Professional Documents
Culture Documents
Medical-Surgical Nursing 9th Edition Lewis Test Bank 1
Medical-Surgical Nursing 9th Edition Lewis Test Bank 1
MULTIPLE CHOICE
1. When caring for an older patient with hypertension who has been hospitalized after a transient
ischemic (TIA), which topic is the most important for the nurse to include in the discharge
teaching?
a. Effect of atherosclerosis on blood vessels
b. Mechanism of action of anticoagulant drug therapy
c. Symptoms indicating that the patient should contact the health care provider
d. Impact of the patient’s family history on likelihood of developing a serious stroke
ANS: C
One of the tasks for patients with chronic illnesses is to prevent and manage a crisis. The
patient needs instruction on recognition of symptoms of hypertension and TIA and
appropriate actions to take if these symptoms occur. The other information also may be
included in patient teaching but is not as essential in the patient’s self-management of the
illness.
2. The nurse performs a comprehensive geriatric assessment of a patient who is being assessed
for admission to an assisted living facility. Which question is the most important for the nurse
to ask?
a. “Have you had any recent infections?”
b. “How frequently do you see a doctor?”
c. “Do you have a history of heart disease?”
d. “Are you able to prepare your own meals?”
ANS: D
The patient’s functional abilities, rather than the presence of an acute or chronic illness, are
more useful in determining how well the patient might adapt to an assisted living situation.
The other questions will also provide helpful information but are not as useful in providing a
basis for determining patient needs or for developing interventions for the older patient.
4. The nurse plans to complete a thorough assessment of an older patient. Which method should
the nurse use to gather the most complete information?
a. Use a geriatric assessment instrument to evaluate the patient.
b. Ask the patient to write down medical problems and medications.
c. Interview both the patient and the primary caregiver for the patient.
d. Review the patient’s medical record for a history of medical problems.
ANS: A
The most complete information about the patient 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 medical record, interviews with the patient and caregiver, and written
information by the patient are all included in a comprehensive geriatric assessment.
5. An older patient is hospitalized with pneumonia. Which intervention should the nurse
implement to provide optimal care for this patient?
a. Use a standardized geriatric nursing care plan.
b. Minimize activity level during hospitalization.
c. Plan for transfer to a long-term care facility upon discharge.
d. Consider the preadmission functional abilities when setting patient goals.
ANS: D
The plan of care for older adults should be individualized and based on the patient’s current
functional abilities. A standardized geriatric nursing care plan will not address individual
patient needs and strengths. A patient’s need for discharge to a long-term care facility is
variable. Activity level should be designed to allow the patient to retain functional abilities
while hospitalized and also to allow any additional rest needed for recovery from the acute
process.
DIF: Cognitive Level: Apply (application) REF: 71
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
6. The nurse cares for an older adult patient who lives in a rural area. Which intervention should
the nurse plan to implement to best meet this patient’s needs?
a. Suggest that the patient move to an urban area.
b. Assess the patient for chronic diseases that are unique to rural areas.
c. Ensure transportation to appointments with the health care provider.
d. Obtain adequate medications for the patient to last for 4 to 6 months.
ANS: C
Transportation can be a barrier to accessing health services in rural areas. The patient living in
a rural area may lose the benefits of a familiar situation and social support by moving to an
urban area. There are no chronic diseases unique to rural areas. Because medications may
change, the nurse should help the patient plan for obtaining medications through alternate
means such as the mail or delivery services, not by purchasing large quantities of the
medications.
7. Which nursing action will be most helpful in decreasing the risk for drug-drug interactions in
an older adult?
a. Teach the patient to have all prescriptions filled at the same pharmacy.
b. Instruct the patient to avoid taking over-the-counter (OTC) medications.
c. Make a schedule for the patient as a reminder of when to take each medication.
d. Have the patient bring all medications, supplements, and herbs to each
appointment.
ANS: D
The most information about drug use and possible interactions is obtained when the patient
brings all prescribed medications, OTC medications, and supplements to every health care
appointment. The patient 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 patient take medications as scheduled
but will not prevent drug-drug interactions.
8. A patient who has just moved to a long-term care facility has a nursing diagnosis of relocation
stress syndrome. Which action should the nurse include in the plan of care?
a. Remind the patient that making changes is usually stressful.
b. Discuss the reason for the move to the facility with the patient.
c. Restrict family visits until the patient is accustomed to the facility.
d. Have staff members write notes welcoming the patient to the facility.
ANS: D
Having staff members write notes will make the patient feel more welcome and comfortable at
the long-term care facility. Discussing the reason for the move and reminding the patient that
change is usually stressful will not decrease the patient’s stress about the move. Family
member visits will decrease the patient’s sense of stress about the relocation.
9. An older patient complains of having “no energy” and feeling increasingly weak. The patient
has had a 12-pound weight loss over the last year. Which action should the nurse take
initially?
a. Ask the patient about daily dietary intake.
b. Schedule regular range-of-motion exercise.
c. Discuss long-term care placement with the patient.
d. Describe normal changes associated with aging to the patient.
ANS: A
In a frail older patient, nutrition is frequently compromised, and the nurse’s initial action
should be to assess the patient’s nutritional status. Active range of motion may be helpful in
improving the patient’s strength and endurance, but nutritional assessment is the priority
because the patient has had a significant weight loss. The patient may be a candidate for long-
term care placement, but more assessment is needed before this can be determined. The
patient’s assessment data are not consistent with normal changes associated with aging.
10. The nurse admits an acutely ill, older patient to the hospital. Which action should the nurse
take first?
a. Speak slowly and loudly while facing the patient.
b. Obtain a detailed medical history from the patient.
c. Perform the physical assessment before interviewing the patient.
d. Ask a family member to go home and retrieve the patient’s cane.
ANS: C
When a patient is acutely ill, the physical assessment should be accomplished first to detect
any physiologic changes that require immediate action. Not all older patients have hearing
deficits, and it is insensitive of the nurse to speak loudly and slowly to all older patients. To
avoid tiring the patient, much of the medical history can be obtained from medical records.
After the initial physical assessment to determine the patient’s current condition, then the
nurse could ask someone to obtain any assistive devices for the patient if applicable.
11. The nurse cares for an alert, homeless older adult patient who was admitted to the hospital
with a chronic foot infection. Which intervention is the most appropriate for the nurse to
include in the discharge plan for this patient?
a. Refer the patient to social services for further assessment.
b. Teach the patient how to assess and care for the foot infection.
c. Schedule the patient to return to outpatient services for foot care.
d. Give the patient written information about shelters and meal sites.
ANS: A
An interdisciplinary approach, including social services, is needed when caring for homeless
older adults. Even with appropriate teaching, a homeless individual may not be able to
maintain adequate foot care because of a lack of supplies or a suitable place to accomplish
care. Older homeless individuals are less likely to use shelters or meal sites. A homeless
person may fail to keep appointments for outpatient services because of factors such as fear of
institutionalization or lack of transportation.
12. The home health nurse cares for an older adult patient who lives alone and takes several
different prescribed medications for chronic health problems. Which intervention, if
implemented by the nurse, would best encourage medication compliance?
a. Use a marked pillbox to set up the patient’s medications.
b. Discuss the option of moving to an assisted living facility.
c. Remind the patient about the importance of taking medications.
d. Visit the patient daily to administer the prescribed medications.
ANS: A
Because 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 patient needs to move to assisted living or
that the patient does not understand the importance of medication compliance. Home health
care is not designed for the patient who needs ongoing assistance with activities of daily living
(ADLs) or instrumental ADLs (IADLs).
13. The home health nurse visits an older patient with mild forgetfulness. The nurse is most
concerned if which information is obtained?
a. The patient tells the nurse that a close friend recently died.
b. The patient has lost 10 pounds (4.5 kg) during the last month.
c. The patient is cared for by a daughter during the day and stays with a son at night.
d. The patient’s son uses a marked pillbox to set up the patient’s medications weekly.
ANS: B
A 10-pound 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 patient. It is not unusual that an 86-year-old would have
friends who have died.
14. Which statement, if made by an older adult patient, would be of most concern to the nurse?
a. “I prefer to manage my life without much help from other people.”
Another document from Scribd.com that is
random and unrelated content:
By MURRAY and HERMAN.
One Traveller Returns.
Paul Jones’s Alias.
The Bishops’ Bible.
By D. CHRISTIE MURRAY.
A Model Father.
Joseph’s Coat.
Coals of Fire.
Val Strange.
Old Blazer’s Hero.
Hearts.
The Way of the World.
Cynic Fortune.
A Life’s Atonement.
By the Gate of the Sea.
A Bit of Human Nature.
First Person Singular.
Bob Martin’s Little Girl.
Time’s Revenges.
A Wasted Crime.
By HENRY MURRAY.
A Game of Bluff.
A Song of Sixpence.
By HUME NISBET.
“Bail Up!”
Dr. Bernard St. Vincent.
By ALICE O’HANLON.
The Unforeseen.
Chance? or Fate?
By GEORGES OHNET.
Dr. Rameau.
A Last Love.
A Weird Gift.
By Mrs. OLIPHANT.
Whiteladies.
The Primrose Path.
The Greatest Heiress in England.
By OUIDA.
Held in Bondage.
Strathmore.
Chandos.
Idalia.
Under Two Flags.
Cecil Castlemaine’s Gage.
Tricotrin.
Puck.
Folle Farine.
A Dog of Flanders.
Pascarel.
Signa.
Princess Napraxine.
In a Winter City.
Ariadne.
Friendship.
Two Little Wooden Shoes.
Moths.
Bimbi.
Pipistrelle.
A Village Commune.
Wanda.
Othmar.
Frescoes.
In Maremma.
Guilderoy.
Ruffino.
Syrlin.
Santa Barbara.
Ouida’s Wisdom, Wit, and Pathos.
By C. L. PIRKIS.
Lady Lovelace.
By EDGAR A. POE.
The Mystery of Marie Roget.
By E. C. PRICE.
Valentina.
The Foreigners.
Mrs. Lancaster’s Rival.
Gerald.
By RICHARD PRYCE.
Miss Maxwell’s Affections.
By JAMES PAYN.
Bentinck’s Tutor.
Murphy’s Master.
A County Family.
At Her Mercy.
Cecil’s Tryst.
The Clyffards of Clyffe.
The Foster Brothers.
Found Dead.
The Best of Husbands.
Walter’s Word.
Halves.
Fallen Fortunes.
Humorous Stories.
£200 Reward.
A Marine Residence.
Mirk Abbey.
By Proxy.
Under One Roof.
High Spirits.
Carlyon’s Year.
From Exile.
For Cash Only.
Kit.
The Canon’s Ward.
Talk of the Town.
Holiday Tasks.
A Perfect Treasure.
What He Cost Her.
A Confidential Agent.
Glow-worm Tales.
The Burnt Million.
Sunny Stories.
Lost Sir Massingberd.
A Woman’s Vengeance.
The Family Scapegrace.
Gwendoline’s Harvest.
Like Father, Like Son.
Married Beneath Him.
Not Wooed, but Won.
Less Black than We’re Painted.
Some Private Views.
A Grape from a Thorn.
The Mystery of Mirbridge.
The Word and the Will.
A Prince of the Blood.
A Trying Patient.
By CHARLES READE.
It is Never Too Late to Mend.
Christie Johnstone.
The Double Marriage.
Put Yourself in His Place.
Love Me Little, Love Me Long.
The Cloister and the Hearth.
The Course of True Love.
The Jilt.
The Autobiography of a Thief.
A Terrible Temptation.
Foul Play.
The Wandering Heir.
Hard Cash.
Singleheart and Doubleface.
Good Stories of Men and other Animals.
Peg Woffington.
Griffith Gaunt.
A Perilous Secret.
A Simpleton.
Readiana.
A Woman-Hater.
By Mrs. J. H. RIDDELL.
Weird Stories.
Fairy Water.
Her Mother’s Darling.
The Prince of Wales’s Garden Party.
The Uninhabited House.
The Mystery in Palace Gardens.
The Nun’s Curse.
Idle Tales.
By AMELIE RIVES.
Barbara Dering.
By F. W. ROBINSON.
Women are Strange.
The Hands of Justice.
By JAMES RUNCIMAN.
Skippers and Shellbacks.
Grace Balmaign’s Sweetheart.
Schools and Scholars.
By W. CLARK RUSSELL.
Round the Galley Fire.
On the Fo’k’sle Head.
In the Middle Watch.
A Voyage to the Cape.
A Book for the Hammock.
The Mystery of the “Ocean Star.”
The Romance of Jenny Harlowe.
An Ocean Tragedy.
My Shipmate Louise.
Alone on a Wide Wide Sea.
By JOHN SAUNDERS.
Guy Waterman.
The Two Dreamers.
The Lion in the Path.
By KATHARINE SAUNDERS.
Joan Merryweather.
The High Mills.
Heart Salvage.
Sebastian.
Margaret and Elizabeth.
By GEORGE R. SIMS.
Rogues and Vagabonds.
The Ring o’ Bells.
Mary Jane’s Memoirs.
Mary Jane Married.
Tales of To-day.
Dramas of Life.
Tinkletop’s Crime.
Zeph.
My Two Wives.
Memoirs of a Landlady.
Scenes from the Show.
By ARTHUR SKETCHLEY.
A Match in the Dark.
By HAWLEY SMART.
Without Love or Licence.
By T. W. SPEIGHT.
The Mysteries of Heron Dyke.
The Golden Hoop.
Hoodwinked.
By Devious Ways.
Back to Life.
The Loudwater Tragedy.
Burgo’s Romance.
Quittance In Full.
By R. A. STERNDALE.
The Afghan Knife.
By R. LOUIS STEVENSON.
New Arabian Nights.
Prince Otto.
By BERTHA THOMAS.
Cressida.
Proud Maisie.
The Violin-Player.
By WALTER THORNBURY.
Tales for the Marines.
Old Stories Retold.
By T. ADOLPHUS TROLLOPE.
Diamond Cut Diamond.
By F. ELEANOR TROLLOPE.
Like Ships upon the Sea.
Anne Furness.
Mabel’s Progress.
By ANTHONY TROLLOPE.
Frau Frohmann.
Marion Fay.
Kept in the Dark.
John Caldigate.
The Way We Live Now.
The Land-Leaguers.
The American Senator.
Mr. Scarborough’s Family.
The Golden Lion of Granpere.
By J. T. TROWBRIDGE.
Farnell’s Folly.
By MARK TWAIN.
A Pleasure Trip on the Continent.
The Gilded Age.
Huckleberry Finn.
Mark Twain’s Sketches.
Tom Sawyer.
A Tramp Abroad.
Stolen White Elephant.
Life on the Mississippi.
The Prince and the Pauper.
A Yankee at the Court of King Arthur.
The £1,000,000 Bank-Note.
By C. C. FRASER-TYTLER.
Mistress Judith.
By SARAH TYTLER.
The Bride’s Pass.
Buried Diamonds.
St. Mungo’s City.
Lady Bell.
Noblesse Oblige.
Disappeared.
The Huguenot Family.
The Blackhall Ghosts.
What She Came Through.
Beauty and the Beast.
Citoyenne Jacqueline.
By ALLEN UPWARD.
The Queen against Owen.
By WILLIAM WESTALL.
Trust-Money.
By Mrs. F. H. WILLIAMSON.
A Child-Widow.
By J. S. WINTER.
Cavalry Life.
Regimental Legends.
By H. F. WOOD.
The Passenger from Scotland Yard.
The Englishman of the Rue Cain.
By Lady WOOD.
Sabina.
By EDMUND YATES.
The Forlorn Hope.
Land at Last.
Castaway.
OGDEN, SMALE AND CO. LIMITED, PRINTERS, GREAT SAFFRON HILL, E.C.
Is recommended by all the best
authorities, as on account of its
emollient, non-irritant character,
Redness, Roughness, and Chapping
are prevented, and a healthful and
attractive complexion ensured.
Transcriber’s Note
This book was written in a period when many words had not become
standardized in their spelling. Words may have multiple spelling
variations or inconsistent hyphenation in the text.
1.D. The copyright laws of the place where you are located also
govern what you can do with this work. Copyright laws in most
countries are in a constant state of change. If you are outside the
United States, check the laws of your country in addition to the
terms of this agreement before downloading, copying, displaying,
performing, distributing or creating derivative works based on this
work or any other Project Gutenberg™ work. The Foundation
makes no representations concerning the copyright status of any
work in any country other than the United States.
1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form,
including any word processing or hypertext form. However, if you
provide access to or distribute copies of a Project Gutenberg™
work in a format other than “Plain Vanilla ASCII” or other format
used in the official version posted on the official Project
Gutenberg™ website (www.gutenberg.org), you must, at no
additional cost, fee or expense to the user, provide a copy, a means
of exporting a copy, or a means of obtaining a copy upon request, of
the work in its original “Plain Vanilla ASCII” or other form. Any
alternate format must include the full Project Gutenberg™ License
as specified in paragraph 1.E.1.
• You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to the
Project Gutenberg Literary Archive Foundation. Royalty
payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
about donations to the Project Gutenberg Literary Archive
Foundation.”
• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.
1.E.9. If you wish to charge a fee or distribute a Project
Gutenberg™ electronic work or group of works on different terms
than are set forth in this agreement, you must obtain permission in
writing from the Project Gutenberg Literary Archive Foundation,
the manager of the Project Gutenberg™ trademark. Contact the
Foundation as set forth in Section 3 below.
1.F.
1.F.4. Except for the limited right of replacement or refund set forth
in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR
IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES
OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.
Please check the Project Gutenberg web pages for current donation
methods and addresses. Donations are accepted in a number of
other ways including checks, online payments and credit card
donations. To donate, please visit: www.gutenberg.org/donate.
Most people start at our website which has the main PG search
facility: www.gutenberg.org.