Test bank for Lewis's Medical-Surgical Nursing in Canada-Assessment and Management of Clin, Exams of Nursing

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Detailed Test Bank

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Lewis's Medical-Surgical Nursing in Canada

Assessment and Management of Clinical

Problems

5th Edition

Jane Tyerman, Shelley Cobbett

Mariann M. Harding, Jeffrey Kwong

Dottie Roberts, Debra Hagler

Courtney Reinisch

TABLE OF CONTENTS

Section One – Concepts in Nursing Practice

Chapter 1 Introduction to Medical-Surgical Nursing Practice in Canada

Chapter 2 Cultural Competence and Health Equity in Care

Chapter 3 Health History and Physical Examination

Chapter 4 Patient and Caregiver Teaching

Chapter 5 Chronic Illness

Chapter 6 Community-Based Nursing and Home Care

Chapter 7 Older Adults

Chapter 8 Stress and Stress Management

Chapter 9 Sleep and Sleep Disorders

Chapter 10 Pain

Chapter 11 Substance Use

Chapter 12 Complementary and Alternative Therapies

Chapter 13 Palliative Care at the End of Life

Section Two – Pathophysiological Mechanisms of Disease

Chapter 14 Inflammation and Wound Healing

Chapter 15 Genetics

Chapter 16 Altered Immune Response and Transplantation

Chapter 17 Infection and Human Immunodeficiency Virus Infection

Chapter 18 Cancer

Chapter 19 Fluid, Electrolyte, and Acid–Base Imbalances

Section Three – Perioperative Care

Chapter 20 Nursing Management: Preoperative Care

Chapter 21 Nursing Management: Intraoperative Care

Chapter 22 Nursing Management: Post-operative Care

Section Four – Problems Related to Altered Sensory Input

Chapter 23 Nursing Assessment: Visual and Auditory Systems

Chapter 24 Nursing Management: Visual and Auditory Problems

Chapter 25 Nursing Assessment: Integumentary System

Chapter 26 Nursing Management: Integumentary Problems

Chapter 27 Nursing Management: Burns

Section Five – Problems of Oxygenation: Ventilation

Chapter 28 Nursing Assessment: Respiratory System

Chapter 29 Nursing Management: Upper Respiratory Problems

Chapter 30 Nursing Management: Lower Respiratory Problems

Chapter 31 Nursing Management: Obstructive Pulmonary Diseases

Section Six – Problems of Oxygenation: Transport

Chapter 32 Nursing Assessment: Hematological System

Chapter 33 Nursing Management: Hematological Problems

Section Seven – Problems of Oxygenation: Perfusion

Chapter 34 Nursing Assessment: Cardiovascular System

Chapter 35 Nursing Management: Hypertension

Chapter 36 Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome

Chapter 37 Nursing Management: Heart Failure

Chapter 38 Nursing Management: Dysrhythmias

Chapter 39 Nursing Management: Inflammatory and Structural Heart Diseases

Chapter 40 Nursing Management: Vascular Disorders

Section Eight – Problems of Ingestion, Digestion, Absorption, and Elimination

Chapter 41 Nursing Assessment: Gastrointestinal System

Chapter 42 Nursing Management: Nutritional Problems

Chapter 43 Nursing Management: Obesity

Chapter 44 Nursing Management: Upper Gastrointestinal Problems

Chapter 45 Nursing Management: Lower Gastrointestinal Problems

Chapter 69 Nursing Management: Shock, Systemic Inflammatory Response Syndrome, and

Multiple-Organ Dysfunction Syndrome

Chapter 70 Nursing Management: Respiratory Failure and Acute Respiratory Distress

Syndrome

Chapter 71 Nursing Management: Emergency Care Situations

Chapter 72 Emergency Management and Disaster Planning

Link I: Should you face any challenges, do not hesitate to send an email to: charlirumwa@gmail.com We respond and resolve to all queries within 6 hours.

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Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada

Tyerman: Lewis’s Medical-Surgical Nursing in Canada, 5th Edition

MULTIPLE CHOICE

1. 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: (1) clinical state, setting, and circumstances; (2) patient preferences and actions; (3) best research evidence; and (4) 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
2. Which of the following best explains the nurses’ 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
3. The nurse is caring for a critically ill patient in the intensive care unit and plans an every 2 - hour 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

3 | P a g e 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

7. Which of the following represents a nursing activity that is carried out during the evaluation phase of the nursing process? a. Determining if interventions have been effective in meeting patient outcomes b. (^) Documenting the nursing care plan in the progress notes in the medical record c. (^) Deciding whether the patient’s health problems have been completely resolved d. (^) Asking the patient to evaluate whether 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: Comprehension TOP: Nursing Process: Evaluation
8. Which of the following would the nurse perform during the assessment phase of the nursing process? a. (^) Obtains data with which to diagnose patient problems b. (^) Uses patient data to develop priority nursing diagnoses c. (^) Teaches interventions to relieve patient health problems d. (^) Assists the patient to identify realistic outcomes to health problems ANS: A During the assessment phase, the nurse gathers information about the patient. The other responses are examples of the intervention, diagnosis, and planning phases of the nursing process. DIF: Cognitive Level: Knowledge TOP: Nursing Process: Assessment
9. Which of the following is an example of a correctly written nursing diagnosis statement? a. (^) Altered tissue perfusion related to heart failure b. (^) Risk for impaired tissue integrity related to sacral redness c. (^) Ineffective coping related to insufficient sense of control d. (^) Altered urinary elimination related to urinary tract infection ANS: C This diagnosis statement includes a NANDA nursing diagnosis and an etiology that describes a patient’s response to a health problem that can be treated by nursing. The use of a medical diagnosis (as 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 characteristics as the etiology. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Diagnosis

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10. Which of the following includes the components required for a complete nursing diagnosis statement? a. A problem and the suggested patient goals or outcomes b. (^) A problem, its cause, and objective data that support the problem c. (^) A problem with all its possible causes and the planned interventions d. (^) A problem with its etiology and the signs and symptoms of the problem ANS: D The PES format is used when writing nursing diagnoses. 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: Knowledge TOP: Nursing Process: Diagnosis
11. 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 to the patient rather than to the patient’s underlying medical condition. DIF: Cognitive Level: Knowledge TOP: Nursing Process: Evaluation
12. When using the Five Steps of the e vidence- i nformed p ractice (EIP) Process, which of the flowing elements is the final step when constructing a clinical question? a. (^) Comparison of interest b. (^) Population of interest c. (^) Outcome of interest d. (^) Timeframe of interest ANS: D The order of the nurse’s statements follows the PICOT format with the final step being the “T”, or timeframe of interest. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

6 | P a g e Because the patient has traditional health care beliefs, it is appropriate for the nurse to ask whether the patient would like a visit from a cultural healer. Nurses ask key questions with regard to language, diet, religion, and acculturation and eliciting the patient’s explanatory model of health and illness. There is no cultural reason for the nurse to avoid asking the patient questions, and questions may be necessary to obtain necessary health information. The patient (rather than the daughter) should be consulted about personal cultural beliefs. The hospital routines for meals, care, and visits should be adapted to the patient’s preferences rather than expecting the patient to adapt to the hospital schedule. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

4. When caring for an Indigenous patient, which of the following actions is the best initial approach in relation to eye contact for the nurse to take? a. (^) Avoid all eye contact with the patient. b. (^) Observe the patient’s use of eye contact. c. (^) Look directly at the patient when interacting. d. (^) Ask the family about the patient’s cultural beliefs. ANS: B Eye contact varies greatly among and within cultures so the nurses’ initial action is to assess the patient’s use of eye contact. Although nurses are often taught to maintain direct eye contact, patients who are Asian, Arab, or Indigenous may avoid direct eye contact and consider direct eye contact disrespectful or aggressive. Looking directly at the patient or avoiding eye contact may be appropriate, depending on the patient’s individual cultural beliefs. The nurse should assess the patient, rather than asking family members about the patient’s beliefs. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
5. A graduate nurse is assessing a newly admitted non–English-speaking Chinese patient who complains of severe headaches. Which of the following actions by the graduate nurse would cause the charge nurse to intervene during this assessment interview? a. (^) Sit down at the bedside. b. (^) Palpate the patient’s scalp. c. (^) Call for a medical interpreter. d. (^) Avoid eye contact with the patient. ANS: B Many people of Asian ethnicity believe that touching a person’s head is disrespectful; the nurse should always ask permission before touching any patient’s head. The other actions are appropriate. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
6. The nurse is caring for a patient who speaks a language different from the nurse’s language and there is no interpreter available. Which of the following actions is the most appropriate for the nurse to implement? 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 simple gestures to demonstrate meaning while talking to the patient.

7 | P a g e ANS: D The use of gestures will enable some information to be communicated to the patient. The other actions will not improve communication with the patient. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation

7. According to the ABC(DE)s of cultural competence, awareness of and sensitivity to cultural values is in which of the following domains? a. (^) Skills domain b. (^) Affective domain c. (^) Knowledge domain d. (^) Behavioural domain ANS: B The affective domain reflects an awareness of and sensitivity to cultural values, needs, and biases. The skills domain does not reflect an awareness of and sensitivity to cultural values, needs, and biases. There is no skills or knowledge domain; with ABC(DE) it is affective, behavioural, and cognitive domains as well as dynamics of difference and environment. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning
8. Which of the following actions represents the best example of culturally appropriate nursing care when caring for a newly admitted patient? a. (^) Have family members provide most of the patient’s personal care. b. (^) Maintain a personal space of at least 0.5 metres when assessing the patient. c. Ask permission before touching a patient during the physical assessment. d. (^) Consider the patient’s ethnicity as the most important factor in planning care. ANS: C Many cultures consider it disrespectful to touch a patient without asking permission, so asking a patient for permission is always culturally appropriate. The other actions may be appropriate for some patients but are not appropriate across all cultural groups or for all individual patients. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation
9. While talking with the nursing supervisor, a staff nurse expresses frustration that an Indigenous patient always has several family members at the bedside. Which of the following actions is the most appropriate action for the nursing supervisor in this situation? a. (^) Remind the nurse that family support is important to this family and patient. b. (^) Have the nurse explain to the family that too many visitors will tire the patient. c. (^) Suggest that the nurse ask family members to leave the room during patient care. d. (^) Ask about the nurse’s personal beliefs about family support during hospitalization. ANS: D The first step in providing culturally competent care is to understand one’s own beliefs and values related to health and health care. Asking the nurse about personal beliefs will help to achieve this step. Reminding the nurse that this cultural practice is important to the family and patient will not decrease the nurse’s frustration. The remaining responses (suggest that the nurse ask family members to leave the room, and have the nurse explain to family that too many visitors will tire the patient) are not culturally appropriate for this patient.

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13. An Indigenous 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. Which of the following statements depicts what the patient is describing to the nurse? a. (^) Evidence-informed national guidelines b. (^) Awareness and knowledge of his own culture c. (^) The explanatory model of health and health practices d. (^) Knowledge about the difference in modern and folk health practices ANS: C The explanatory model is a set of beliefs regarding what causes the disease or illness and the methods that would potentially treat the condition best. Different cultural groups have different beliefs about the causes of illness and the appropriateness of various treatments. The situation is not reflective of national guidelines. There is no comparison between modern and folk health practices. The patient is explaining experiences and beliefs’ rather than awareness and knowledge. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
14. Which of the following statements represents a health inequity currently experienced in Canada? a. (^) Indigenous adults are less likely to smoke tobacco than other adults in Canada. b. (^) Overall suicide rate among First Nation communities is about twice the rate of the general population. c. (^) Individuals from lower income neighbourhoods undergo preventive health screening more that their higher income counterparts. d. (^) Recent immigrants are more likely to have a primary care physician than Canadian-born individuals. ANS: B Suicide rates are five to seven times higher among Indigenous youth than among non-Indigenous youth. Suicide rates among Indigenous youth are among the highest in the world, at 11 times the national average. Smoking rates are more than two times higher among the three Indigenous groups than among the non-Indigenous population. Individuals from higher income neighbourhoods undergo preventive health screening more than those from lower income neighbourhoods. Recent immigrants are less likely to have a primary care physician than Canadian-born individuals. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment
15. When performing a cultural assessment with a patient of a different culture, which of the following actions is the initial action to be taken by the nurse? a. (^) Wait until a cultural healer is available to help with the assessment. b. (^) Obtain a list of any cultural remedies that the patient currently uses. c. (^) Ask the patient about any affiliation with a particular cultural group. d. (^) Tell the patient what the nurse already knows about the patient’s culture. ANS: C An early step in performing a cultural assessment is to determine the cultural group with which the patient identifies. The other actions may be appropriate if the patient does identify with a particular culture.

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16. Equity in health care is concerned with creating equal opportunities for good health for everyone in which one of the following ways? a. (^) Increase negative effect of social determinants of health. b. (^) Increase awareness of acute care programs. c. (^) Decrease non-modifiable risk factors. d. (^) Reduce exclusion. ANS: D Health equity is concerned with creating equal opportunities for good health for everyone in two ways: (a) decreasing the negative effect of the social determinants of health and (b) by improving services to enhance access and reduce exclusion. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

12 | P a g e ANS: B Information about the setting is obtained by asking where the patient was and what the patient was doing when the symptom occurred. The other questions from the nurse are appropriate for obtaining information about chronology, frequency, and associated clinical manifestations. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

4. The nurse records the following general survey of a patient: “The patient is a 78-year-old female Asian accompanied by her two daughters. Alert and oriented. Does not make eye contact with the nurse and responds appropriately to questions. No apparent disabilities or distinguishing features.” Which of the following information should be added to this general survey documentation? a. Nutritional status b. (^) Intake and output c. (^) Reasons for contact with the health care system d. (^) Comments of family members about his condition ANS: A The general survey also describes the patient’s general nutritional status. The other information will be obtained when doing the complete nursing history and examination but is not obtained through the initial scanning of a patient. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
5. A nurse is performing a health history and physical examination for a patient with right-sided rib fractures. Which of the following data is a pertinent negative finding? a. (^) Patient states that there have been no other health problems recently. b. (^) Patient denies having pain when the area over the fractures is palpated. c. (^) Patient has several bruised and swollen areas on the right anterior chest. d. (^) Patient refuses to take a deep breath because of the associated chest pain. ANS: B The nurse expects that a patient with rib fractures will have pain over the fractured area. The first statement is neither a positive nor a negative finding with regard to the rib fractures. The bruising and swelling and pain with breathing are positive findings. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
6. As the nurse assesses the patient’s neck, the patient says, “My neck is so stiff I can hardly move it.” This patient statement indicates the nurse should perform which of the following assessments? a. (^) Focused b. (^) Screening c. (^) Emergency d. (^) Comprehensive ANS: A

13 | P a g e The focused assessment is needed when a patient has clinical manifestations that indicate a problem. An emergency assessment is done when the nurse needs to obtain information about life-threatening problems quickly while simultaneously taking action to maintain vital function. The screening assessment is not recognized as one of the three main types of assessment. A comprehensive assessment is a detailed health history and physical examination. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment

7. The nurse is preparing to perform a focused abdominal assessment for a patient who has high-pitched bowel sounds. Which equipment will be needed? a. (^) Flashlight b. (^) Stethoscope c. (^) Tongue blades d. (^) Percussion hammer ANS: B A stethoscope is used to auscultate bowel sounds. The other equipment may be used for a comprehensive assessment, but will not be needed for a focused abdominal assessment. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment
8. When the nurse is planning for the physical examination of an alert older-adult patient, which of the following adaptations to the examination technique should be considered? a. (^) Speaking slowly when directing the patient b. (^) Avoiding the use of touch as much as possible c. (^) Using slightly more pressure for palpation of the liver d. (^) Organizing the sequence to minimize position changes ANS: D Older patients may have age-related changes in mobility that make it more difficult to change position. There is no need to avoid the use of touch when examining older patients. Less pressure should be used over the liver. Since the patient is alert, there is no indication that there is any age-related difficulty in understanding directions from the nurse. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
9. While the nurse is taking the health history, a patient states, “My father and grandfather both had heart attacks and were unable to be very active afterwards.” This statement reflects which of the following functional health patterns? a. (^) Activity—exercise b. Cognitive—perceptual c. (^) Coping—stress tolerance d. (^) Health perception—health management ANS: D The information in the patient statement relates to risk factors that may cause cardiovascular problems in the future. Identification of risk factors falls into the health perception—health maintenance pattern. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment