Chapter 01: Caring for Medical-Surgical Patients
deWit: Medical-Surgical Nursing: Concepts & Practice, 4th Edition
MULTIPLE CHOICE
1. Which statement accurately describes the primary purpose of the state nurse practice act
(NPA)?
a.To test and license LPN/LVNs.
b.To define the scope of LPN/LVN practice.
c.To improve the quality of care provided by the LPN/LVN.
d.To limit the LPN/LVN employment placement.
ANS: B
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
vocational nurse has not been taught during her educational program. How should the
vocational nurse respond?
a. Ask a more experienced nurse to demonstrate the procedure.
b. Look up the procedure in the procedure manual.
c. Attempt to perform the procedure with supervision.
d. Inform the charge nurse of her lack of training in this procedure.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the
vocational nurse should seek further training to gain proficiency. Although the other options
might be helpful, they are not safe.
PTS: 1 DIF: Cognitive Level: Application REF: 3
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
3. Which patient statement indicates a need for further discharge teaching that the vocational
nurse should address?
a. ―I have no idea of how this drug will affect me.‖
b. ―Do you know if my physician is coming back today?‖
c. ―Will my insurance pay for my stay?‖
d. ―Am I going to have to go to a nursing home?‖
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that
should be addressed by the vocational nurse. The other concerns in the options are the
responsibility of other departments to which the nurse might refer the patient.
PTS: 1 DIF: Cognitive Level: Application REF: 2
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
facility acts in which capacity?
a. Working under direct supervision of an RN on the unit
b. Working with the RN in the building
c. Working under general supervision by the RN available on site or by phone
d. Working as an independent vocational nurse
ANS: C
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
the general supervision of an RN available on site or by phone.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
5. The nurse is educating a patient that is a member of a health maintenance organization
(HMO). Which information should the nurse include?
a.Seek the opinion of an alternate health care provider.
b.Obtain insurance approval for medical services prior to treatment.
c.Provide detailed documentation of all care received for his condition.
d.Wait at least 6 months to see a specialist.
ANS: B
Most HMOs require preprocedure authorization for treatment. Patients are not required to
seek a second opinion, provide documentation of care, or wait a specific time period before
visiting a specialist.
PTS: 1 DIF: Cognitive Level: Application REF: 9
OBJ: 9 TOP: Charge Nurse/Manager
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the
hospital. Which statement accurately explains a deductible?
a. An amount of money put aside for the payment of future medical bills
b. A one-time fee for service
c. An amount of money deducted from the bill by the insurance company
d. An annual amount of money the patient must pay out-of-pocket for medical care
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
company assuming the cost. This practice improves the profit of the insurance company.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 7
OBJ: 9 TOP: Health Care Financing
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
,7. The nurse compares the characteristics of a health maintenance organization (HMO) and a
preferred provider organization (PPO). Which information should the nurse include about
HMOs?
a. HMOs require a set fee of each member monthly.
b. HMOs allow the member to select his health care provider.
c. HMOs permit admission to any facility the member prefers.
d. HMOs offer unlimited diagnostic tests and treatments.
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated by
the HMO staff in HMO-approved facilities. Excessive use of diagnostic tests and treatments is
discouraged by the HMO.
PTS: 1 DIF: Cognitive Level: Application REF: 9
OBJ: 9 TOP: Managed Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
8. A patient asks the nurse what Medicare Part A covers. Which response is correct?
a. Medicare Part A covers inpatient hospital costs.
b. Medicare Part A covers reimbursement to the physician.
c. Medicare Part A covers outpatient hospital services.
d. Medicare Part A covers ambulance transportation.
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
services.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 7, Box 1-4
OBJ: 9 TOP: Government-Sponsored Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
9. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
a. Hospitals focus only on the specific diagnosis.
b. Hospitals treat and discharge patients quickly.
c. Reduced cost drugs are ordered for specific diagnoses.
d. Diagnostic group classification streamlines care.
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
contained, and the patient is discharged sooner.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 8
OBJ: 9 TOP: Government-Sponsored Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
, 10. The nurse is assessing a group of patients. Which patient would most likely qualify for
Medicaid?
a. A 35-year-old unemployed single mother with diabetes
b. A 70-year-old Medicare recipient with retirement income who needs to be in a
long-term care facility
c. An 80-year-old blind woman living in her own home who has inadequate private
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-income
people with no insurance.
PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1-5
OBJ: 9 TOP: Government-Sponsored Health Insurance–Medicaid
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
11. Which area is the major focus of Healthy People 2020 and the primary mechanism through
which to improve the health of Americans in the second decade of the century?
a.Research funding
b.Health information distribution
c.Healthy lifestyle encouragement
d.Health improvement program designs
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and
information to reduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and to
increase effective immunizations, healthy eating habits, and healthy weight.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6
OBJ: 7 TOP: Healthy People 2020
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
12. Which term explains the type of care that addresses interventions for all dimensions of a
patient’s life?
a. Focused care
b. General care
c. Directed care
d. Holistic care
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of
the patient.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6
OBJ: 8 TOP: Holistic Care
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
deWit: Medical-Surgical Nursing: Concepts & Practice, 4th Edition
MULTIPLE CHOICE
1. Which statement accurately describes the primary purpose of the state nurse practice act
(NPA)?
a.To test and license LPN/LVNs.
b.To define the scope of LPN/LVN practice.
c.To improve the quality of care provided by the LPN/LVN.
d.To limit the LPN/LVN employment placement.
ANS: B
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
vocational nurse has not been taught during her educational program. How should the
vocational nurse respond?
a. Ask a more experienced nurse to demonstrate the procedure.
b. Look up the procedure in the procedure manual.
c. Attempt to perform the procedure with supervision.
d. Inform the charge nurse of her lack of training in this procedure.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the
vocational nurse should seek further training to gain proficiency. Although the other options
might be helpful, they are not safe.
PTS: 1 DIF: Cognitive Level: Application REF: 3
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
3. Which patient statement indicates a need for further discharge teaching that the vocational
nurse should address?
a. ―I have no idea of how this drug will affect me.‖
b. ―Do you know if my physician is coming back today?‖
c. ―Will my insurance pay for my stay?‖
d. ―Am I going to have to go to a nursing home?‖
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that
should be addressed by the vocational nurse. The other concerns in the options are the
responsibility of other departments to which the nurse might refer the patient.
PTS: 1 DIF: Cognitive Level: Application REF: 2
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
facility acts in which capacity?
a. Working under direct supervision of an RN on the unit
b. Working with the RN in the building
c. Working under general supervision by the RN available on site or by phone
d. Working as an independent vocational nurse
ANS: C
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
the general supervision of an RN available on site or by phone.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
5. The nurse is educating a patient that is a member of a health maintenance organization
(HMO). Which information should the nurse include?
a.Seek the opinion of an alternate health care provider.
b.Obtain insurance approval for medical services prior to treatment.
c.Provide detailed documentation of all care received for his condition.
d.Wait at least 6 months to see a specialist.
ANS: B
Most HMOs require preprocedure authorization for treatment. Patients are not required to
seek a second opinion, provide documentation of care, or wait a specific time period before
visiting a specialist.
PTS: 1 DIF: Cognitive Level: Application REF: 9
OBJ: 9 TOP: Charge Nurse/Manager
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the
hospital. Which statement accurately explains a deductible?
a. An amount of money put aside for the payment of future medical bills
b. A one-time fee for service
c. An amount of money deducted from the bill by the insurance company
d. An annual amount of money the patient must pay out-of-pocket for medical care
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
company assuming the cost. This practice improves the profit of the insurance company.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 7
OBJ: 9 TOP: Health Care Financing
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
,7. The nurse compares the characteristics of a health maintenance organization (HMO) and a
preferred provider organization (PPO). Which information should the nurse include about
HMOs?
a. HMOs require a set fee of each member monthly.
b. HMOs allow the member to select his health care provider.
c. HMOs permit admission to any facility the member prefers.
d. HMOs offer unlimited diagnostic tests and treatments.
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated by
the HMO staff in HMO-approved facilities. Excessive use of diagnostic tests and treatments is
discouraged by the HMO.
PTS: 1 DIF: Cognitive Level: Application REF: 9
OBJ: 9 TOP: Managed Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
8. A patient asks the nurse what Medicare Part A covers. Which response is correct?
a. Medicare Part A covers inpatient hospital costs.
b. Medicare Part A covers reimbursement to the physician.
c. Medicare Part A covers outpatient hospital services.
d. Medicare Part A covers ambulance transportation.
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
services.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 7, Box 1-4
OBJ: 9 TOP: Government-Sponsored Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
9. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
a. Hospitals focus only on the specific diagnosis.
b. Hospitals treat and discharge patients quickly.
c. Reduced cost drugs are ordered for specific diagnoses.
d. Diagnostic group classification streamlines care.
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
contained, and the patient is discharged sooner.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 8
OBJ: 9 TOP: Government-Sponsored Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
, 10. The nurse is assessing a group of patients. Which patient would most likely qualify for
Medicaid?
a. A 35-year-old unemployed single mother with diabetes
b. A 70-year-old Medicare recipient with retirement income who needs to be in a
long-term care facility
c. An 80-year-old blind woman living in her own home who has inadequate private
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-income
people with no insurance.
PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1-5
OBJ: 9 TOP: Government-Sponsored Health Insurance–Medicaid
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
11. Which area is the major focus of Healthy People 2020 and the primary mechanism through
which to improve the health of Americans in the second decade of the century?
a.Research funding
b.Health information distribution
c.Healthy lifestyle encouragement
d.Health improvement program designs
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and
information to reduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and to
increase effective immunizations, healthy eating habits, and healthy weight.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6
OBJ: 7 TOP: Healthy People 2020
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
12. Which term explains the type of care that addresses interventions for all dimensions of a
patient’s life?
a. Focused care
b. General care
c. Directed care
d. Holistic care
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of
the patient.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6
OBJ: 8 TOP: Holistic Care
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
