TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane Tyerman,.pdf

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TEST BANK For Lewis's Medical Surgical
Nursing in Canada, 4th Edition
by Jane Tyerman, Shelley Cobbett, Chapters 1 - 72

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TABLE OF CONTENTS
Section One – Concepts in Nursing Practice
1 Introduction to Medical-Surgical Nursing Practice in Canada 2
Cultural Competence and Health Equity in 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

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35 Nursing Management: Hypertension
36 Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome

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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

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Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada
Lewis: Medical-Surgical Nursing in Canada, 4th 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
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’ prM
imary use of the nursing process when
providing care to clients? U S N T O
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

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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 on
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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.

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U S N T
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
b. Uses client data to develo
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c. Teaches interventions to relieve client 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

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10. Which of the following includes the components required for a complete nursing diagnosis
statement?
a. A problem and the suggested 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: Cognitive Level: Knowledge TOP: Nursing Process: Evaluation
12. When using the Five Steps
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practice (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.

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Chapter 02: Cultural Competence and Health Equity in Nursing Care
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.
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 transporta
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b. Obtain low-cost medication
U
s. SNT O
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.
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

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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.
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
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ing Process: Implementation
U S N T O
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.
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.

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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.
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.
8. Which of the following actions represents the best example of culturally appropriate nursing
care when caring for a newly admitted client?
a. Have family members provide most of the client’s personal care.
b. Maintain a personal space of at least 0.5 m when assessing the client.
c. Ask permission before touching a client during the physical assessment.
d. Consider the client’s ethnicity as the most important factor in planning care.
NURSINGTB.CO
M
C
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.
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
CORR
E
CT
ANSWE
R:

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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.

Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
NURSINGTB.COM
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.
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
age-standardized mortality ra
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r than those of the Canadian-born
population. Underemployment, unemployment, and workplace stress place immigrants at
increased health risks as well as the risk for social exclusion.
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.

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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.
14. Which of the following statements represents a health inequity currently experienced in
Canada?
a. Indigenous adults are less likely to smoke tobacco than other adults in Canada.
b. Overall suicide rate among First Nation communities is about twice the rate of the
general population.
c. Individuals from lower income neighbourhoods undergo preventive health
screening more that their higher income counterparts.
d. Recent immigrants are more likely to have a primary care physician than
Canadian-born individuaN
ls. R IGB.CM
U S N T O
B
Suicide rates are five to seven times higher among Indigenous youth than among
non-Indigenous youth. Suicide rates among Indigenous youth are among the highest in the
world, at 11 times the national average. Smoking rates are more than two times higher among the
three Indigenous groups than among the non-Indigenous population. Individuals from higher
income neighbourhoods undergo preventive health screening more than those from lower
income neighbourhoods. Recent immigrants are less likely to have a primary care physician than
Canadian-born individuals.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment
15. When performing a cultural assessment with a client of a different culture, which of the
following actions is the initial action to be taken by the nurse?
a. Wait until a cultural healer is available to help with the assessment.
b. Obtain a list of any cultural remedies that the client currently uses.
c. Ask the client about any affiliation with a particular cultural group.
d. Tell the client what the nurse already knows about the client’s culture.
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.
CORR
E
CT
ANSWE
R:

NURSINGTB.COM
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.
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NURSINGTB.COM
Chapter 03: Health History and Physical Examination
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.
N R I G B.C M
2. Immediate surgery is planned fU
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en t w
Tith acu
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te abdominal pain. Which of the following
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.
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?”
d. “Do you have any other symptoms along with the spells?”

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U S N T
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.
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.
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
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b. Client denies having pain when the 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.
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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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.
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.
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
d. Organizing the sequence toU
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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.
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.

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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?
a. Focused
b. Subjective
c. Emergency
d. Comprehensive
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.
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. Intake and
output, reasons for co nt aN
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system, and comments of family members
about the client’s condition are not part of the general survey.
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.
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.
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.
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on an adult client. The nurse should
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.

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Chapter 04: Patient and Caregiver Teaching
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.
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 responsibilitN
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make dietary changes has been
fulfilled. U S N T O
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 long-term
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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U S N T O
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.
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.
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5. When using the Transtheoretical Model of Health Behaviour Change during client teaching,
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.
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.
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.
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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.
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.
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.
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
d. Lecture-discussion
CORRECT ANSWER:
A
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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.
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.
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.
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
best approach for the nurse toN
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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.
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.
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.
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 theU
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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.
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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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.
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.
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Chapter 05: Chronic Illness
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.
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%).
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.
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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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.
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.
6. What is the average life expectancy in Canada?
a. 60 years
b. 70 years
c. 80 years
d. 90 years
CORRECT
ANSWER:
C
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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.
8. Which of the following models views disability as directly caused by disease or trauma?
a. Social
b. Nursing
c. Medical
d. Collaborative

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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.
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.
10. What is the most influential source of self-efficacy?
a. Mastery
b. Affective states
c. Verbal persuasion
d. Vicarious experience
CORRECT ANSWER: A
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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.
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).

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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.
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.
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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.
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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CORRECT
ANSWER:
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).
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.
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. Downward
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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.
18. Which one of the following levels is part of the client response to health care
recommendations based on a continuum of self-care?
a. Self-esteem
b. Adherence
c. Denial
d. Acceptance
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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Chapter 06: Community-Based Nursing and Home Care
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.
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
The role of the case managerN
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ent’s care through multiple settings 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.
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.

NURSINGTB.COM
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.
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 appropriate
home health se r vN
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e homebound, but not bed bound, to 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.
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

NURSINGTB.COM
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.
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.
8. Which of the following statem
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Mto nursing-sensitive outcomes?
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.
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

NURSINGTB.COM
U S N T O
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.
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.
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
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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.
CORR
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NURSINGTB.COM
N R I G B.C
Chapter 07: Older Adults
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.
2. The nurse is assessing the nutritional status of an older-adult client using the SCALES
acronym. Which of the followiU
ng sS
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ld tT
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e assess when 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.
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

NURSINGTB.COM
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.
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?
a. Interview both the client and the primary client caregiver.
b. Use a geriatric assessment instrument to evaluate the client.
c. Review the client’s chart for the history of medical problems.
d. Ask the client to write down medical problems and medications.
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.
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
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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.
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

NURSINGTB.COM
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.
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
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ing Process: Implementation
U S N T O
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.
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.

NURSINGTB.COM
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.
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.
11. The home health nurse is c a rN
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lient who lives alone and is taking 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).
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.
d. The client’s son uses a marked pillbox to set up the client’s medications weekly.

NURSINGTB.COM
U S N T
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.
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.
14. The nurse is admitting an old
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Murinary urgency and a possible urinary
tract infection (UTI). Which of the following actions should the nurse 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.
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

NURSINGTB.COM
N R I
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.
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.
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 the nurse take first? GB.CM
a. Notify an elder protective sU
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ncy abo
O
ut 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.
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

NURSINGTB.COM
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.
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.
NURSINGTB.CO
M

TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane Tyerman,.pdf

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