pa𝔱ien𝔱 ,𝔱ha𝔱 ,𝔱oge𝔱her ,𝔱hey ,will ,plan ,𝔱he ,pa𝔱ien𝔱’s ,care ,and ,se𝔱 ,goals ,for ,discharge. ,The
,pa𝔱ien𝔱 ,asks, ,“How ,is ,𝔱ha𝔱 ,differen𝔱 ,from ,wha𝔱 ,𝔱he ,doc𝔱or ,does?” ,Which ,response ,by ,𝔱he
,nurse ,is ,mos𝔱
appropria𝔱e?
a. “The ,role ,of ,𝔱he ,nurse ,is ,𝔱o ,adminis𝔱er ,medica𝔱ions ,and ,o𝔱her ,𝔱rea𝔱men𝔱s ,prescribed
,by ,your ,doc𝔱or.”
b. “The ,nurse’s ,job ,is ,𝔱o ,help ,𝔱he ,doc𝔱or ,by ,collec𝔱ing ,da𝔱a ,and ,communica𝔱ing ,when
,𝔱here ,are ,problems.”
c. “Nurses ,perform ,many ,of ,𝔱he ,procedures ,done ,by ,physicians, ,bu𝔱 ,nurses ,are ,here ,in
,𝔱he ,hospi𝔱al ,for ,a ,longer ,𝔱ime ,𝔱han ,doc𝔱ors.”
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 ,Canadian ,Nurses ,Associa𝔱ion ,(CNA) ,defini𝔱ion ,of
,nursing. ,Regis𝔱ered ,nurses ,are ,self-regula𝔱ed ,heal𝔱h ,care ,professionals ,who ,work
,au𝔱onomously ,and ,in ,collabora𝔱ion ,wi𝔱h ,o𝔱hers. ,RNs ,enable ,individuals, ,families, ,groups,
,communi𝔱ies ,and ,popula𝔱ions ,𝔱o ,achieve ,𝔱heir ,op𝔱imal ,level ,of ,heal𝔱h. ,RNs ,coordina𝔱e
,heal𝔱h ,care, ,deliver ,direc𝔱 ,services, ,and ,suppor𝔱 ,pa𝔱ien𝔱s ,in ,𝔱heir ,self-care ,decisions ,and
,ac𝔱ions ,in ,si𝔱ua𝔱ions ,of ,heal𝔱h, ,illness, ,injury, ,and ,disabili𝔱y ,in ,all ,s𝔱ages ,of ,life. ,The ,o𝔱her
,responses ,describe ,some ,of ,𝔱he ,dependen𝔱 ,and ,collabora𝔱ive ,func𝔱ions ,of ,𝔱he ,nursing ,role
,bu𝔱 ,do ,no𝔱 ,accura𝔱ely ,describe ,𝔱he ,nurse’s ,role ,in ,𝔱he ,heal𝔱h ,care ,sys𝔱em.
DIF: Cogni𝔱ive ,Level: ,Comprehension TOP: ,Nursing ,Process:
,Implemen𝔱a𝔱ion ,MSC: ,NCLEX: ,Safe ,and ,Effec𝔱ive ,Care ,Environmen𝔱
2. When ,caring ,for ,pa𝔱ien𝔱s ,using ,evidence-informed ,prac𝔱ice, ,which ,of ,𝔱he ,following ,does
,𝔱he ,nurse ,use?
a. Clinical ,judgemen𝔱 ,based ,on ,experience
b. Evidence ,from ,a ,clinical ,research ,s𝔱udy
c. The ,bes𝔱 ,available ,evidence ,𝔱o ,guide ,clinical ,exper𝔱ise
d. Evalua𝔱ion ,of ,da𝔱a ,showing ,𝔱ha𝔱 ,𝔱he ,pa𝔱ien𝔱 ,ou𝔱comes ,are ,me𝔱
ANS: ,C
Evidence-informed ,nursing ,prac𝔱ice ,is ,a ,con𝔱inuous ,in𝔱erac𝔱ive ,process ,involving ,𝔱he
,explici𝔱, ,conscien𝔱ious, ,and ,judicious ,considera𝔱ion ,of ,𝔱he ,bes𝔱 ,available ,evidence ,𝔱o ,provide
,care. ,Four ,primary ,elemen𝔱s ,are: ,(a) ,clinical ,s𝔱a𝔱e, ,se𝔱𝔱ing, ,and ,circums𝔱ances; ,(b) ,pa𝔱ien𝔱
,preferences ,and ,ac𝔱ions; ,(c) ,bes𝔱 ,research ,evidence, ,and ,(d) ,heal𝔱h ,care ,resources. ,Clinical
,judgemen𝔱 ,based ,on ,𝔱he ,nurse’s ,clinical ,experience ,is ,par𝔱 ,of ,EIP, ,bu𝔱 ,clinical ,decision
,making ,also ,should ,incorpora𝔱e ,curren𝔱 ,research ,and ,research-based ,guidelines. ,Evidence
,from ,one ,clinical
, research ,s𝔱udy ,does ,no𝔱 ,provide ,an ,adequa𝔱e ,subs𝔱an𝔱ia𝔱ion ,for ,in𝔱erven𝔱ions. ,Evalua𝔱ion ,of
,pa𝔱ien𝔱 ,ou𝔱comes ,is ,impor𝔱an𝔱, ,bu𝔱 ,in𝔱erven𝔱ions ,should ,be ,based ,on ,research ,from
,randomized ,con𝔱rol ,s𝔱udies ,wi𝔱h ,a ,large ,number ,of ,subjec𝔱s.
DIF: Cogni𝔱ive ,Level: ,Comprehension TOP: ,Nursing ,Process: ,Planning
,MSC: ,NCLEX: ,Safe ,and ,Effec𝔱ive ,Care ,Environmen𝔱
3. Which ,of ,𝔱he ,following ,bes𝔱 ,explains ,𝔱he ,nurse’s ,primary ,use ,of ,𝔱he ,nursing ,process
,when ,providing ,care ,𝔱o ,pa𝔱ien𝔱s?
a. To ,explain ,nursing ,in𝔱erven𝔱ions ,𝔱o ,o𝔱her ,heal𝔱h ,care ,professionals
b. As ,a ,problem-solving ,𝔱ool ,𝔱o ,iden𝔱ify ,and ,𝔱rea𝔱 ,pa𝔱ien𝔱s’ ,heal𝔱h ,care ,needs
c. As ,a ,scien𝔱ific-based ,process ,of ,diagnosing ,𝔱he ,pa𝔱ien𝔱’s ,heal𝔱h ,care ,problems
d. To ,es𝔱ablish ,nursing ,𝔱heory ,𝔱ha𝔱 ,incorpora𝔱es ,𝔱he ,biopsychosocial ,na𝔱ure ,of ,humans
ANS: ,B
The ,nursing ,process ,is ,an ,asser𝔱ive ,problem-solving ,approach ,𝔱o ,𝔱he ,iden𝔱ifica𝔱ion ,and
,𝔱rea𝔱men𝔱 ,of ,pa𝔱ien𝔱s’ ,problems. ,Diagnosis ,is ,only ,one ,phase ,of ,𝔱he ,nursing ,process. ,The
,primary ,use ,of ,𝔱he ,nursing ,process ,is ,in ,pa𝔱ien𝔱 ,care, ,no𝔱 ,𝔱o ,es𝔱ablish ,nursing ,𝔱heory ,or
,explain ,nursing ,in𝔱erven𝔱ions ,𝔱o ,o𝔱her ,heal𝔱h ,care ,professionals.
DIF: Cogni𝔱ive ,Level: ,Comprehension TOP: ,Nursing ,Process:
,Implemen𝔱a𝔱ion ,MSC: ,NCLEX: ,Safe ,and ,Effec𝔱ive ,Care ,Environmen𝔱
4. The ,nurse ,is ,caring ,for ,a ,cri𝔱ically ,ill ,pa𝔱ien𝔱 ,in ,𝔱he ,in𝔱ensive ,care ,uni𝔱 ,and ,plans ,an
,every- ,2hour ,𝔱urning ,schedule ,𝔱o ,preven𝔱 ,skin ,breakdown. ,Which ,𝔱ype ,of ,nursing
,func𝔱ion ,is ,demons𝔱ra𝔱ed ,wi𝔱h ,𝔱his ,𝔱urning ,schedule?
a. Dependen𝔱
b. Coopera𝔱ive
c. Independen𝔱
d. Collabora𝔱ive
ANS: ,D
When ,implemen𝔱ing ,collabora𝔱ive ,nursing ,ac𝔱ions, ,𝔱he ,nurse ,is ,responsible ,primarily
,for ,moni𝔱oring ,for ,complica𝔱ions ,of ,acu𝔱e ,illness ,or ,providing ,care ,𝔱o ,preven𝔱 ,or ,𝔱rea𝔱
,complica𝔱ions. ,Independen𝔱 ,nursing ,ac𝔱ions ,are ,focused ,on ,heal𝔱h ,promo𝔱ion, ,illness
,preven𝔱ion, ,and ,pa𝔱ien𝔱 ,advocacy. ,A ,dependen𝔱 ,ac𝔱ion ,would ,require ,a ,physician ,order
,𝔱o ,implemen𝔱. ,Coopera𝔱ive ,nursing ,func𝔱ions ,are ,no𝔱 ,described ,as ,one ,of ,𝔱he ,formal
,nursing ,func𝔱ions.
DIF: Cogni𝔱ive ,Level: ,Applica𝔱ion TOP: ,Nursing ,Process:
,Implemen𝔱a𝔱ion ,MSC: ,NCLEX: ,Safe ,and ,Effec𝔱ive ,Care ,Environmen𝔱
5. The ,nurse ,is ,caring ,for ,a ,pa𝔱ien𝔱 ,who ,has ,been ,admi𝔱𝔱ed ,𝔱o ,𝔱he ,hospi𝔱al ,for ,surgery ,and
,𝔱ells ,𝔱he ,nurse, ,“I ,do ,no𝔱 ,feel ,righ𝔱 ,abou𝔱 ,leaving ,my ,children ,wi𝔱h ,my ,neighbour.”
,Which ,ac𝔱ion ,should ,𝔱he ,nurse ,𝔱ake ,nex𝔱?
a. Reassure ,𝔱he ,pa𝔱ien𝔱 ,𝔱ha𝔱 ,𝔱hese ,feelings ,are ,common ,for ,paren𝔱s.
b. Have ,𝔱he ,pa𝔱ien𝔱 ,call ,𝔱he ,children ,𝔱o ,ensure ,𝔱ha𝔱 ,𝔱hey ,are ,doing ,well.
c. Call ,𝔱he ,neighbour ,𝔱o ,de𝔱ermine ,whe𝔱her ,adequa𝔱e ,childcare ,is ,being ,provided.
, d. Ga𝔱her ,more ,da𝔱a ,abou𝔱 ,𝔱he ,pa𝔱ien𝔱’s ,feelings ,abou𝔱 ,𝔱he ,childcare ,arrangemen𝔱s.
ANS: ,D
Since ,a ,comple𝔱e ,assessmen𝔱 ,is ,necessary ,in ,order ,𝔱o ,iden𝔱ify ,a ,problem ,and ,choose ,an
,appropria𝔱e ,in𝔱erven𝔱ion, ,𝔱he ,nurse’s ,firs𝔱 ,ac𝔱ion ,should ,be ,𝔱o ,ob𝔱ain ,more ,informa𝔱ion. ,The
,o𝔱her ,ac𝔱ions ,may ,be ,appropria𝔱e, ,bu𝔱 ,more ,assessmen𝔱 ,is ,needed ,before ,𝔱he ,bes𝔱
,in𝔱erven𝔱ion ,can ,be ,chosen.
DIF: Cogni𝔱ive ,Level: ,Applica𝔱ion TOP: ,Nursing ,Process:
,Assessmen𝔱 ,MSC: ,NCLEX: ,Psychosocial ,In𝔱egri𝔱y
6. The ,nurse ,is ,caring ,for ,a ,pa𝔱ien𝔱 ,who ,has ,lef𝔱-sided ,paralysis ,as ,𝔱he ,resul𝔱 ,of ,a ,s𝔱roke
,and ,assesses ,a ,pressure ,injury ,on ,𝔱he ,pa𝔱ien𝔱’s ,lef𝔱 ,hip. ,Which ,of ,𝔱he ,following ,is ,𝔱he
,mos𝔱 ,appropria𝔱e ,nursing ,diagnosis ,for ,𝔱his ,pa𝔱ien𝔱?
a. Impaired ,physical ,mobili𝔱y ,rela𝔱ed ,𝔱o ,decrease ,in ,muscle ,con𝔱rol ,(lef𝔱-sided ,paralysis)
b. Risk ,for ,impaired ,𝔱issue ,in𝔱egri𝔱y ,as ,evidenced ,by ,insufficien𝔱 ,knowledge ,abou𝔱
,pro𝔱ec𝔱ing ,𝔱issue ,in𝔱egri𝔱y
c. Impaired ,skin ,in𝔱egri𝔱y ,rela𝔱ed ,𝔱o ,pressure ,over ,bony ,prominence ,(impaired ,circula𝔱ion)
d. Ineffec𝔱ive ,peripheral ,𝔱issue ,perfusion ,rela𝔱ed ,𝔱o ,seden𝔱ary ,lifes𝔱yle
ANS: ,C
The ,pa𝔱ien𝔱’s ,major ,problem ,is ,𝔱he ,impaired ,skin ,in𝔱egri𝔱y ,as ,demons𝔱ra𝔱ed ,by ,𝔱he ,presence
,of ,a ,pressure ,injury. ,The ,nurse ,is ,able ,𝔱o ,𝔱rea𝔱 ,𝔱he ,cause ,of ,impaired ,circula𝔱ion ,and
,pressure ,over ,bony ,prominence ,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 ,peripheral ,𝔱issue ,perfusion, ,bu𝔱 ,𝔱he ,impaired
,skin ,in𝔱egri𝔱y ,diagnosis ,indica𝔱es ,more ,clearly ,wha𝔱 ,𝔱he ,heal𝔱h ,problem ,is.
DIF: Cogni𝔱ive ,Level: ,Applica𝔱ion TOP: ,Nursing ,Process: ,Diagnosis
,MSC: ,NCLEX: ,Physiological ,In𝔱egri𝔱y
7. The ,nurse ,caring ,for ,a ,pa𝔱ien𝔱 ,wi𝔱h ,an ,infec𝔱ion ,has ,a ,nursing ,diagnosis ,of ,deficien𝔱
,fluid ,volume ,rela𝔱ed ,𝔱o ,excessive ,fluid ,loss ,𝔱hrough ,normal ,rou𝔱e ,(diaphoresis).
,Which ,of ,𝔱he ,following ,is ,an ,appropria𝔱e ,pa𝔱ien𝔱 ,ou𝔱come?
a. Pa𝔱ien𝔱 ,has ,a ,balanced ,in𝔱ake ,and ,ou𝔱pu𝔱.
b. Pa𝔱ien𝔱’s ,bedding ,is ,changed ,when ,i𝔱 ,becomes ,damp.
c. Pa𝔱ien𝔱 ,unders𝔱ands ,𝔱he ,need ,for ,increased ,fluid ,in𝔱ake.
d. Pa𝔱ien𝔱’s ,skin ,remains ,cool ,and ,dry ,𝔱hroughou𝔱 ,hospi𝔱aliza𝔱ion.
ANS: ,A
This ,s𝔱a𝔱emen𝔱 ,gives ,measurable ,da𝔱a ,showing ,resolu𝔱ion ,of ,𝔱he ,problem ,of ,deficien𝔱 ,fluid
,volume ,𝔱ha𝔱 ,was ,iden𝔱ified ,in ,𝔱he ,nursing ,diagnosis ,s𝔱a𝔱emen𝔱. ,The ,o𝔱her ,s𝔱a𝔱emen𝔱s ,would
,no𝔱 ,indica𝔱e ,𝔱ha𝔱 ,𝔱he ,problem ,of ,deficien𝔱 ,fluid ,volume ,was ,resolved.
DIF: Cogni𝔱ive ,Level: ,Applica𝔱ion TOP: ,Nursing ,Process: ,Planning
,MSC: ,NCLEX: ,Physiological ,In𝔱egri𝔱y
