TEST BANK For Lewis's Medical Surgical
Nursing in Canada, 5th Edition
by Jane Tyerman, Shelley Cobbett
Chapters 1 - 72 Complete
TABLE OF CONTENTS
1 Introduction to Medical-Surgical Nursing Practice in Canada 2
Cultural Competence and Health Equity in 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 Use
12 Complementary and Alternative Therapies
13 Palliative Care at the End of Life
Section Two – Pathophysiological Mechanisms of Disease 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
Section Three – Perioperative Care
20 Nursing Management: Preoperative Care 21
Nursing Management: Intraoperative Care 22
Nursing Management: Post-operative 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 Diseases 40
Nursing Management: Vascular Disorders
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 Urological 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 Neurological 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 Management and Disaster Planning
Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada
Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. When caring for clients 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 client outcomes are met
CORRECT ANSWER: 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)
client 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 client 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 N
e xp lRa i n sIt h eGn u B
rse
imary use of the nursing process
. sC’ prM
USNT
O
when providing care to clients?
a. To explain nursing interventions to other health care professionals
b. As a problem-solving tool to identify and treat clients’ health care needs
c. As a scientific-based process of diagnosing the client’s health care problems
d. To establish nursing theory that incorporates the biopsychosocial nature of humans
CORRECT ANSWER: B
The nursing process is an assertive problem-solving approach to the identification and
treatment of clients’ problems. Diagnosis is only one phase of the nursing process. The
primary use of the nursing process is in client 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 client 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
CORRECT ANSWER: 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 client 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
4. The nurse is caring for a client 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 client that these feelings are common for parents.
b. Have the client 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 client’s feelings about the childcare arrangements.
CORRECT ANSWER: 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
5. The nurse is caring for a client who has left-sided paralysis as the result of a stroke and
assesses a pressure injury o n t he c l ient ’ s le ft hip . W hich of the following is the
N R I G B. C M
h is cNl i e nTt ? O
most appropriate nursing diagnosis fUo r t S
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 tissue perfusion related to sedentary lifestyle
CORRECT ANSWER: C
The client’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 altered circulation and
pressure by frequently repositioning the client. Although left-sided weakness is a
problem for the client, the nurse cannot treat the weakness. The “risk for” diagnosis is
not appropriate for this client, who already has impaired tissue integrity. The client does
have ineffective tissue perfusion, but the impaired skin integrity diagnosis indicates
more clearly what the health problem is.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Diagnosis
6. The nurse caring for a client with an infection has a nursing diagnosis of deficient
fluid volume related to excessive diaphoresis. Which of the following is an
appropriate client outcome?
a. Client has a balanced intake and output.
b. Client’s bedding is changed when it becomes damp.
c. Client understands the need for increased fluid intake.
d. Client’s skin remains cool and dry throughout hospitalization.
CORRECT ANSWER: 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 client outcomes
b. Documenting the nursing care plan in the progress notes in the medical record
c. Deciding whether the client’s health problems have been completely resolved
d. Asking the client to evaluate whether the nursing care provided was satisfactory
CORRECT ANSWER: A
Evaluation consists of determining whether the desired client 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 client problems
p pR
ursB
in.g C
d iagMnoses
b. Uses client data to develoN
Ur ioSr Ii tclient
Ny nGT
c. Teaches interventions to relieve
health problems
d. Assists the client to identify realistic outcomes to health problems
CORRECT ANSWER: A
During the assessment phase, the nurse gathers information about the client. 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
CORRECT ANSWER: C
This diagnosis statement includes a NANDA nursing diagnosis and an etiology that
describes a client’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
10. Which of the following includes the components required for a complete nursing
diagnosis statement?
a. A problem and the suggested client 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
CORRECT ANSWER: 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 client
and is
related to the care or services provided rather than the client’s medical condition?
a. Negligence
b. Adverse event
c. Incident report
d. Nonmaleficence
CORRECT ANSWER: B
An adverse event is an event that results in unintended harm to the client and is related
to the care or services provided to the client rather than to the client’s underlying
medical condition.
DIF:
12.
Cognitive Level: Knowledge
N R I
When
Steps using the Five
Nursing
GTOP:
B.CO
M Process: Evaluation
U
h S N Tpractice (EIP) Process, which of the
of t e evidence informed
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
CORRECT ANSWER: 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
Chapter 02: Cultural Competence and Health Equity in Nursing Care Lewis:
Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. Which of the following terms 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
CORRECT ANSWER: B
Ethnicity is the common social, cultural, linguistic, or religious heritage of a group of
people. Diversity is a presence of persons with differences from the majority or dominant
group that is assumed to be the norm. Ethnocentrism is a tendency of individuals to
believe that their way of viewing and responding to the world is the most correct,
natural, and superior one. Cultural imposition is imposition of one person's own cultural
beliefs and practices, intentionally or unintentionally, on another person or group of
people.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Planning
2. The nurse is caring for Indigenous clients in a community clinic setting. Which of
the following would the nurse include when developing strategies to decrease
health care disparities?
a. Improve public transportaNtion
M
R. SI GNB.C
U
T
O
b. Obtain low-cost medication s.
c. Update equipment and supplies for the clinic.
d. Educate staff about Indigenous health beliefs.
CORRECT ANSWER: D
Health care disparities are due to stereotyping, biases, and prejudice of health care
providers; the nurse can decrease these through staff education. The other strategies
also may be addressed by the nurse but will not impact health disparities.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
3. A family member of an elderly Hispanic client admitted to the hospital tells the nurse that
the client has traditional beliefs about health and illness. Which of the following actions
is most appropriate for the nurse in this situation?
a. Avoid asking any questions unless the client initiates conversation.
b. Ask the client whether it is important that cultural healers are contacted.
c. Explain the usual hospital routines for meal times, care, and family visits.
d. Obtain further information about the client’s cultural beliefs from the daughter.
CORRECT ANSWER: B
Because the client has traditional health care beliefs, it is appropriate for the nurse to ask
whether the client would like a visit from a cultural healer. Nurses ask key questions with
regard to language, diet, religion, and acculturation and eliciting the client’s explanatory
model of health and illness. There is no cultural reason for the nurse to avoid asking the
client questions, and questions may be necessary to obtain necessary health information.
The client (rather than the daughter) should be consulted about personal cultural beliefs.
The hospital routines for meals, care, and visits should be adapted to the client’s
preferences rather than expecting the client to adapt to the hospital schedule.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
4. When caring for an Indigenous client, 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 client.
b. Observe the client’s use of eye contact.
c. Look directly at the client when interacting.
d. Ask the family about the client’s cultural beliefs.
CORRECT ANSWER: B
Eye contact varies greatly among and within cultures so the nurses’ initial action is to
assess the client’s use of eye contact. Although nurses are often taught to maintain direct
eye contact, clients who are Asian, Arab, or Indigenous may avoid direct eye contact and
consider direct eye contact disrespectful or aggressive. Looking directly at the client or
avoiding eye contact may be appropriate, depending on the client’s individual cultural
beliefs. The nurse should assess the client, rather than asking family members about the
client’s beliefs.
DIF:
Cognitive Level: Applic ation
O P : N ur s i ng Process: Implementation
N RU SI N
GT T
B .C MO
5. A graduate nurse is assessing a newly admitted non–English-speaking Chinese client 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 client’s scalp.
c. Call for a medical interpreter.
d. Avoid eye contact with the client.
CORRECT ANSWER: B
Many people of Asian ethnicity believe that touching a person’s head is disrespectful; the
nurse should always ask permission before touching any client’s head. The other actions
are appropriate.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
6. The nurse is caring for a client 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 client recognizes their importance.
d. Use simple gestures to demonstrate meaning while talking to the client.
CORRECT ANSWER: D
The use of gestures will enable some information to be communicated to the client. The
other actions will not improve communication with the client.
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
CORRECT ANSWER: 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 client?
Have family members provide most of the client’s personal care.
Maintain a personal space of at least 0.5 m when assessing the client.
Ask permission before touching a client during the physical assessment.
Consider the client’s ethnicity as the most important factor in planning care.
a.
b.
c.
d.
CORR
CT
E
ANSWE
R: C
NURSINGTB.COM
Many cultures consider it disrespectful to touch a client without asking permission, so
asking a client for permission is always culturally appropriate. The other actions may be
appropriate for some clients but are not appropriate across all cultural groups or for all
individual clients.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Implementation
9. While talking with the nursing supervisor, a staff nurse expresses frustration that an
Indigenous client 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 client.
b. Have the nurse explain to the family that too many visitors will tire the client.
c. Suggest that the nurse ask family members to leave the room during client care.
d. Ask about the nurse’s personal beliefs about family support during hospitalization.
CORRECT ANSWER: 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 client 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 client) are not culturally appropriate
for this client.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
10. An elderly Asian Canadian client tells the nurse that she has lived in Canada for 50 years.
The client speaks English but lives in a predominantly Asian neighbourhood. Which of the
following actions is most appropriate for the nurse?
a. Arrange to have a folk healer available when planning the client’s care.
b. Ask the client about any special cultural beliefs or practices.
c. Avoid making direct eye contact with the client during care.
d. Involve the client’s oldest son in making health care decisions.
CORRECT ANSWER: B
Further assessment of the client’s health care preferences is needed before making
further plans for culturally appropriate care. The other responses indicate stereotyping
of the client, based on ethnicity, and would not be appropriate initial actions.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
11. Which of the following statements is true related to immigrants to Canada?
a. Decreased risk of social exclusion related to Canada’s multicultural population.
b. New immigrants tend to be in overall better health than the resident population.
c. Health status of immigrants is not related to length of time in Canada.
d. Unemployment is not associated with poorer health outcomes for immigrants.
CORRECT ANSWER: B
The healthy immigrant effect indicates that new immigrants tend to be in better overall
health than the general resident population. This finding is not surprising inasmuch as
immigrants are screened before being granted admittance to Canada. Health status is
related to length of time in Canada, the health of immigrants, 20 years after immigration,
as determined by
teU
s,RisSgIeN
neG
raT
llB
y .poC
orOeM
r than those of the Canadian-born
age-standardized mortality raN
population. Underemployment, unemployment, and workplace stress place immigrants
at
increased health risks as well as the risk for social exclusion.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Planning
12. Which of the following question formats is the most appropriate for the nurse to ask
when communicating with a client that has limited English proficiency?
a. Are you tired and in discomfort?
b. You have taken your pills right?
c. Are you alright?
d. Are you in pain?
CORRECT ANSWER: D
When communicating with a client that has limited English proficiency, the best questions
to ask are ones that are in simple language a couple of words, plain simple terms, such
as “Are you in pain?” Asking about tiredness and discomfort in the same sentence
should be avoided—ask one item at a time and use the term ‘pain’, not discomfort.
Asking the client “are you alright” is vague and will elicit a yes or no answer. “You have
taken your pills right?” is accusatory and should be avoided.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
NURSINGTB.COM
Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
13. An Indigenous client 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 client 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
CORRECT ANSWER: 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 client 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
ls. R I G B.C M
than Canadian-born individuaN
CORR
CT
E
ANSWE
R: B
USNT
O
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 client of a different culture, which of
the following actions is the initial action to be taken by the nurse?
Wait until a cultural healer is available to help with the assessment.
Obtain a list of any cultural remedies that the client currently uses.
Ask the client about any affiliation with a particular cultural group.
Tell the client what the nurse already knows about the client’s culture.
a.
b.
c.
d.
CORRECT ANSWER: C
An early step in performing a cultural assessment is to determine the cultural group with
which the client identifies. The other actions may be appropriate if the client does
identify with a particular culture.
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
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.
CORRECT ANSWER: 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
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
Chapter 03: Health History and Physical Examination
Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. An older-adult client who is having difficulty breathing is admitted to the hospital. Which
of the following approaches is the best for the nurse to use to obtain a complete
health history?
a. Obtain subjective data about the client from family members.
b. Omit subjective data collection and obtain the physical examination.
c. Use the health care provider’s medical history to obtain subjective data.
d. Schedule several short sessions with the client to gather subjective data.
CORRECT ANSWER: D
In the case of an older-adult client with a low energy level, several short sessions may
have to be scheduled. Allowing time for the client to volunteer information about
particular areas of concern enables the nurse to work with the client to identify existing
and potential health problems. In an emergency situation, the nurse may need to ask
only the most pertinent questions for a specific problem and obtain more information
later. A complete health history will include subjective information that is not available in
the health care provider’s medical history. Family members may be able to provide some
subjective data, but only the client will be able to give subjective information about the
shortness of breath. Since the subjective data about the client’s respiratory status will be
essential, obtaining the physical examination alone will not provide sufficient
information.
DIF:
Cognitive Level: Application
2. Immediate surgery is
TOP: Nursing Process: Assessment
N R I G B.C M
Ti t h a cuOt e abdo minal pain. Which of the following
en t w
fUo aSc li N
p la nned
r
questions will elicit the most complete information about the client’s coping-stress
tolerance pattern?
a. “Can you tell me how intense your pain is now?”
b. “What do you think caused this abdominal pain?”
c. “How do you feel about yourself and your hospitalization?”
d. “Are there other major problems that are a concern right now?”
CORRECT ANSWER: D
The coping-stress tolerance pattern includes information about other major stressors
confronting the client. The health perception–health management pattern includes
information about the client’s ideas about risk factors. Feelings about self and the
hospitalization are assessed in the self-perception–self-concept pattern. Intensity of pain
is part of the cognitive–perceptual pattern.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
3. During the health history interview, a client tells the nurse about periodic fainting
spells. Which question by the nurse will be most helpful in determining the setting
in which the fainting spells occur?
a. “How frequently do you have the fainting spells?”
b. “Where are you when you have the fainting spells?”
c. “Do the spells tend to occur at any special time of day?”
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
d. “Do you have any other symptoms along with the spells?”
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
CORRECT ANSWER: B
Information about the setting is obtained by asking where the client was and what the
client 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 client: “The client is a 68-year-old male
Asian accompanied by his wife and two daughters. Alert and oriented. Does not make eye
contact with the nurse and responds slowly, but 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
CORRECT ANSWER: A
The general survey also describes the client’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 client.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
5. A nurse is performing a health history and physical examination for a client with right-
sided rib fractures. Which of the following data is a pertinent negative finding?
a. Client states that there haN
ve bReenIno G
e rh
. eCalthMproblems recently.
U S the
Noth
TB
b. Client denies having pain when
area
over the fractures is palpated.
c. Client has several bruised and swollen areas on the right anterior chest.
d. Client refuses to take a deep breath because of the associated chest pain.
CORRECT ANSWER: B
The nurse expects that a client 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 client’s neck, the client says, “My neck is so stiff I can hardly
move it.” This client statement indicates the nurse should perform which of the
following assessments?
a. Focused
b. Screening
c. Emergency
d. Comprehensive
CORRECT ANSWER: A
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
The focused assessment is needed when a client 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 client
who has high-pitched bowel sounds. Which equipment will be needed?
a. Flashlight
b. Stethoscope
c. Tongue blades
d. Percussion hammer
CORRECT ANSWER: 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 client,
which of the following adaptations to the examination technique should be
considered?
a. Speaking slowly when directing the client
b. Avoiding the use of touch as much as possible
c. Using slightly more pressure for palpation of the liver
Ri mINiz eGpToBsi.tioCnOchanges
d. Organizing the sequence t oUN
mi S
n
CORRECT ANSWER: D
Older clients 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
clients. Less pressure should be used over the liver. Since the client 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 client 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
CORRECT ANSWER: D
The information in the client 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
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
10. A client is seen in the emergency department with chest pain and hypotension. Which
type of assessment should the nurse do at this time?
Focused
Subjective
Emergency
Comprehensive
a.
b.
c.
d.
CORRECT ANSWER: C
Since the client is hemodynamically unstable, an emergency assessment is needed.
Comprehensive and focused assessments may be needed after the client is stabilized.
Subjective information is needed, but objective data such as vital signs also are essential
for the unstable client.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
11. The nurse records the following general survey of a client: “The client is a 68-year-old
Indigenous male accompanied by his wife and two daughters. Alert and oriented. Does
not make eye contact with the nurse and responds slowly, but appropriately, to
questions. No apparent disabilities or distinguishing features.” Which of the following
areas does the nurse need to assess to complete the general survey?
a. Body movements
b. Intake and output
c. Reasons for contact with the health care system
d. Comments of family members about his condition
CORRECT ANSWER: A
To complete a general survey, the nurse needs to assess the client’s body movements.
c t UwRi t S
h IthN
eG
heT
aB
lth.cC
arO
eM
system, and comments of
Intake and output, reasons for c o n t aN
family members about the client’s condition are not part of the general survey.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
12. When assessing the circulation to the lower leg of a client who has had knee surgery,
which action should the nurse take first?
a. Feel for the temperature of the foot.
b. Visually inspect the colour of the foot.
c. Check the client’s pedal pulses using the fingertips.
d. Compress the nail beds to determine capillary refill time.
CORRECT ANSWER: B
Inspection is the first of the major techniques used in the physical examination. Palpation
and auscultation are used later in the examination.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
13. When assessing a client’s abdomen during the admission assessment, which of these
actions should the nurse take first?
a. Feel for any masses.
b. Palpate the abdomen.
c. Percuss the liver borders.
d. Listen to the bowel sounds.
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CORRECT ANSWER: D
When assessing the abdomen, auscultation is done before palpation or percussion
because palpation and percussion can cause changes in bowel sounds and alter the
findings. All of the techniques are appropriate, but auscultation should be done first.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
14. When admitting a client who has just arrived on the medical unit with severe abdominal
pain, what should the nurse do first?
a. Complete only basic demographic data before addressing the client’s
abdominal pain.
b. Medicate the client for the abdominal pain before attending to the health
history and examination.
c. Inform the client that the abdominal pain will be treated as soon as the
health history is completed.
d. Take the initial vital signs and then deal with the abdominal pain
before completing the health history.
CORRECT ANSWER: D
The client priority in this situation will be to decrease the pain level because the client will
be unlikely to cooperate in providing demographic data or the health history until the
nurse addresses the pain. However, obtaining information about vital signs is essential
before using either pharmacological or nonpharmacological therapies for pain control.
The vital signs may indicate hemodynamic instability that would need to be addressed
immediately.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
urU
olR
ogSicIaN
l aGssTeB
ss.mC
enO
tM
on an adult client. The nurse should
15. The nurse is completing a neN
implement which one of the following assessments when assessing the client’s motor
status?
a. Toe walk
b. Finger to nose
c. Romberg
d. Heel to opposite shin
CORRECT ANSWER: A
A neurological assessment is completed to observe motor status by assessing gait, toe
and heel walk, and drift whereas when assessing coordination, the nurses observes
finger to nose, Romberg sign and heel to opposite shin.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
Chapter 04: Patient and Caregiver Teaching
Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. A client with newly diagnosed breast cancer has a nursing diagnosis of deficient
knowledge related to insufficient information (about breast cancer). When the nurse is
planning teaching for the client, which is the most important initial learning goal?
a. The client will select the most appropriate breast cancer therapy.
b. The client will state ways of preventing the recurrence of the tumour.
c. The client will demonstrate coping skills needed to manage the disease.
d. The client will choose methods to minimize adverse effects of treatment.
CORRECT ANSWER: A
Adults learn best when given information that can be used immediately. The first action
the client will need to take after a cancer diagnosis is to choose a treatment option. The
other goals may be appropriate as treatment progresses.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
2. After the nurse implements diet instruction for a client with heart disease, the client
can explain the information but fails to make the recommended dietary changes.
Which of the following statements reflects the correct evaluation of the
intervention?
a. Learning did not occur because the client’s behaviour did not change.
b. Choosing not to follow the diet is the behaviour that resulted from learning.
c. The nursing responsibilit y fo r help in g t h e cl ient make dietary changes has
N R I G B. C M
USNT
O
been fulfilled.
d. The teaching methods were ineffective in helping the client learn the
dietary information.
CORRECT ANSWER: B
Although the client behaviour has not changed, the client’s ability to explain the
information indicates that learning has occurred and the client is choosing at this time to
continue with the previous diet. The client may be in the contemplation or preparation
state in the Transtheoretical Model. The nurse should reinforce the need for change and
continue to provide information and assistance with planning for change.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Evaluation
3. The nurse is caring for an adult client who has been diagnosed with type 2 diabetes
mellitus after being admitted to the hospital with an infected foot wound. When
applying principles of adult learning, which teaching strategy by the nurse is most likely
to be effective?
a. Discuss the importance of blood glucose control in maintenance of longterm health.
b. Demonstrate the correct method for cleaning and redressing the wound
to the client.
c. Assure the client that the nurse is an expert on management of
diabetes complications.
d. Wait until after discharge and have a home health nurse teach about foot
care and diabetes management.
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CORRECT ANSWER: B
Principles of adult education indicate that readiness and motivation to learn are high
when facing new tasks (such as wound care) and when demonstration and practice of
skills are available. Although a home health referral may be needed for this client,
teaching should not be postponed until discharge. Adult learners are independent; the
nurse should act as a facilitator for learning, rather than as the expert. Adults learn best
when the topic is of immediate usefulness; long-term goals may not be very motivating.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
4. A client admitted to the hospital with hyperglycemia and newly diagnosed diabetes
mellitus is scheduled for discharge the second day after admission. When implementing
client teaching, which is the best action for the nurse to take?
a. Instruct about the increased risk for cardiovascular disease.
b. Provide detailed information about dietary control of glucose.
c. Teach glucose self-monitoring and medication administration.
d. Give information about the effects of exercise on glucose control.
CORRECT ANSWER: C
When time is limited, the nurse should focus on the priorities of teaching. In this situation,
the client should know how to test blood glucose and administer medications to control
glucose levels. The client will need further teaching about the role of diet, exercise,
various medications, and the many potential complications of diabetes, but these topics
can be addressed through planning for appropriate referrals.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
N R I G B.C M
U S
N of
T Health
O Behaviour Change during client teaching,
5. When using the Transtheoretical
Model
the nurse identifies that the client who states, “I told my wife that I was going to start
exercising, and I think I will join a fitness club,” is in which of the following stages?
a. Preparation
b. Termination
c. Maintenance
d. Contemplation
CORRECT ANSWER: A
The client’s statement indicating that the plan for change is being shared with someone
else indicates that the preparation stage has been achieved. Contemplation of a change
would be indicated by a statement like “I know I should exercise.” Maintenance of a
change occurs when the client practices the behaviour regularly. Termination would be
indicated when the change is a permanent part of the lifestyle.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
6. While admitting a client to the medical unit, the nurse learns that the client has
difficulty reading. This information will guide the nurse in determining which of the
following strategies would be the most appropriate when planning for client
teaching?
a. Assessing the degree of client motivation and readiness to learn
b. Deciding what information the client will be able to understand
c. Ensuring that the family be included in the teaching process
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d. Choosing which instructional strategies should be used in teaching
CORRECT ANSWER: D
The information that the client has poor health literacy skills indicates that the nurse
should avoid the use of written materials in teaching and choose other strategies. The
client does not indicate a lack of motivation or an inability to understand new
information. The client’s lack of reading ability does not necessarily imply that the family
must be included in the teaching process.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Planning
7. When assessing the learning needs for a client who has coronary heart disease, the nurse
finds that the client has recently made dietary changes to decrease fat intake and has
stopped smoking. Which of the following is the most appropriate initial statement by the
nurse at this time?
a. “Although those are important, it is essential that you make other changes, too.”
b. “Are you having any difficulty in maintaining the changes you have already
made?”
c. “You have already accomplished some changes that are important in heart health.”
d. “Which additional changes in your lifestyle would you like to implement at this
time?”
CORRECT ANSWER: C
Positive reinforcement of the learner’s achievements is critical in making lifestyle
changes. This client is in the action stage of the Transtheoretical Model, when
reinforcement of the changes being made is an important nursing intervention. The
other responses are also appropriate, but are not the best initial response.
DIF:
NURSINGTB.COM
TOP: Nursing Process: Implementation
Cognitive Level: Application
8. When assessing a client’s readiness to learn before planning teaching activities,
which question should the nurse ask?
a. “What kind of work and leisure activities do you do?”
b. “What information do you think you need right now?”
c. “Do you have any religious beliefs that are inconsistent with the treatment?”
d. “Can you describe the types of activities that help you learn new information?”
CORRECT ANSWER: B
Motivation and readiness to learn depend on what the client values and perceives as
important. The other questions are also important in developing the teaching plan, but
do not address what information most interests the client at present.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
9. The nurse is caring for a client with diabetes and develops a nursing diagnosis of
ineffective health management related to insufficient knowledge of therapeutic
regimen (resulting in low motivation). Which of the following client actions is the basis
for this nursing diagnosis?
a. Does not perform capillary blood glucose tests as directed
b. Occasionally forgets to take the daily prescribed medication
c. Says that dietary intake does not seem to impact fatigue level
d. Cannot identify signs or symptoms of high and low blood glucose
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CORRECT ANSWER: C
The client’s motivation to follow a diabetic diet will be decreased if the client feels that
dietary changes do not impact symptoms. The other responses do not indicate that the
ineffective health maintenance is caused by lack of motivation.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Diagnosis
10. A client with poor circulation to the feet requires teaching about foot care. Which
learning goal should the nurse include in the teaching plan?
a. The nurse will demonstrate the proper technique for trimming toenails.
b. The client will list three ways to protect the feet from injury by discharge.
c. The nurse will instruct the client on appropriate foot care before discharge.
d. The client will understand the rationale for proper foot care after instruction.
CORRECT ANSWER: B
Learning goals should state clear, measurable outcomes of what is to be accomplished
from the learning process. Demonstrating a proper technique or providing instruction
are actions that the nurse will take, rather than behaviours that would indicate if client
learning has occurred. Having the client understand the rational for proper foot care
after instruction is an example of a learning outcome.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
11. The nurse is planning a teaching session for a client who needs to improve skills in being
more assertive. Which of the following is the most effective teaching strategy for this
client?
a. Role-playing
b. Peer teaching
c. Printed materials
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d. Lecturediscussion
CORRECT ANSWER: A
Role playing allows the client to practice assertive behaviour and receive feedback about
how the behaviour is perceived. This strategy is most often used when clients need to
examine their attitudes and behaviours; understand the viewpoints and attitudes of
others; or practise carrying out thoughts, ideas, or decisions. Lecture-discussion, peer
teaching, and printed materials are more useful for other learning needs.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Planning
12. The client’s teaching plan includes this goal: “The client will select a 2-g sodium diet from
the hospital menu for the next 3 days.” Which evaluation method will be best for the
nurse to use when determining whether teaching was effective?
a. Check the sodium content of the client’s menu choices over the next 3 days.
b. Ask the client to identify which foods on the hospital menus are high in sodium.
c. Have the client list favourite foods that are high in sodium and foods that
could be substituted for these favourites.
d. Compare the client’s sodium intake over the next 3 days with the sodium
intake before the teaching was implemented.
CORRECT ANSWER: A
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All of the answers address the client’s sodium intake, but the desired client behaviours in
the learning objective are most clearly addressed by evaluation of the client’s menu
choices.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Evaluation
13. The nurse is preparing written handouts to be used as part of the standardized
teaching plan for clients who have been recently diagnosed with diabetes and requires
an awareness of literacy levels. Which of the following literacy levels is generally
reflective of students who graduate from high school?
a. 1
b. 2
c. 3
d. 4
CORRECT ANSWER: C
People with Level 3 literacy have the minimum skills necessary for everyday life in a
complex society, such as graduation from high school. People with Level 1 literacy have
very poor skills; for example, they were unable to determine the correct dose of
medication from information on the package. People with Level 2 literacy require
material to be simple and clearly laid out, and only tasks that are not too complex are to
be included in learning material. People at this level could read but had poor test results.
People with Levels 4 and 5 literacy had higher-order skills in information processing.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
14. The nurse in the hospital has implemented a teaching plan to assist a client with
rheumatoid arthritis in accomplishing daily activities independently. Which of the
following actions is the
GrdeT
B
tUa kRe SIn
i oN
r t.o C
evaO
luat e the client’s long-term response to
best approach for the nurse to N
the
teaching?
a. Make a referral to the home health nursing department for home visits.
b. Assess the client’s ability to bathe without any assistance the next day.
c. Have the client demonstrate the learned skills at the end of the teaching session.
d. Arrange a physical therapy visit before the client is discharged from the hospital.
CORRECT ANSWER: A
The client’s long-term response may need to be assessed after discharge; long-term
evaluation necessitates follow-up by the nurse, outpatient clinic, or outside agency. In
this case, a home health referral would allow this to occur. The other actions allow
evaluation of the client’s short-term response to teaching.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Evaluation
15. A young adult client tells the nurse, “I enjoy smoking and have no plans to quit.” Which
stage of the Transtheoretical Model of Health Behaviour Change does this example
portray?
a. Contemplation
b. Precontemplation
c. Preparation
d. Maintenance
CORRECT ANSWER: B
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The precontemplation phase indicates that the client is not considering a change and is
not ready to learn. In the contemplation phase, a change is being considered. The client
starts gathering information for the change in the preparation stage. In the
maintenance stage, the change has already occurred.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Diagnosis
16. An older-adult client is seen at the health clinic and diagnosed with protein
malnutrition. Which of the following actions is priority to be included in the
teaching plan?
a. Suggest the use of liquid supplements as a way to increase protein intake.
b. Encourage the client to increase the dietary intake of meat, cheese, and milk.
c. Ask the client to record the intake of all foods and beverages for a 3-day period.
d. Focus on the use of combinations of beans and rice to improve daily protein intake.
CORRECT ANSWER: C
Assessment is the first step in assisting a client with health changes. The other answers
may be appropriate for the client, but the nurse will not be able to determine this until
the assessment of the client is complete.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
17. The nurse is caring for a client who has been newly diagnosed with diabetes. The client
tells the nurse, “I want to know how to give my own insulin.” Which initial action will
the nurse take when implementing the standardized diabetic teaching plan?
a. Demonstrate how to draw up and administer insulin.
b. Discuss the use of exercise to decrease insulin needs.
c. Teach about differences between the various types of insulin.
d. Provide handouts about t heU
rNap eR
SutIicNaGnTdBa.dvCerO
sM
e effects of insulin.
CORRECT ANSWER: A
Adult education is most effective when focused on information that the client thinks is
needed right now. All of the indicated information will need to be included when
planning teaching for this client, but the teaching will be most effective if the nurse starts
with the client’s stated priority topic.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
18. Which action should the nurse take first when teaching a client’s spouse how to manage
the
blood pressure (BP) for a client with newly diagnosed hypertension?
a. Teach the caregiver how to take the client’s BP using a manual blood
pressure cuff.
b. Have the dietitian meet with the client and caregiver to discuss low sodium
dietary choices.
c. Ask the client and caregiver to select important information from a
list of hypertension teaching topics.
d. Provide written information about treatment and complications of
hypertension for the client and caregiver.
CORRECT ANSWER: C
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
Since adults learn best when given information that they view as being needed
immediately, asking the caregiver and client to prioritize learning needs is likely to be the
most successful approach to home management of health problems. The other actions
also may be appropriate, depending on what learning needs the caregiver and client
have, but the initial action should be to assess what the learners feel is important.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
19. Which of the following determinants of learning is an evaluation of learning?
a. Learner needs
b. Demonstrated learner behaviour
c. State of learner readiness
d. Preferred learning style
CORRECT ANSWER: B
Demonstrated learner behaviour is an evaluation of learning. The three determinants of
learning that require learning assessments are learner needs, state of learner readiness,
and the client’s preferred learning style.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
Chapter 05: Chronic Illness
Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. The nurse is caring for a client with type 2 diabetes who has been hospitalized with
severe hyperglycemia. Which of the following topics will be most important to include
in discharge teaching?
a. Effect of endogenous insulin on transportation of glucose into cells
b. Function of the liver in formation of glycogen and gluconeogenesis
c. Impact of the client’s family history on likelihood of developing diabetes
d. Symptoms indicating that the client should contact the health care provider
CORRECT ANSWER: D
One of the tasks for clients with chronic illnesses is to prevent and manage a crisis. The
client needs instruction on recognition of symptoms of hyperglycemia and appropriate
actions to take if these symptoms occur. The other information also may be included in
client teaching, but is not as essential in the client’s self-management of the illness.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
2. Which of the following diseases has the highest proportion of chronic illness
deaths in Canada?
a. Cancer
b. Diabetes
c. Cardiovascular disease NURSINGTB.COM
d. Chronic respiratory disease
CORRECT ANSWER: C
Cardiovascular diseases (37%) were responsible for the highest proportion of global
deaths in 2012, followed by cancers (27%), chronic respiratory diseases (8%), and diabetes
(4%).
DIF:
Cognitive Level: Knowledge
TOP: Nursing Process: Assessment
3. Which of the following is an example of multimorbidity?
a. Chronic obstructive pulmonary disease and a urinary tract infection
b. Lung cancer and pneumonia
c. Chronic kidney disease and appendicitis
d. Diabetes and exacerbation of rheumatoid arthritis
CORRECT ANSWER: D
Multimorbidity is the simultaneous occurrence of several chronic medical conditions,
which may or may not be related to each other, in the same person. Pneumonia, urinary
tract infection, and appendicitis are all acute conditions.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
4. Which of the following factors has a major impact on the development of chronic illness?
a. Poverty
b. Social stability
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
c. Urban dwelling
d. High school diploma
CORRECT ANSWER: A
Poverty and socioeconomic disadvantage are recognized to have a major impact
on the development of chronic illness. Social stability, urban living, and having a
high school education are not factors contributing to the development of chronic
illness.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process: Assessment
5. Which of the following statements is true related to nonmodifiable risk factors for
chronic illness?
a. Cannot be changed
b. Requires intervention in order to change
c. Can be altered to benefit health outcomes
d. Can be changed with client perseverance
CORRECT ANSWER: A
Nonmodifiable risk factors cannot be changed. Requiring intervention in order to
change, altering, and changed with perseverance all indicate that change is possible.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
6. What is the average life expectancy in Canada?
a. 60 years
b. 70 years
c. 80 years
d. 90
N R I G B.C
years
U SN T
OM
CORRECT
ANSWER:
C
The life expectancy in Canada is estimated to be 80 years, specifically in 2010, it was 78.5
years for males and 82.7 years for females.
DIF:
Cognitive Level: Knowledge
TOP: Nursing Process: Planning
7. Which of the following types of cancers has a genetic predisposition to its occurrence?
a. Lung
b. Breast
c. Cervix
d. Testicles
CORRECT ANSWER: B
Genetic testing can also show an inherited predisposition to several different types of
cancer, including breast and ovarian cancer, melanoma, and colon cancer.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
8. Which of the following models views disability as directly caused by disease or trauma?
a. Social
b. Nursing
c. Medical
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
d. Collaborative
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
CORRECT ANSWER: C
The medical model views disability as directly caused by disease, trauma, or another
health condition. Disability, from the medical model perspective, necessitates medical
care provided in the form of individual treatment by providers to “correct” the problem
with the individual. The social model of disability, conversely, sees disability as a socially
created problem and not an inherent attribute of an individual.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
9. Which of the following client statements reflect an outcome expectancy statement?
a. “I am not able to exercise.”
b. “Exercise helps people lose weight.”
c. “Exercise is too hard on my arthritis.”
d. “Dietary restrictions work better than exercise to lose weight.”
CORRECT ANSWER: B
An outcome expectancy is the individual’s belief that a specific behaviour will lead to
certain outcomes. For example, the client who tells the nurse that exercising helps
people to lose weight is voicing an outcome expectancy.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
10. What is the most influential source of self-efficacy?
a. Mastery
b. Affective states
c. Verbal persuasion
d. Vicarious
experience
NURSINGTB.COM
CORRECT ANSWER: A
Four primary influences shape an individual's self-efficacy beliefs: mastery; vicarious
experience; verbal persuasion and other social influences; and physiological and affective
states that help us judge our capability and our vulnerability to dysfunction. Mastery
reflects a belief about whether or not “we have what it takes to succeed” and is
considered the most influential source of self-efficacy.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
11. Which of the following is a characteristic of health-related hardiness known as “challenge”?
a. Confidence to appraise a health stressor
b. Ability to modify responses to health stressors
c. Viewing a health stressor as an opportunity for growth
d. Optimal psychosocial adaptation to a health stressor
CORRECT ANSWER: C
Challenge is the anticipation of change. The person with health-related hardiness, when
confronted with a health stressor, possesses sufficient self-mastery and confidence to
appraise and modify responses appropriately (control) and cognitively reappraises the
health stressor so it is viewed as stimulating and beneficial or an opportunity for growth
(challenge).
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
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12. Which of the following characteristics is true related to chronic illness?
a. Abrupt onset
b. Usually single cause
c. Short latency period
d. Noninfectious origin
CORRECT ANSWER: D
Chronic (or noncommunicable) illnesses are typically characterized as having an uncertain
etiology, multiple risk factors, long latency, prolonged duration, and a noninfectious
origin and can be associated with impairments or functional disability. Abrupt onset,
usually a single cause and cure most likely, are characteristic of acute illness.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
13. Clients with chronic illness want the health care system to provide them with which of
the following?
a. Less information
b. Less travel time
c. Ways to adjust to disease consequences
d. Limited information on ways to cope with their symptoms
CORRECT ANSWER: C
Clients with chronic illness want the health care system to provide them with ways to
adjust to disease consequences such as uncertainty, fear and depression, anger,
loneliness, sleep disorders, memory loss, exercise needs, nocturia, sexual dysfunction,
and stress. They did not identify wanting less information, shorter travel times, or limited
information on coping strategies but they do also want shorter wait times.
DIF:
NURSINGTB.COM
TOP: Nursing Process: Assessment
Cognitive Level: Comprehension
14. Which of the following models calls for a political response to disability?
a. Social
b. Medical
c. Activist
d. Collaborative
CORRECT ANSWER: A
The social model of disability, conversely, sees disability as a socially created problem
and not an inherent attribute of an individual (Barnes, 2012). The social model
perspective calls for a political response, because the problem is created by an
unaccommodating physical environment brought about by attitudes and other features
of the social environment.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
15. According to the World Health Organization’s ICF Bio-Psycho-Social Model, which of
the following factors is an environmental contextual factor?
a. Social background
b. Behaviour pattern
c. Social attitudes
d. Coping style
CORRECT ANSWER: C
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Contextual factors are composed of external environmental factors (e.g., social
attitudes, architectural characteristics, and legal and social structures, as well as climate,
terrain, and so forth). The other choices represent internal personal factors (e.g.,
gender, age, coping styles, social background, education, profession, past and current
experience, overall behaviour pattern, character, and other factors that influence how
disability is experienced by the individual).
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
16. Which of these clients assigned to the nurse is most likely to need planning for long-
term nursing management?
a. 22-year-old with appendicitis who has had an emergency appendectomy
b. 56-year-old with bilateral knee osteoarthritis who weighs 159 kg
c. 34-year-old with cholecystitis who has had a laparoscopic cholecystectomy
d. 62-year-old with acute sinusitis who will require antibiotic therapy for 5 days
CORRECT ANSWER: B
The client’s osteoarthritis is a chronic problem that will require planning for long-term
interventions such as physical therapy and nutrition counselling. The other clients have
acute problems that are not likely to require long-term management.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
17. “Set in motion and continue the trajectory projection and scheme” is a goal of
management in which of the following trajectory phases?
a. Pretrajectory
b. Onset
c. Comeback
d. Downwar
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d
CORRECT
ANSWER: C
“Set in motion and continue the trajectory projection and scheme” is a goal of
management in the trajectory phase of comeback. Pretrajectory goal is to prevent the
onset of chronic illness. The onset goal of management is to form an appropriate
trajectory projection and scheme. The goal of the downward phase is to adapt to
increasing disability.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
18. Which one of the following levels is part of the client response to health
care recommendations based on a continuum of self-care?
Self-esteem
Adherence
Denial
Acceptance
a.
b.
c.
d.
CORRECT ANSWER: B
Compliance, adherence, and self-care makeup the three levels of client response to health
care recommendations on a continuum of self-care. Adherence is now the term most
widely accepted because it incorporates the notion of the client agreeing with the
treatment plan presented by the health care provider.
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DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
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Chapter 06: Community-Based Nursing and Home Care
Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. A family caregiver tells the home health nurse, “I feel like I can never get away to do
anything
for myself.” Which action is the most appropriate for the nurse to take?
a. Assist the caregiver in finding respite services.
b. Assure the caregiver that the work is appreciated.
c. Teach the caregiver that family members provide excellent client care.
d. Encourage the caregiver to discuss feelings openly with the nurse as-needed.
CORRECT ANSWER: A
Respite services allow family caregivers to have free time. The other actions also may be
helpful, but the caregiver’s statement clearly indicates the need for some free time.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
2. A client who was in an automobile accident is assigned a nurse as a case manager.
Which of the following responsibilities is required of the nurse in this role?
a. Care for the client during hospitalization for the injuries.
b. Assist the client with home care activities during recovery.
c. Coordinate the services that the client receives in the hospital and at home.
d. Determine the types of medical care the client needs for optimal rehabilitation.
CORRECT ANSWER: C
o cSoIoN
rdG
inaTtB
e .thC
eO
c l iMe nt ’ s care through multiple settings
The role of the case managerNisUt R
and levels of care to allow the maximal client benefit at the least cost. The case manager
does not
provide direct care in either the acute or home setting. The case manager coordinates
and advocates for care but does not determine what types of medical care are needed,
that is done by the health care provider or other provider.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Implementation
3. The nurse is conducting a home visit and notes that the caregiver may be
experiencing caregiver burnout. Which of the following assessments would
support this finding?
a. Anxiety
b. Sleeplessness
c. Weight gain
d. Increased use of respite care
CORRECT ANSWER: B
Assessment of the signs of caregiver burnout (e.g., sleeplessness, difficulty
concentrating) is a critical role of the home care nurse. Weight gain is an indication that
the caregivers’ nutritional intake exceeds requirements. An increased use of respite care
could indicate an increased involvement of the caregiver in outside support and activity
groups. This assessment finding would require further assessment before linking it to
caregiver burnout.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
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4. An older-adult client who lives alone was hospitalized for a fractured hip and has
recovered from the surgery but needs to continue to work to improve mobility. Which
of the following settings would the nurse anticipate that the client be transferred to?
a. Another acute care setting
b. A transitional care setting
c. A residential care facility
d. Their own home with home health nursing
CORRECT ANSWER: D
Home health nursing is appropriate for clients who need continued rehabilitation and can
implement this in their own home. The client is no longer in need of the more continuous
assessment and care given in acute care settings. There is no indication that the client will
need the permanent and ongoing medical and nursing services available in intermediate
care. The client is not yet independent enough to transfer to a residential care facility.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
5. The nurse is describing home care services to a client that requires extended care.
Which of the following statements is true related to home care services?
a. Technologically complex therapies must be managed in the hospital.
b. The client’s family will be included in planning and the client’s care.
c. Home care services are limited to visits by registered nurses or home health aides.
d. In order for insurance to cover the home care, the client must be confined to bed.
CORRECT ANSWER: B
Family members who are providing care are included in planning the client’s care and
treatments. Other disciplines, such as physical and occupational therapy, also provide
.uCstObMe homebound, but not bed bound, to
ThIeN
cG
lieT
ntBm
appropriate home health s e r vNi cUe sR. S
receive reimbursement for home care services. High-tech services are increasingly
accomplished in the home setting where the client is more comfortable and the risks for
complications such as infection are less.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Implementation
6. Which of the following statements represents a current trend in home health nursing?
a. Increased numbers of registered nurses are being employed as home health nurses.
b. Decreased numbers of licensed practical nurses are being employed as home
health nurses.
c. There are more employment opportunities for newly graduated nurses.
d. That a minimum of two years of acute care experience is required
before employment as a home health nurse.
CORRECT ANSWER: C
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There are many opportunities for newly graduated nurses to begin practice as a home
health nurse. It was widely believed for many years that nurses required a minimum of 2
years of acute care hospital experience before being hired as a home health nurse but is
no longer true. Registered nurses generally received hiring preference over licensed
practical nurses because it was believed that registered nurse preparation provided the
best foundation for home care nursing. However, partly because the growing nursing
shortage, enhancements to the scope of practice and educational programs for licensed
practical nurses, and the need to provide
long-term interventions to a growing population with complex and unpredictable care
needs, many home health employers now hire both registered nurses and licensed
practical nurses right after graduation.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
7. When the home health nurse is caring for a client who needs to relearn self-care skills
such as dressing and self-feeding, which referral will be best?
a. Dietitian
b. Speech therapist
c. Physical therapist
d. Occupational therapist
CORRECT ANSWER: D
Occupational therapists assist clients with self-care skills. Physical therapists assist
clients with strengthening, transferring, and ambulation. Dietitians assist with
nutritional choices. Speech therapists assist with speech and swallowing needs.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Planning
NU
enR
tsSisItN
ruG
eT
inBre.laCtiO
onMto nursing-sensitive outcomes?
8. Which of the following statem
a. Only used to evaluate client care
b. Are outside of the nurse’s scope of practice
c. Have no influence on health care budgets
d. Require empirical evidence
CORRECT ANSWER: D
Nursing-sensitive outcomes are “those that are relevant, based on nurses’ scope and
domain of practice, and for which there is empirical evidence linking nursing inputs and
interventions to the outcomes.” Outcomes data may also be used to evaluate the nurses
own practice or that of their team or program, as well as client care. Decision makers and
funders require outcomes data to support budget needs, program design and delivery,
and the development of accountability mechanisms such as balanced scorecards.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
9. Which of these clients should the nurse refer for home health care services?
a. A 71-year-old with dementia who needs 24-hour care to prevent injury
b. An 82-year-old whose family has asked for help to organize pills into a pill box
c. A 67-year-old who requires assistance with shopping, housework, and cooking
d. A 79-year-old with terminal cancer who needs hospice palliative
CORRECT ANSWER: D
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Hospice palliative care is one aspect of home health care services. Services such as
shopping, housework, and cooking are not skilled nursing services and do not require
home health care. Institutional care is required for clients that need 24-hour care.
Medication assistance can be achieved through the client’s pharmacy when filling
medications, request bubble packs.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
10. Which of the following concepts is foundational to home health nursing?
a. Acute care management
b. Health promotion
c. Chronic disease management
d. Health restoration
CORRECT ANSWER: B
A foundational concept of home health nursing is health promotion. Acute care and
chronic disease management are roles, they are not the foundation upon which home
health nursing is based. Health restoration is a core expectation but is not the
foundation for home health nursing.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
11. Which of the following nursing activities is appropriate for the home care nurse who is
caring for a client newly diagnosed with diabetes to delegate to a home support
worker?
a. Assist the client to choose an appropriate diet.
b. Check the client’s feet for signs of breakdown.
c. Help the client with a daily bath and oral care.
d. Teach the client how to m o n i t o r bloo d g luco se.
T B . OC M
N URS IN G
CORR
E
CT
ANSWE
R: C
Assisting with client hygiene is included in the home support workers education and
scope of practice. Assessment of the client and instructing the client in new skills, such
as diet and blood glucose monitoring, are complex skills that are included in RN
education and scope of practice.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
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Chapter 07: Older Adults
Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. Findings from a health history indicate that the client takes daily supplements of
the antioxidants beta carotene, vitamins C and E. This health practice reflects
which of the following theories of biological aging?
a. Free radicals
b. Cross-linking
c. Somatic mutation
d. Telomere–telomerase depletion
CORRECT ANSWER: A
Free radicals are natural by-products of many normal cellular processes and are also
created under the influence of such environmental factors as smog, tobacco smoke, and
radiation.
Numerous natural protective mechanisms are in place to prevent oxidative damage.
Recent research has focused on the roles of various antioxidants, including vitamins C
and E, in slowing down the oxidative process and, ultimately, the aging process. The
somatic mutation theory focuses on spontaneous mutations. The cross-linking theory is
based upon lipids, proteins, CHO, and nucleic acid reactions. The telomere–telomerase
depletion theory focuses on the loss of telomeres, repeated sequences at the ends of
DNA.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
2. The nurse is assessing the nutritional status of an older-adult client using the
N R I G B.C
ng sSh o uNl d t T
h e nu rs O
e assess when
SCALES acronym. Which of the followiU
completing the “S”?
a. Serum potassium level
b. Sadness or mood change
c. Social support
d. Sexual intimacy
CORRECT ANSWER: B
The acronym SCALES can be used to remind the nurses to assess important nutritional
indicators. In the case of the “S”, the nurse is to assess sadness or mood changes.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
3. The nurse is planning care for an alert and active older-adult client who takes multiple
medications for chronic cardiac and respiratory disease and lives with a daughter who
works during the day. Which nursing diagnosis is most appropriate?
a. Risk for injury as evidenced by exposure to toxic chemical (drug-drug interactions)
b. Social isolation related to social behavior incongruent with norms (weakness
and fatigue)
c. Disabled family coping related to differing coping styles between support
person and client
d. Caregiver role strain related to increase in care needs
CORRECT ANSWER: A
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The client’s age and multiple medications indicate a risk for injury caused by interactions
between the multiple drugs being taken and a decreased drug metabolism rate. The client
data do not indicate problems with social isolation, caregiver role strain, or compromised
family coping.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Diagnosis
4. Which of the following actions would enable the nurse to obtain the most
complete information when doing an assessment with an older-adult client?
Interview both the client and the primary client caregiver.
Use a geriatric assessment instrument to evaluate the client.
Review the client’s chart for the history of medical problems.
Ask the client to write down medical problems and medications.
a.
b.
c.
d.
CORRECT ANSWER: B
The most complete information about the client will be obtained through the use of an
assessment instrument specific to the geriatric population, which includes information
about both medical diagnoses and treatments and about functional health patterns
and abilities. A review of the chart, interviews of the client and caregiver, and written
information by the client will all be included in a comprehensive geriatric assessment.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
5. Which of the following actions should the nurse consider when developing the plan of
care for an older adult who is hospitalized for an acute illness?
a. Use a standardized geriatric nursing care plan.
b. Minimize activity level during hospitalization.
c. Plan for transfer to a long-tU
eN
r mR
Sc aIrNe G
faT
ciB
lit.y C
afO
tM
er the hospitalization.
d. Consider preadmission functional abilities when setting client goals.
CORRECT ANSWER: D
The plan of care for older adults should be individualized and based on the client’s
current functional abilities. A standardized geriatric nursing care plan will not address
individual client needs and strengths. A client’s need for discharge to a long-term care
facility is variable. Activity level should be designed to allow the client to retain
functional abilities while hospitalized and also to allow any additional rest needed for
recovery from the acute process.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
6. The nurse is caring for clients in a geriatric family practice clinic with a primary health
care provider. Which of the following actions should the nurse do when caring for
older adults who live in rural areas?
a. Assess the client for chronic diseases that are unique to rural areas.
b. Ensure transportation to appointments with the health care provider.
c. Schedule appointments for the client in an urban area for better health care.
d. Obtain adequate medications for the client to last for 4–6 months.
CORRECT ANSWER: B
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Transportation can be a barrier to accessing health services in rural areas. There are no
chronic diseases unique to rural areas. Because medications may change, the nurse
should help the client plan for obtaining medications through alternate means such as
the mail or delivery services, not by purchasing large quantities of the medications. The
client living in a rural area may lose the benefits of a familiar situation and social support
by moving to an urban area.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
7. The nurse is providing care to older adults in a Northern outreach clinic. Which nursing
action will be most helpful in decreasing the risk for drug–drug interactions?
a. Teach the client to have all prescriptions filled at the same pharmacy.
b. Instruct the client to avoid taking over-the-counter (OTC) medications.
c. Make a medication schedule for the client as a reminder about when to take
each medication.
d. Have the client bring all the medications, supplements, and herbs to every
health care appointment.
CORRECT ANSWER: D
The most information about drug use and possible interactions is obtained when the
client brings all prescribed medications, OTC medications, and supplements to every
health care appointment. The client should discuss the use of any OTC medications with
the health care provider and obtain all prescribed medications from the same pharmacy,
but use of supplements and herbal medications also need to be considered in order to
prevent drug–drug interactions. Use of a medication schedule will help the client take
medications as scheduled but will not prevent drug–drug interactions.
DIF:
Cognitive Level: Applic ation
O P : N ur s i n g Process: Implementation
N RU SI N
GT T
B .C MO
8. Which action will the nurse take when planning for discharge of an older-adult client who
will
need daily assistance with activities such as shopping and transportation?
a. Complete a referral to Medicare.
b. Apply for transfer to an assisted-living facility.
c. Arrange for home health care visits.
d. Apply for attendance at an adult day care program.
CORRECT ANSWER: C
Home health care visits, from an unregulated health care worker, can enable the client
to remain at home but obtain assistance with shopping and transportation.
Medicare, assisted-living facilities, and adult day care programs provide funding for
specific medical services, but not for needs such as shopping or transportation.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
9. The nurse is caring for an older-adult client with multiple health problems who reports
having “no energy” and feeling increasingly weak. The client has had a 5 kg weight loss
over the last year. Which of the following interventions should the nurse implement
initially?
a. Ask the client about daily dietary intake.
b. Schedule regular range-of-motion exercise.
c. Discuss long-term care placement with the client.
d. Describe normal changes with aging to the client.
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CORRECT ANSWER: A
In the frail elderly client, nutrition is frequently compromised, and the nurse’s initial
action should be to assess the client’s nutritional status. Active range-of-motion may be
helpful in improving the client’s strength and endurance, but nutritional assessment is
the priority because the client has had a significant weight loss. The client may be a
candidate for
long-term care placement, but more assessment is needed before this can be determined.
The
client’s assessment data are not consistent with normal changes associated with aging.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
10. The nurse is admitting an acutely ill older-adult client to the hospital. Which of the
following interventions should the nurse implement during the admission process?
a. Speak slowly and loudly while facing the client.
b. Obtain a detailed medical history from the client.
c. Interview the client before the physical assessment.
d. Determine whether the client uses glasses or hearing aids.
CORRECT ANSWER: D
Assistive devices should be in place before assessing the client to minimize anxiety and
confusion. When a client is acutely ill, the physical assessment should be accomplished
first to detect any physiological changes that require immediate action. Not all older
clients have hearing deficits, and it is insensitive of the nurse to speak loudly and slowly
to all older clients. To avoid tiring the client, much of the medical history can be
obtained from medical records.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
i nU
gR
foS
r IanNoG
ldT
erB
-a.dC
ulO
t cMlie nt who lives alone and is taking
11. The home health nurse is c a r N
seven different prescribed medications for chronic health problems. Which of the
following nursing interventions would be most appropriate to ensure medication
compliance?
a. Use a marked pillbox to set up the client’s medications.
b. Discuss the option of moving to an assisted-living facility.
c. Remind the client about the importance of taking medications.
d. Visit the client daily to administer the prescribed medications.
CORRECT ANSWER: A
Since forgetting to take medications is a common cause of medication errors in older
adults, the use of medication reminder devices is helpful when older adults have multiple
medications to take. There is no indication that the client needs to move to assisted living
or that the client does not understand the importance of medication compliance. Home
health care is not designed for the client who needs ongoing assistance with activities of
daily living (ADLs) or instrumental ADLs (IADLs).
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
12. Which information obtained by the home health nurse when making a visit to a
frail older-adult client with mild forgetfulness is of concern?
a. The client tells the nurse that a close friend recently died.
b. The client has lost 4.5 kg during the last month.
c. The client is cared for by a daughter during the day and stays with a son at night.
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d. The client’s son uses a marked pillbox to set up the client’s medications weekly.
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CORRECT ANSWER: B
A 4.5 kg weight loss may be an indication of elder neglect or depression and requires
further assessment by the nurse. The use of a marked pillbox and planning by the family
for 24-hour care are appropriate for this client. It is not unusual that an elderly adult
would have friends who have died.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
13. Which information about an older-adult client who is being assessed by the home health
nurse is of most concern?
a. The client organizes medications in a marked pillbox “so I don’t forget them.”
b. The client uses three different medications for chronic heart and joint problems.
c. The client says, “I don’t go on my daily walks since I had pneumonia 3 months
ago.”
d. The client tells the nurse, “I prefer to manage my life without much help from
others.”
CORRECT ANSWER: C
Inactivity and immobility lead rapidly to loss of function in older adults. The nurse should
develop a plan to prevent further deconditioning and restore function for the client.
Self-management is appropriate for independently living older adults. The use of three
medications is not unusual for an older adult. The use of memory devices to assist with
safe medication administration is recommended for older adults.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
14. The nurse is admitting an oldN
er-aR
dulIt cliG
ent B
w .h oCha sMu r inar y urgency and a possible
U SofNtheTfollowing actions should the nurse
urinary tract infection (UTI). Which
implement first?
a. Assess the client’s orientation.
b. Inspect for abdominal distension.
c. Question the client about hematuria.
d. Invite the client to use the bathroom.
CORRECT ANSWER: D
Before beginning the assessment of an older client with a UTI and urgency, the nurse
should have the client empty the bladder because bladder fullness or discomfort will
distract from the client’s ability to provide accurate information. The client may seem
disoriented if distracted by pain or urgency. The physical assessment data are obtained
after the client is as comfortable as possible.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
15. The nurse is teaching an older-adult female client about her new medications and the
client replies that she “just can’t remember all that information anymore.” Which of
the following changes may interfere with the client’s ability to learn about the new
medications?
a. Intellectual ability declines with age.
b. All mental abilities slow as individual’s age.
c. Declining physical health can impair cognitive function.
d. Impaired vocabulary and verbal function decrease reasoning with age.
CORRECT ANSWER: C
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Declining physical health is an important factor in cognitive impairment. Intellectual
ability does not decline with age. All mental abilities do not slow as an individual ages.
Vocabulary and verbal function do not decrease with age.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
16. The nurse is admitting an older-adult client who is hospitalized with an acute illness.
Which of the following interventions should the nurse do first?
a. Orient the client to their room.
b. Administer the prescribed PRN sedative medication.
c. Ask the health care provider to order a vest restraint.
d. Place the client in a “geri-chair” near the nurse’s station for observation.
CORRECT ANSWER: A
The older adult who moves to a different location needs a thorough orientation to the
environment. The nurse should repeatedly reassure the client that he or she is safe and
attempt to answer all questions. The unit should foster client orientation by displaying
large-print clocks, avoiding complex or visually confusing wall designs, clearly
designating doors, and using simple bed and nurse-call systems. Physical or chemical
restraints may be necessary, but the nurse’s first action should be to provide an ongoing
and clear physical orientation.
There is no indication that the client needs observation at this time.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
17. The nurse suspects that elder abuse may be occurring when a frail older-adult client
with a broken arm is brought to the emergency department by a family member.
Which of these actions should
N the
R nurse
I take fir s t? G B.C M
a. Notify an elder protective sU
e rv S
i c es Na g eTnc y aboOut the possible abuse.
b. Make a referral for a home assessment visit by the home health nurse.
c. Have the family member stay in the waiting area while the client is assessed.
d. Ask the client how the injury occurred and observe the family member’s reaction.
CORRECT ANSWER: C
The initial action should be assessment and interviewing of the client. The client should be
interviewed alone because the client will be unlikely to give accurate information if the
abuser is present. If abuse is occurring, the client should not be discharged home for a
later assessment by a home health nurse. The nurse needs to collect and document
physiological data before notifying the elder protective services agency.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
18. Which one of the following nursing actions will the nurse take to assess for
possible malnutrition in an older-adult client?
a. Assess respiratory function.
b. Assess food allergies.
c. Ask about transportation needs.
d. Determine food preferences.
CORRECT ANSWER: C
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
Transportation impacts clients’ ability to shop for groceries and needs to be assessed.
Assessing respiratory function does not provide evidence related to malnutrition. Food
likes, dislikes, and preferences are not necessarily associated with malnutrition.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
19. The nurse is visiting a homeless shelter for older adults to provide a health-promotion
activity. Which one of the following factors is associated with adult homelessness?
a. Increased cognitive capacity
b. Decreased health problems
c. Abundance of affordable housing
d. Living alone
CORRECT ANSWER: D
Key factors associated with homelessness are low income, reduced cognitive capacity,
and living alone. There is a shortage of affordable housing and homeless adults generally
have an increase in health problems.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Assessment
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Chapter 08: Stress and Stress Management
Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. A young adult arrives in the emergency department (ED) with multiple abrasions
after a motor vehicle accident and has an initial blood pressure (BP) of 180/98.
Which of the following interventions should the nurse implement?
a. Discuss the need for hospital admission to control blood pressure.
b. Change the dressing on the abrasions and discuss the risks associated
with hypertension.
c. Recheck the blood pressure before the client’s discharge from the ED.
d. Start an intravenous (IV) line to administer antihypertensive medications.
CORRECT ANSWER: C
Because hypertension is expected when a client has experienced an acute stressor, the
nurse should plan to check the BP before discharge, which will provide a more accurate
idea of the client’s usual blood pressure. Hypertension that occurs in response to acute
stress does not increase risk for health problems such as stroke, indicate a need for
hospitalization, or indicate a need for IV antihypertensive medications.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
2. A hospitalized client who is usually well organized and calm is receiving diabetic
teaching after being newly diagnosed with diabetes. The client is forgetful, irritable,
and has poor concentration. Which action should the nurse take?
N RS ING TB.C O
M
a. Ask the health care provideU
r fo r a p sychiatric referral.
b. Administer the PRN sedative medication every 4 hours.
c. Suggest the use of a home caregiver to the client’s family.
d. Plan to reinforce and repeat teaching about diabetes management.
CORRECT ANSWER: D
Since behavioural responses to stress include temporary changes such as irritability,
changes in memory, and poor concentration, client teaching will need to be repeated.
Psychiatric referral or home caregiver referral will not be needed for these expected
short-term cognitive changes. Sedation will decrease the client’s ability to learn the
necessary information for
self-management.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
3. The nurse is caring for a client who has been hospitalized following a heart attack and tells
the nurse, “I didn’t sleep last night because I worried about missing work and losing my
insurance coverage.” Which nursing diagnosis is appropriate to include in the plan of
care?
a. Anxiety
b. Defensive coping
c. Ineffective denial
d. Risk-prone health behaviour
CORRECT ANSWER: A
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The information about the client indicates that anxiety is an appropriate nursing
diagnosis. The client data do not support defensive coping, ineffective denial, or riskprone health behaviour as problems for this client.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Diagnosis
4. The nurse is assisting with a breast biopsy for an alert client who has a lump in the
right breast. Which relaxation technique will be best to use at this time?
a. Massage
b. Meditation
c. Guided imagery
d. Relaxation breathing
CORRECT ANSWER: D
Relaxation breathing is the easiest of the relaxation techniques to use. It will be difficult
for the nurse to provide massage while assisting with the biopsy. Meditation and guided
imagery require more time to practise and learn.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
5. The nurse is preparing a health-promotion session on meditation for older adults at a
community centre. Which of the following points should the nurse include in the
session?
a. Have clients bring earphones to the session
b. Breathing pattern to slowly increase speed
c. Allow a 10–20 minute time frame for meditation
d. Practise two to three times per week
CORR
E
CT
ANSWE
R: C
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Guidelines for basic mediation include continuing it for 10–20 minutes, although even 5
minutes can be helpful. Clients won’t need earphones as the guideline is to find a quiet
place with no distractions. The breathing pattern is to breathe slowly and consistently,
relaxation breathing, not to speed up the rate. Meditation guidelines suggest that this
be done once or twice a day.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
6. When choosing music to help relax a client who is having a painful dressing change,
which action is best for the nurse to take?
a. Use music composed by Mozart.
b. Ask the client about music preferences.
c. Select music that has 60–80 beats/minute.
d. Encourage the client to use music without words.
CORRECT ANSWER: B
Although music with 60–80 beats/minute, music without words, and music
composed by Mozart are frequently recommended to reduce stress, each client
responds individually to music and personal preferences are important.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
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7. The nurse is teaching a hospitalized client to use imagery as a relaxation technique.
Which statement by the nurse is appropriate?
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a. “Place your stress in the image of a form you can destroy.”
b. “Think of a place where you feel peaceful and comfortable.”
c. “Bring what you hear and sense in your present environment into your image of
the scene.”
d. “If your scene is stressful to you, continue visualizing until you can overcome the
distress.”
CORRECT ANSWER: B
When using imagery for relaxation, the client should visualize a comfortable and
peaceful place. The goal is to offer a relaxing retreat from the actual client environment.
Imagery may be used to target a disease or pathology, but this type of imagery will not
lead to relaxation.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
8. An overweight client who enjoys active outdoor activities develops arthritis in the knees.
Which action by the nurse is most appropriate to assist the client in coping with the
diagnosis?
a. Ask the client to discuss feelings about the diagnosis.
b. Have the client practise frequent relaxation breathing.
c. Educate the client on the use of imagery to decrease pain and decrease stress.
d. Encourage the client to think about how weight loss might improve symptoms.
CORRECT ANSWER: D
For problems that can be changed or controlled, problem-focused coping strategies, such
as encouraging the client to lose weight, are most helpful. The other strategies also may
assist the client in coping with the diagnosis, but they will not be as helpful as a problemoriented strategy.
DIF:
atiU
o nRSINGTT
OB
P :.C
N uOr sMing Process: Implementation
Cognitive Level: ApplicN
9. The nurse is caring for a hospitalized client with diabetes who states to the nurse, “I
don’t understand why I can keep my blood sugar under control at home with diet alone,
but when I get sick, my blood sugar goes up.” Which response by the nurse is
appropriate?
a. “It is probably just coincidental that your blood sugars are high when you are ill.”
b. “Stressors such as illness cause the release of hormones that increase blood sugar.”
c. “Increased blood sugar occurs because the kidneys are not able to metabolize
glucose as well during stressful times.”
d. “Your diet is different here in the hospital than at home and that is the most likely
cause of the increased glucose level.”
CORRECT ANSWER: B
The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels.
The increase in blood sugar is not coincidental. The kidneys do not control blood glucose.
A diabetic client who is hospitalized will be on an appropriate diet to help control blood
glucose.
DIF:
Cognitive Level: Comprehension
TOP: Nursing Process: Implementation
10. Which of the following actions should the nurse take to monitor the effects of an
acute stressor on a hospitalized client?
a. Assess for bradycardia.
b. Monitor for a decrease in respiratory rate.
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c. Observe for increased appetite.
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d. Check for elevated blood glucose levels.
CORRECT ANSWER: D
The physiological changes associated with the acute stress response can cause a
decrease in appetite, increased gastrointestinal upset, and elevation of blood glucose.
Stress causes an increase in respiratory and heart rates.
DIF:
Cognitive Level: Analysis
TOP: Nursing Process: Assessment
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
Chapter 09: Sleep and Sleep Disorders
Lewis: Medical-Surgical Nursing in Canada, 5th Canadian Edition
MULTIPLE CHOICE
1. The nurse is caring for a client in the ambulatory care setting that has chronic
insomnia. Which of the following interventions should the nurse do initially?
a. Schedule a polysomnography (PSG) study.
b. Arrange for the client to have a sleep study.
c. Ask the client to keep a 2-week sleep diary.
d. Teach the client about the use of an actigraph.
CORRECT ANSWER: C
The diagnosis of insomnia is made on the basis of subjective complaints and an
evaluation of a 1- to 2-week sleep diary completed by the client. Actigraphy and PSG
studies/sleep studies may be used for determining specific sleep disorders, but are not
necessary to make an initial insomnia diagnosis.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
2. Which instruction will the nurse include when teaching a client with chronic insomnia
about ways to improve sleep quality?
a. Avoid aerobic exercise during the day.
b. Read in bed for a few minutes each night.
c. Keep the bedroom temperature slightly warm.
d. Try to go to bed at the sa me t imee ve r y evening .
N R I G B. C M
CORR
E
CT
ANSWE
R: D
USNT
O
A regular evening schedule is recommended to improve sleep time and quality. Aerobic
exercise may improve sleep quality, but should occur several hours before bedtime.
Reading in bed is discouraged for clients with insomnia. The bedroom temperature
should be slightly cool.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
3. After the nurse has taught a client about the use of extended-release zopiclone for
insomnia, which client statement indicates a need for further teaching?
a. “I will take the medication an hour before bedtime.”
b. “I should take the medication on an empty stomach.”
c. “I should not take this medication unless I can sleep for at least 6 hours.”
d. “I will schedule activities that require mental alertness for later in the day.”
CORRECT ANSWER: A
Benzodiazepine receptor agonists such as zopiclone work quickly and should be taken
immediately before bedtime, not 1 hour before. The other client statements are
correct.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Evaluation
4. Which action is best for the nurse to include in the plan of care in order to improve
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
sleep quality for a critically ill client in the intensive care unit (ICU)?
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
a.
b.
c.
d.
Ask all visitors to leave the ICU for the night.
Lower the level of light from 8:00 PM until 7:00 AM.
Avoid the use of opioids for pain relief during the evening hours.
Schedule assessments to allow at least 4 hours of uninterrupted sleep.
CORRECT ANSWER: B
Lowering the level of light will help mimic normal day/night patterns and maximize the
opportunity for sleep. Although frequent assessments and opioid use can disturb sleep
patterns, these actions are necessary for the care of critically ill clients. For some
clients, having a family member or friend at the bedside may decrease anxiety and
improve sleep.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Planning
5. Which information will the nurse plan to include when teaching a client with narcolepsy
about management of the disorder?
a. Stimulant drugs should be used for only a short time because of the risk for abuse.
b. Driving an automobile may be possible with appropriate treatment of narcolepsy.
c. Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy.
d. Antidepressant drugs are prescribed to treat the depression caused by the disorder.
CORRECT ANSWER: B
The accident rate for clients with narcolepsy who are receiving appropriate treatment is
similar to the general population. Stimulant medications are used on an ongoing basis for
clients with narcolepsy. The purpose of antidepressant drugs in the treatment of
narcolepsy is the management of cataplexy, not to treat depression. Changes in sleep
hygiene are recommended for clients with narcolepsy to improve sleep quality.
DIF:
atiU
o nRSINGTT
OB
P :.C
N uOr sMing Process: Planning
Cognitive Level: ApplicN
6. Which action by the nurse manager of an acute care unit will improve the alertness of
nurses who work the night shift?
a. Arrange for older staff members to work most night shifts.
b. Provide a sleeping area for staff to use for napping at night.
c. Post reminders about the relationship of sleep and alertness.
d. Schedule nursing staff to rotate day and night shifts monthly.
CORRECT ANSWER: B
Short on-site naps will improve alertness. Rotating shifts causes the most disruption in
sleep habits. Reminding staff members about the impact of lack of sleep on alertness will
not improve sleep or alertness.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
7. The nurse takes the health history for four clients in the clinic. Which information regarding
the clients’ sleep is most important to communicate to the health care provider?
a. A 21-year-old student takes melatonin to assist in sleeping when travelling
from the Canada to Europe.
b. A 32-year-old who is experiencing a stressful week uses diphenhydramine
for several nights.
c. A 41-year-old with a body mass index (BMI) of 42 kg/m2 says that the spouse
complains about the client’s snoring.
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d. A 64-year-old nurse who works the night shift reports drinking hot
chocolate before going to bed in the morning.
CORRECT ANSWER: C
The client’s BMI and snoring suggest possible sleep apnea, which can cause
complications such as cardiac dysrhythmias, hypertension, and right-sided heart failure.
Melatonin is safe to use as a therapy for jet lag. Short-term use of diphenhydramine in
young adults is not a concern. Hot chocolate contains only 5 mg of caffeine and is
unlikely to be affecting this client’s sleep quality.
DIF:
Cognitive Level: Analysis
TOP: Nursing Process: Assessment
8. Which of these actions should the nurse take first for a client in the clinic who is
complaining of insomnia and daytime fatigue?
a. Question the client about the use of over-the-counter (OTC) sleep aids.
b. Suggest that the client decrease intake of caffeine-containing beverages.
c. Advise the client to get out of bed if unable to fall asleep in 10–20 minutes.
d. Recommend that the client use any prescribed sleep aids for only 2–3 weeks.
CORRECT ANSWER: A
The nurse’s first action should be assessment of the client for factors that may
contribute to poor sleep quality or daytime fatigue such as the use of OTC medications.
The other actions may be appropriate, but assessment is needed first to choose
appropriate interventions to improve the client’s sleep.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
o rUeR
cS
e ivIeN
dG
aTneB
w.pC
r es cMr ip t io n for a continuous positive
9. A client with sleep apnea w hN
airway pressure (CPAP) device a week ago returns to the clinic and says that severe
daytime fatigue
is still a problem. Which action should the nurse take first?
a. Teach about radiofrequency ablation.
b. Plan to schedule a nighttime PSG study.
c. Ask the client whether the CPAP is being used every night.
d. Discuss the possible surgical approaches used for sleep apnea.
CORRECT ANSWER: C
CPAP is very effective in reducing sleep apnea, but patient adherence is frequently a
problem. Surgery, radiofrequency ablation, or a follow-up PSG study may be indicated,
but the nurse’s first action should be to assess whether the CPAP is being used as
prescribed.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
10. The nurse is providing a health-promotion session to young adults that have difficulty
sleeping at night and has instructed them to limit their caffeine intake. Which of the
following beverages have more than 50 mg of caffeine?
a. Green tea (237 mL)
b. Chocolate cake (5 cm square)
c. Brewed coffee (237 mL)
d. Black tea (237 mL)
CORRECT ANSWER: C
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
Brewed coffee is the only choice that has more than 50 mg of caffeine; it has 135 mg
caffeine. Black tea, either leaf or bag, has 50 mg of caffeine. Green tea has 30 mg of
caffeine.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
11. The nurse is caring for a client that has sleep deprivation and is teaching about the effects
that lack of sleep can have on the body. Which of the following information would be
included in the teaching plan for this client?
a. Decreased insulin resistance
b. Increased growth hormone
c. Decreased risk of type 2 diabetes
d. Increased risk of gastro-esophageal reflux disease (GERD)
CORRECT ANSWER: D
Clients with sleep deprivation are at an increased risk of GERD, type 2 diabetes, heart
disease, hypertension and impaired immune function and can also experience cognitive
impairment, and behavioural changes such as irritability and moodiness. Sleep
deprivation causes an increase in insulin resistance and a decrease in growth hormone.
DIF:
Cognitive Level: Application
TOP: Nursing Process: Implementation
IF YOU WANT THIS TEST BANK OR SOLUTION
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IF YOU WANT THIS TEST BANK OR SOLUTION
MANUAL EMAIL ME donc8246@gmail.com TO
RECEIVE ALL CHAPTERS IN PDF FORMAT
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