Table of Contents
Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice
Chapter 02: Community-Based Nursing Practice
Chapter 03: Critical Thinking, Ethical Decision Making and the Nursing Process
Chapter 04: Health Education and Promotion
Chapter 05: Adult Health and Nutritional Assessment
Chapter 06: Individual and Family Homeostasis, Stress, and Adaptation
Chapter 07: Overview of Transcultural Nursing
Chapter 08: Overview of Genetics and Genomics in Nursing
Chapter 09: Chronic Illness and Disability
Chapter 10: Principles and Practices of Rehabilitation
Chapter 11: Health Care of the Older Adult
Chapter 12: Pain Management
Chapter 13: Fluid and Electrolytes: Balance and Disturbance
Chapter 14: Shock and Multiple Organ Dysfunction Syndrome
Chapter 15: Management of Patients with Oncologic Disorders
Chapter 16: End-of-Life Care
Chapter 17: Preoperative Nursing Management
Chapter 18: Intraoperative Nursing Management
Chapter 19: Postoperative Nursing Management
Chapter 20: Assessment of Respiratory Function
Chapter 21: Respiratory Care Modalities
Chapter 22: Management of Patients With Upper Respiratory Tract Disorders
Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders
Chapter 24: Management of Patients With Chronic Pulmonary Disease
Chapter 25: Assessment of Cardiovascular Function
Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems
Chapter 27: Management of Patients With Coronary Vascular Disorders
Chapter 28: Management of Patients With Structural, Infectious, and Inflammatory Cardiac
Chapter 29: Management of Patients With Complications from Heart Disease
Chapter 30: Assessment and Management of Patients With Vascular Disorders and
Problems of Peripheral Circulation
Chapter 31: Assessment and Management of Patients With Hypertension
Chapter 32: Assessment of Hematologic Function and Treatment Modalities
Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders
Chapter 34: Management of Patients With Hematologic Neoplasms
Chapter 35: Assessment of Immune Function
Chapter 36: Management of Patients With Immune Deficiency Disorders
Chapter 37: Assessment and Management of Patients With Allergic Disorders
Chapter 38: Assessment and Management of Patients With Rheumatic Disorders
Chapter 39: Assessment of Musculoskeletal Function
Chapter 40: Musculoskeletal Care Modalities
Chapter 41: Management of Patients With Musculoskeletal Disorders
Chapter 42: Management of Patients With Musculoskeletal Trauma
Chapter 43: Assessment of Digestive and Gastrointestinal Function
Chapter 44: Digestive and Gastrointestinal Treatment Modalities
Chapter 45: Management of Patients with Oral and Esophageal Disorders
Chapter 46: Management of Patients with Gastric and Duodenal Disorders
Chapter 47: Management of Patients With Intestinal and Rectal DisordersChapter 48: Assessment and Management of Patients with Obesity
Chapter 49: Assessment and Management of Patients with Hepatic Disorders
Chapter 50: Assessment and Management of Patients with Biliary Disorders
Chapter 51: Assessment and Management of Patients with Diabetes
Chapter 52: Assessment and Management of Patients with Endocrine Disorders
Chapter 53: Assessment of Kidney and Urinary Function
Chapter 54: Management of Patients with Kidney Disorders
Chapter 55: Management of Patients with Urinary Disorders
Chapter 56: Assessment and Management of Patients With Female Physiologic Processes
Chapter 57: Management of Patients with Female Reproductive Disorders
Chapter 58: Assessment and Management of Patients with Breast Disorders
Chapter 59: Assessment and Management of Patients With Male Reproductive Disorders
Chapter 60: Assessment of Integumentary Function
Chapter 61: Managements of Patients with Dermatologic Problems
Chapter 62: Managements of Patients with Burn Injury
Chapter 63: Assessment and Management of Patients with Eye and Vision Disorders
Chapter 64: Assessment and Management of Patients with Hearing and Balance Disorders
Chapter 65: Assessment of Neurologic Function
Chapter 66: Management of Patients with Neurologic Dysfunction
Chapter 67: Management of Patients with Cerebrovascular Disorders
Chapter 68: Management of Patients with Neurologic Trauma
Chapter 69: Management of Patients with Neurologic Infections, Autoimmune Disorders,
Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders
Chapter 71: Management of Patients With Infectious Diseases
Chapter 72: Emergency Nursing
Chapter 73: Terrorism, Mass Casualty, and Disaster Nursing
Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice
1. The public health nurse is presenting a health promotion class to a group of new mothers. How should
the nurse best define health?
A) Health is being disease free.
B) Health is having fulfillment in all domains of life.
C) Health is having psychological and physiological harmony.
D) Health is being connected in body, mind, and spirit.
The World Health Organization (WHO) defines health in the preamble to its constitution as a state of
complete physical, mental, and social well-being and not merely the absence of disease and infirmity.
The other answers are incorrect because they are not congruent with the WHO definition of health.
2. A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What is
one characteristic the nurse would cite as necessary to possess to be an effective nurse?
A) Sensitivity to cultural differences
B) Team-focused approach to problem-solving
C) Strict adherence to routine
D) Ability to face criticism
To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be
culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict
adherence to routine are not characteristics needed to be an effective nurse. The ability to handle
criticism is important, but to a lesser degree than cultural competence.
3. With increases in longevity, people have had to become more knowledgeable about their health and the
professional health care that they receive. One outcome of this phenomenon is the development of
organized self-care education programs. Which of the following do these programs prioritize?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 3
A) Adequate prenatal care
B) Government advocacy and lobbying
C) Judicious use of online communities
D) Management of illness
Organized self-care education programs emphasize health promotion, disease prevention, management
of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and
Internet activities are secondary.
4. The home health nurse is assisting a patient and his family in planning the patients return to work after
surgery and the development of postsurgical complications. The nurse is preparing a plan of care that
addresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does the
patients need for self-fulfillment relate?
C) Love and belonging
Maslows highest level of human needs is self-actualization, which includes self-fulfillment, desire to
know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does
not relate directly to them.
5. The view that health and illness are not static states but that they exist on a continuum is central to
professional health care systems. When planning care, this view aids the nurse in appreciating which of
A) Care should focus primarily on the treatment of disease.
B) A persons state of health is ever-changing.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 4
C) A person can transition from health to illness rapidly.
D) Care should focus on the patients compliance with interventions.
By viewing health and illness on a continuum, it is possible to consider a person as being neither
completely healthy nor completely ill. Instead, a persons state of health is ever-changing and has the
potential to range from high-level wellness to extremely poor health and imminent death. The other
answers are incorrect because patient care should not focus just on the treatment of disease. Rapid
declines in health and compliance with treatment are not key to this view of health.
6. A group of nursing students are participating in a community health clinic. When providing care in this
context, what should the students teach participants about disease prevention?
A) It is best achieved through attending self-help groups.
B) It is best achieved by reducing psychological stress.
C) It is best achieved by being an active participant in the community.
D) It is best achieved by exhibiting behaviors that promote health.
Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen
as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach
that disease prevention is best achieved through attending self-help groups, by reducing stress, or by
being an active participant in the community, though each of these activities is consistent with a healthy
7. A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee.
When describing quality improvement programs to nursing colleagues and members of other health
disciplines, what characteristic should the nurse cite?
A) These programs establish consequences for health care professionals actions.
B) These programs focus on the processes used to provide care.
C) These programs identify specific incidents related to quality.
D) These programs seek to justify health care costs and systems.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 5
Numerous models seek to improve the quality of health care delivery. A commonality among them is a
focus on the processes that are used to provide care. Consequences, a focus on incidents, and
justification for health care costs are not universal characteristics of quality improvement efforts.
8. Nurses in acute care settings must work with other health care team members to maintain quality care
while facing pressures to care for patients who are hospitalized for shorter periods of time than in the
past. To ensure positive health outcomes when patients return to their homes, what action should the
A) Promotion of health literacy during hospitalization
B) Close communication with insurers
C) Thorough and evidence-based discharge planning
D) Participation in continuing education initiatives
Following discharges that occur after increasingly short hospital stays, nurses in the community care for
patients who need high-technology acute care services as well as long-term care in the home. This is
dependent on effective discharge planning to a greater degree than continuing education, communication
with insurers, or promotion of health literacy.
9. You are admitting a patient to your medical unit after the patient has been transferred from the
emergency department. What is your priority nursing action at this time?
A) Identifying the immediate needs of the patient
B) Checking the admitting physicians orders
C) Obtaining a baseline set of vital signs
D) Allowing the family to be with the patient
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Among the nurses important functions in health care delivery, identifying the patients immediate needs
and working in concert with the patient to address them is most important. The other nursing functions
are important, but they are not the most important functions.
10. A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing
assessments and interventions with the aid of a pathway, the nurse should prioritize what goal?
A) Helping the patient to achieve specific outcomes
B) Balancing risks and benefits of interventions
C) Documenting the patients response to therapy
D) Staying accountable to the interdisciplinary team
Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes.
Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient
achieve outcomes is paramount.
11. Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses of
analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice
RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized
patients. How does this demonstrate a role of the APRN?
A) Involving patients in their care while hospitalized
B) Contributing to the scientific basis of nursing practice
C) Critiquing the quality of patient care
D) Explaining medical studies to patients and RNs
Research is within the purview of the APRN. The activity described does not exemplify explaining
studies to RNs, critiquing care, or involving patients in their care.
12. Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of
practice for the nurse in todays health care environment is home health care. What is the main basis for
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 7
the growth in this health care setting?
A) Chronic nursing shortage
B) Western focus on treatment of disease
C) Nurses preferences for day shifts instead of evening or night shifts
D) Discharge of patients who are more critically ill
With shorter hospital stays and increased use of outpatient health care services, more nursing care is
provided in the home and community setting. The other answers are incorrect because they are not the
basis for the growth in nursing care delivered in the home setting.
13. Nurses have different educational backgrounds and function under many titles in their practice setting. If
a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by
influencing the patient, the nurse, and the health care system, what would most accurately describe this
A) Nursing care expert
B) Clinical nurse specialist
C) Nurse manager
D) Staff nurse
Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care
(e.g., cardiovascular, oncology). They define their roles as having five major components: clinical
practice, education, management, consultation, and research. The other answers are incorrect because
they are not the most accurate titles for this nurse.
14. Nursing continues to recognize and participate in collaboration with other health care disciplines to meet
the complex needs of the patient. Which of the following is the best example of a collaborative practice
A) The nurse and the physician jointly making clinical decisions.
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B) The nurse accompanying the physician on rounds.
C) The nurse making a referral on behalf of the patient.
D) The nurse attending an appointment with the patient.
The collaborative model, or a variation of it, promotes shared participation, responsibility, and
accountability in a health care environment that is striving to meet the complex health care needs of the
public. The other answers are incorrect because they are not examples of a collaborative practice model.
15. A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy of
needs, what dimension of care should the nurse consider primary in importance when caring for a dying
Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and
affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know
and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied
to the various nursing models for assessment of a patients strengths, limitations, and need for nursing
interventions. The other answers are incorrect because they are not of primary importance when caring
for a dying patient, though each should certainly be addressed.
16. A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Within
this framework of understanding, what would be the nurses first priority?
A) Allowing the family to see a newly admitted patient
B) Ambulating the patient in the hallway
C) Administering pain medication
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D) Teaching the patient to self-administer insulin safely
In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, such
as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family
addresses a higher level need related to love and belonging. Teaching the patient is also a higher level
need related to the desire to know and understand and is not appropriate at this time, as the basic
physiologic need of pain control must be addressed before the patient can address these higher level
17. A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse
provides care. This nurses compliance with the nurse practice act demonstrates adherence to which of
A) National Council of Nursings guidelines for care
B) National League for Nursings Code of Conduct
American Nurses Associations Social Policy Statement
Department of Health and Human Services White Paper on Nursing
Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply
with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for
Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council
of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included
in the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLN
published a specific code of conduct.
18. Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and the
changing health needs of our aging population. What is one factor that has impacted the need for
certified nurse practitioners (CNPs)?
A) The increased need for primary care providers
B) The need to improve patient diagnostic services
C) The push to drive institutional excellence
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 10
D) The need to decrease the number of medical errors
CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive
additional focused training in primary care or acute care. CNPs help meet the need for primary care
providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent
with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs.
19. A nurse is providing care for a patient who is postoperative day one following a bowel resection for the
treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality
A) By liaising with the members of the interdisciplinary care team
B) By critically appraising the outcomes of care that is provided
C) By integrating the patients preferences into the plan of care
D) By documenting care in the electronic health record in a timely fashion
Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other
listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement
20. Professional nursing expands and grows because of factors driven by the changing needs of health care
consumers. Which of the following is a factor that nurses should reflect in the planning and provision of
A) Decreased access to health care information by individuals
B) Gradual increases in the cultural unity of the American population
C) Increasing mean and median age of the American population
D) Decreasing consumer expectations related to health care outcomes
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The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer
school-age children and more senior citizens, many of whom are women.
The population has become more culturally diverse as increasing numbers of people from different
national backgrounds enter the country. Access to information and consumer expectations continue to
21. A public health nurse has been commissioned to draft a health promotion program that meets the health
care needs and expectations of the community. Which of the following focuses is most likely to
influence the nurses choice of interventions?
A) Management of chronic conditions and disability
B) Increasing need for self-care among a younger population
C) A shifting focus to disease management
D) An increasing focus on acute conditions and rehabilitation
In response to current priorities, health care must focus more on management of chronic conditions and
disability than in previous times. The other answers are incorrect because the change in focus of health
care is not an increasing need for self-care among our aging population; our focus is shifting away from
disease management, not toward it; and we are moving away from the management of acute conditions
to managing chronic conditions.
22. A community health nurse has witnessed significant shifts in patterns of disease over the course of a
four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of
disease in the United States?
A) Type 1 diabetes management
B) Treatment of community-acquired pneumonia
C) Rehabilitation from traumatic brain injuries
D) Management of acute Staphylococcus aureus infections
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 12
Management of chronic diseases such as diabetes is a priority focus of the current health care
environment. This supersedes the treatment of acute infections and rehabilitation needs.
23. The ANA has identified several phenomena toward which the focus of nursing care should be directed,
and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstrates
A) Encouraging the patients dependence on caregivers
B) Fostering the patients ability to make choices
C) Teaching the patient about nurses roles in the health care system
D) Assessing the patients adherence to treatment
The ANA identifies several focuses for nursing care and research, including the ability to make choices.
The other answers are incorrect because they are not phenomena identified by the ANA.
24. The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of
health care. Which of the following activities are considered integral to the CNP role? Select all that
A) Educating patients and family members
B) Coordinating care with other disciplines
C) Using direct provision of interventions
D) Educating registered nurses and practical nurses
E) Coordinating payment plans for patients
Ans: A, B, C
This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in
home care and community nursing. Nurses help patients meet their needs by using direct intervention,
by teaching patients and family members to perform care, and by coordinating and collaborating with
other disciplines to provide needed services. The other answers are incorrect because NPs do not
commonly perform education of nurses and they do not focus on matters related to payment.
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25. The ANA has identified central characteristics of nursing practice that are applicable across the wide
variety of contexts in which nurses practice. A nurse can best demonstrate these principles by
performing which of the following actions?
A) Teaching the public about the role of nursing
B) Taking action to control the costs of health care
C) Ensuring that all of his or her actions exemplify caring
D) Making sure to carry adequate liability insurance
The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA
does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a
central tenet of nursing practice.
26. A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched
within the past decade. In this role, the nurse should prioritize which of the following activities?
A) Acting as a spokesperson for the nursing profession
B) Generating and disseminating new nursing knowledge
C) Diagnosing and treating health problems that have a predictable course
D) Helping patients to navigate the health care system
The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical
leadership, educated to help patients navigate through the complex health care system. The other
answers are incorrect because they are not what nursing has identified as the CNL role.
Chapter 05: Adult Health and Nutritional Assessment
1. A school nurse is teaching a 14-year-old girl of normal weight some of the key factors necessary to
maintain good nutrition in this stage of her growth and development. What interventions should the
nurse most likely prioritize?
A) Decreasing her calorie intake and encouraging her to maintain her weight to avoid obesity
B) Increasing her BMI, taking a multivitamin, and discussing body image
C) Increasing calcium intake, eating a balanced diet, and discussing eating disorders
D) Obtaining a food diary along with providing close monitoring for anorexia
Adolescent girls are considered to be at high risk for nutritional disorders. Increasing calcium intake and
promoting a balanced diet will provide the necessary vitamins and minerals. If adolescents are diagnosed
with eating disorders early, the recovery chances are increased. The question presents no information
that indicates a need for decreasing her calories. There is no apparent need for an increase in BMI. A
food diary is used for assessing eating habits, but the question asks for teaching factors related to good
2. A nurse is conducting a health assessment of an adult patient when the patient asks, Why do you need all
this health information and who is going to see it? What is the nurses best response?
A) Please do not worry. It is safe and will be used only to help us with your care. Its accessible to a
wide variety of people who are invested in your health.
B) It is good you asked and you have a right to know; your information helps us to provide you with
the best possible care, and your records are in a secure place.
C) Your health information is placed on secure Web sites to provide easy access to anyone wishing to
see your medical records. This ensures continuity of care.
D) Health information becomes the property of the hospital and we will make sure that no one sees it.
Then, in 2 years, we destroy all records and the process starts over.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 83
Whenever information is elicited from a person through a health history or physical examination, the
person has the right to know why the information is sought and how it will be used. For this reason, it is
important to explain what the history and physical examination are, how the information will be
obtained, and how it will be used. Medical records allow access to health care providers who need the
information to provide patients with the best possible care, and the records are always held in a secure
environment. Telling the patient not to worry minimizes the patients concern regarding the safety of his
or her health information and a wide variety of people should not have access to patients health
information. Health information should not be placed on Web sites and health records are not destroyed
every 2 years.
3. The nurse is performing an admission assessment of a 72-year-old female patient who understands
minimal English. An interpreter who speaks the patients language is unavailable and no members of the
care team speak the language. How should the nurse best perform data collection?
A) Have a family member provide the data.
B) Obtain the data from the old chart and physicians assessment.
C) Obtain the data only from the patient, prioritizing aspects that the patient understands.
D) Collect all possible data from the patient and have the family supplement missing details.
The informant, or the person providing the information, may not always be the patient. The nurse can
gain information from the patient and have the family provide any missing details. The nurse should
always obtain as much information as possible directly from the patient. In this case, it is not likely
possible to get all the information needed only from the patient.
4. You are the nurse assessing a 28-year-old woman who has presented to the emergency department with
vague complaints of malaise. You note bruising to the patients upper arm that correspond to the outline
of fingers as well as yellow bruising around her left eye. The patient makes minimal eye contact during
the assessment. How might you best inquire about the bruising?
A) Is anyone physically hurting you?
B) Tell me about your relationships.
C) Do you want to see a social worker?
D) Is there something you want to tell me?
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Few patients will discuss the topic of abuse unless they are directly asked. Therefore, it is important to
ask direct questions, such as, Is anyone physically hurting you? The other options are incorrect because
they are not the best way to illicit information about possible abuse in a direct and appropriate manner.
5. You are the nurse performing a health assessment of an adult male patient. The man states, The doctor
has already asked me all these questions. Why are you asking them all over again? What is your best
A) This history helps us determine what your needs may be for nursing care.
B) You are right; this may seem redundant and Im sure that its frustrating for you.
C) I want to make sure your doctor has covered everything thats important for your treatment.
D) I am a member of your health care team and we want to make sure that nothing falls through the
Regardless of the assessment format used, the focus of nurses during data collection is different from
that of physicians and other health team members. Explaining to the patient the purpose of the nursing
assessment creates a better understanding of what the nurse does. It also gives the patient an opportunity
to add his or her own input into the patients care plan. The nurse should address the patients concerns
directly and avoid casting doubt on the thoroughness of the physician.
6. You are taking a health history on an adult patient who is new to the clinic. While performing your
assessment, the patient informs you that her mother has type 1 diabetes. What is the primary significance
of this information to the health history?
A) The patient may be at risk for developing diabetes.
B) The patient may need teaching on the effects of diabetes.
C) The patient may need to attend a support group for individuals with diabetes.
D) The patient may benefit from a dietary regimen that tracks glucose intake.
Nurses incorporate a genetics focus into the health assessments of family history to assess for geneticsrelated
risk factors. The information aids the nurse in determining if the patient may be predisposed to
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 85
diseases that are genetic in origin. The results of diabetes testing would determine whether dietary
changes, support groups or health education would be needed.
7. A registered nurse is performing the admission assessment of a 37-year-old man who will be treated for
pancreatitis on the medical unit. During the nursing assessment, the nurse asks the patient questions
related to his spirituality. What is the primary rationale for this aspect of the nurses assessment?
A) The patients spiritual environment can affect his physical activity.
B) The patients spiritual environment can affect his ability to communicate.
C) The patients spiritual environment can affect his quality of sexual relationships.
D) The patients spiritual environment can affect his response to illness.
Illness may cause a spiritual crisis and can place considerable stresses on a persons internal resources.
The term spiritual environment refers to the degree to which a person has contemplated his or her own
existence. The other listed options may be right, but they are not the most important reasons for a nurse
to assess a patients spiritual environment.
8. A nurse on a medical unit is conducting a spiritual assessment of a patient who is newly admitted. In the
course of this assessment, the patient indicates that she does not eat meat. Which of the following is the
most likely significance of this patients statement?
A) The patient does not understand the principles of nutrition.
B) This is an aspect of the patients religious practice.
C) This constitutes a nursing diagnosis of Risk for Imbalanced Nutrition.
D) This is an example of the patients coping strategies.
Because this datum was obtained during a spiritual assessment, it could be that this is an aspect of the
patients religious practice. It is indeed a personal choice, but this is not the primary significance of the
statement. This practice may not be related to health-seeking if it is in fact a religious practice. This does
not necessarily constitute a risk for malnutrition or a misunderstanding of nutrition.
9. You are beginning your shift on a medical unit and are performing assessments appropriate to each
patients diagnosis and history. When assessing a patient who has an acute staphylococcal infection, what
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 86
is the most effective technique for assessing the lymph nodes of the patients neck?
Palpation is a part of the assessment that allows the nurse to assess a body part through touch. Many
structures of the body (superficial blood vessels, lymph nodes, thyroid gland, organs of the abdomen,
pelvis, and rectum), although not visible, may be assessed through the techniques of light and deep
palpation. The other options are incorrect because lymph nodes are not assessed through inspection,
auscultation, or percussion.
10. In your role as a school nurse, you are working with a female high school junior whose BMI is 31. When
planning this girls care, you should identify what goal?
A) Continuation of current diet and activity level
B) Increase in exercise and reduction in calorie intake
C) Possible referral to an eating disorder clinic
D) Increase in daily calorie intake
A BMI of 31 is considered clinically obese; dietary and exercise modifications would be indicated.
People who have a BMI lower than 24 (or who are 80% or less of their desirable body weight for height)
are at increased risk for problems associated with poor nutritional status. Those who have a BMI of 25 to
29.9 are considered overweight; those with a BMI of 30 or greater are considered to be obese.
11. During your integumentary assessment of an adult female patient, you note that the patient has dry, dull,
brittle hair and dry, flaky skin with poor turgor. When planning this patients nursing care, you should
prioritize interventions that address what problem?
A) Inadequate physical activity
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B) Ineffective personal hygiene
C) Deficient nutritional status
D) Exposure to environmental toxins
Signs of poor nutrition include dry, dull, brittle hair and dry, flaky skin with poor turgor. These findings
do not indicate a lack of physical activity, poor personal hygiene, or damage from an environmental
12. A home care nurse is teaching meal-planning to a patients son who is caring for his mother during her
recovery from hip replacement surgery. Which of the following meals indicates that the son understands
the concept of nutrition, based on the U.S. Department of Agricultures MyPlate?
A) Cheeseburger, carrot sticks, and mushroom soup with whole wheat crackers
B) Spaghetti and meat sauce with garlic bread and a salad
C) Chicken and pepper stir fry on a bed of rice
D) Ham sandwich with tomato on rye bread with peaches and yogurt
This menu has a choice from each of the food groups identified in MyPlate: grains, vegetables, fruits,
dairy, and protein. The other selections are incomplete choices.
13. You are assessing an 80-year-old patient who has presented because of an unintended weight loss of 10
pounds over the past 8 weeks. During the assessment, you learn that the patient has ill-fitting dentures
and a limited intake of high-fiber foods. You would be aware that the patient is at risk for what problem?
B) Deficient fluid volume
C) Malabsorption of nutrients
D) Excessive intake of convenience foods
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 88
Patients with ill-fitting dentures are at a potential risk for an inadequate intake of high-fiber foods. The
elderly are already at an increased risk for constipation because of other developmental factors and the
potential for a decreased activity level. Ill-fitting dentures do not put a patient at risk for dehydration,
malabsorption of nutrients, or a reliance on convenience foods.
14. You are teaching a nutrition education class that is being held for a group of older adults at a senior
center. When planning your teaching, you should be aware that individuals at this point in the lifespan
have which of the following?
A) A decreased need for calcium
B) An increased need for glucose
C) An increased need for sodium
D) A decreased need for calories
The older adult has a decreased metabolism, and absorption of nutrients has decreased. The older adult
has an increased need for sound nutrition but a decreased need for calories. The other options are
incorrect because there is no decreased need for calcium and no increased need for either glucose or
15. You are the emergency department nurse obtaining a health history from a patient who has earlier told
the triage nurse that she is experiencing intermittent abdominal pain. What question should you ask to
elicit the probable reason for the visit and identify her chief complaint?
A) Why do you think your abdomen is painful?
B) Where exactly is your abdominal pain and when did it start?
C) What brings you to the hospital today?
D) What is wrong with you today?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 89
The chief complaint should clearly address what has brought the patient to see the health care provider;
an open-ended question best serves this purpose. The question What brings you to the hospital? allows
the patient sufficient latitude to provide an answer that expresses the priority issue. Focusing solely on
abdominal pain would be too specific to serve as the first question regarding the chief complaint.
Asking, What is wrong with you today? is an open-ended question but still directs the patient toward the
fact that there is a problem.
16. You are the nurse caring for a patient who is Native American who arrives at the clinic for treatment
related to type 2 diabetes. Which question would best provide you with information about the role of
food in the patients cultural practices and identify how the patients food preferences could be related to
A) Do you feel any of your cultural practices have a negative impact on your disease process?
B) What types of foods are served as a part of your cultural practices, and how are they prepared?
C) As a nonnative, I am unaware of your cultural practices. Could you teach me a few practices that
may affect your care?
D) Tell me about foods that are important in your culture and how you feel they influence your
The beliefs and practices that have been shared from generation to generation are known as cultural or
ethnic patterns. Food plays a significant role in both cultural practices and type 2 diabetes. By asking the
question, Tell me about the foods that are important in your culture and how you feel they influence
your diabetes, the nurse demonstrates a cultural awareness to the client and allows an open-ended
discussion of the disease process and its relationship to cultural practice. An overemphasis on negatives
can inhibit assessment and communication. Assessing the types and preparation of foods specific to
cultural practices without relating it to diabetes is inadequate. The question, As a nonnative, I am
unaware of your cultural practices. Could you teach me a few practices that may affect your care?
focuses on care and fails to address the significance of food in cultural practice or diabetes.
17. An 89-year-old male patient is wheelchair bound following a hemorrhagic stroke and has been living in
a nursing home since leaving the hospital. He returns to the adjacent primary care clinic by wheelchair
for follow-up care of hypertension and other health problems. The nurse would modify his health history
to include which question?
A) Tell me about your medications: How do you usually get them each day?
B) Tell me about where you live: Do you feel your needs are being met, and do you feel safe?
C) Your wheelchair would seem to limit your ability to move around. How do you deal with that?
D) What limitations are you dealing with related to your health and being in a wheelchair?
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 90
The question, Tell me about where you live: Do you feel your needs are being met and do you feel safe?
seeks to explore the specific issue of the safety in the home environment. People who are older, have a
disability, and live in the community setting are at a greater risk for abuse. An explicit focus on
limitations may be counterproductive.
18. A 30-year-old man is in the clinic for a yearly physical. He states, I found out that two of my uncles had
heart attacks when they were young. This alerts the nurse to complete a genetic-specific assessment.
What component should the nurse include in this assessment?
A) A complete health history, including genogram along with any history of cholesterol testing or
screening and a complete physical exam
B) A limited health history along with a complete physical assessment with an emphasis on genetic
C) A limited health history and focused physical exam followed by safety-related education
D) A family history focused on the paternal family with focused physical exam and genetic profile
A genetic-specific exam in this case would include a complete health history, genogram, a history of
cholesterol testing or screening, and a complete physical exam. A broad examination is warranted and
safety education is not directly relevant.
19. A patient has a newly diagnosed heart murmur. During the nurses subsequent health education, he asks
if he can listen to it. What would be the nurses best response?
A) Listening to the body is called auscultation. It is done with the diaphragm, and it requires a trained
ear to hear a murmur.
B) Listening is called palpation, and I would be glad to help you to palpate your murmur.
C) Heart murmurs are pathologic and may require surgery. If you would like to listen to your murmur,
I can provide you with instruction.
D) If you would like to listen to your murmur, Id be glad to help you and to show you how to use a
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 91
Listening with a stethoscope is auscultation and it is done with both the bell and diaphragm. The
diaphragm is used to assess high-frequency sounds such as systolic heart murmurs, whereas the bell is
used to assess low-frequency sounds such as diastolic heart murmurs. It is also important to provide
education whenever possible and actively include the patient in the plan of care. Teaching an interested
patient how to listen to a murmur should be encouraged. Many heart murmurs are benign and do not
20. In your role as a school nurse, you are performing a sports physical on a healthy adolescent girl who is
planning to try out for the volleyball team. When it comes time to listen to the students heart and lungs,
what is your best nursing action?
A) Perform auscultation with the stethoscope placed firmly over her clothing to protect her privacy.
B) Perform auscultation by holding the diaphragm lightly on her clothing to eliminate the scratchy
C) Perform auscultation with the diaphragm placed firmly on her skin to minimize extra noise.
D) Defer the exam because the girl is known to be healthy and chest auscultation may cause her
Auscultation should always be performed with the diaphragm placed firmly on the skin to minimize
extra noise and with the bell lightly placed on the skin to reduce distortion caused by vibration. Placing a
stethoscope over clothing limits the conduction of sound. Performing auscultation is an important part of
a sports physical and should never be deferred.
21. A nurse who provides care in a campus medical clinic is performing an assessment of a 21-year-old
student who has presented for care. After assessment, the nurse determines that the patient has a BMI of
45. What does this indicate?
A) The patient is a normal weight.
B) The patient is extremely obese.
C) The patient is overweight.
D) The patient is mildly obese.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 92
Individuals who have a BMI between 25 and 29.9 are considered overweight. Obesity is defined as a
BMI of greater than 30 (WHO, 2011). A BMI of 45 would indicate extreme obesity.
22. A nurse is conducting a home visit as part of the community health assessment of a patient who will
receive scheduled wound care. During assessment, the nurse should prioritize which of the following
A) Availability of home health care, current Medicare rules, and family support
B) The community and home environment, support systems or family care, and the availability of
C) The future health status of the individual, and community and hospital resources
D) The characteristics of the neighborhood, and the patients socioeconomic status and insurance
The community or home environment, support systems or family care, and the availability of needed
resources are the key factors that distinguish community assessment from assessments in the acute-care
setting. The other options fail to address the specifics of either the community or home environment.
23. You are performing the admission assessment of a patient who is being admitted to the postsurgical unit
following knee arthroplasty. The patient states, Youve got more information on me now than my own
family has. How do you manage to keep it all private? What is your best response to this patients
A) Your information is maintained in a secure place and only those health care professionals directly
involved in your care can see it.
B) Your information is available only to people who currently work in patient care here in the
C) Your information is kept electronically on a secure server and anyone who gets permission from
you can see it.
D) Your information is only available to professionals who care for you and representatives of your
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 93
This written record of the patients history and physical examination findings is then maintained in a
secure place and made available only to those health professionals directly involved in the care of the
patient. Only those caring for the patient have access to the health record. Insurance companies have the
right to know the patients coded diagnoses so that bills may be paid; they are not privy to the health
24. You are admitting an elderly woman who is accompanied by her husband. The husband wants to know
where the information you are obtaining is going to be kept and you follow up by describing the system
of electronic health records. The husband states, I sure am not comfortable with that. It is too easy for
someone to break into computer records these days. What is your best response?
A) The Institute of Medicine has called for the implementation of the computerized health record so
all hospitals are doing it.
B) Weve been doing this for several years with good success, so I can assure you that our records are
C) This hospital is as concerned as you are about keeping our patients records private. So we take
special precautions to make sure no one can break into our patients medical records.
D) Your wifes records will be safe, because only people who work in the hospital have the credentials
to access them.
Nurses must be sensitive to the needs of the older adults and others who may not be comfortable with
computer technology. Special precautions are indeed taken. Not every hospital employee has access and
referencing the IOM may not provide reassurance.
25. A family whose religion limits the use of some forms of technology is admitting their grandfather to
your unit. They express skepticism about the fact that you are recording the admission data on a laptop
computer. What would be your best response to their concerns?
A) Its been found that using computers improves our patients care and reduces their health care costs.
B) We have found that it is easier to keep track of our patients information this way rather than with
pen and paper.
C) Youll find that all the hospitals are doing this now, and that writing information with a pen is rare.
D) The government is telling us we have to do this, even though most people, like yourselves, are
opposed to it.
Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 94
Electronic health records are thought to improve the quality of care, reduce medical errors, and help
reduce health care costs; therefore, their implementation is moving forward on a global scale. Electronic
documentation is not always easier and most people are not opposed to it. Stating that all hospitals do
this does not directly address their reluctance or state the benefits. The use of technology in health care
settings is not specifically mandated by legislation.