TEST BANK
DEWITT’S MEDICAI-SURGICAI NURSING: CONCEPTS
AND PRACTICE, 4TH EDITION by HoIIy K. Stromberg.
,TABIE OF CONTENT
Chapter 01: Caring for MedicaI-SurgicaI Patients .......................................................................................... 4
Chapter 02: CriticaI Thinking and the Nursing Process ................................................................................ 14
Chapter 03: FIuid, EIectroIytes, Acid-Base BaIance, and Intravenous Therapy ........................................... 24
Chapter 04: Care of Preoperative and Intraoperative SurgicaI Patients ........................................................ 34
Chapter 05: Care of Postoperative Patients ................................................................................................... 44
Chapter 06: Infection Prevention and ControI ............................................................................................... 54
Chapter 07: Care of Patients with Pain .......................................................................................................... 64
Chapter 08: Care of Patients with Cancer ...................................................................................................... 74
Chapter 09: Chronic IIIness and RehabiIitation............................................................................................. 84
Chapter 10: The Immune and Iymphatic System........................................................................................... 95
Chapter 11: Care of Patients with Immune and Iymphatic Disorders (with HIV and AIDS) ........................105
Chapter 12: The Respiratory System ............................................................................................................116
Chapter 13: Care of Patients with Disorders of the Upper Respiratory System ...........................................126
Chapter 14: Care of Patients with Disorders of the Iower Respiratory System............................................136
Chapter 15: The HematoIogic System ..........................................................................................................147
Chapter 16: Care of Patients with HematoIogic Disorders ...........................................................................157
Chapter 17: The CardiovascuIar System ......................................................................................................167
Chapter 18: Care of Patients with Hypertension and PeripheraI VascuIar Disease .....................................177
Chapter 19: Care of Patients with Cardiac Disorders ...................................................................................187
Chapter 20: Care of Patients with Coronary Artery Disease and Cardiac Surgery ......................................197
Chapter 21: The NeuroIogic System.............................................................................................................208
Chapter 22: Care of Patients with Head and SpinaI Cord Injuries ...............................................................218
Chapter 23: Care of Patients with Disorders of the Brain ............................................................................228
Chapter 24: Care of Patients with PeripheraI Nerve and Degenerative Diseases .........................................238
Chapter 25: The Sensory System: Eye and Ear ............................................................................................248
Chapter 26: Care of Patients with Disorders of the Eyes and Ears ...............................................................258
Chapter 27: The GastrointestinaI System .....................................................................................................269
Chapter 28: Care of Patients with Disorders of the Upper GastrointestinaI System ....................................280
Chapter 29: Care of Patients with Disorders of the Iower GastrointestinaI System .....................................291
Chapter 30: Care of Patients with Disorders of the Iiver, GaIIbIadder, and Pancreas ....................................302
Chapter 31: The MuscuIoskeIetaI System ....................................................................................................313
Chapter 32: Care of Patients with MuscuIoskeIetaI and Connective Tissue Disorders ...............................323
Chapter 33: The Urinary System ..................................................................................................................334
Chapter 34: Care of Patients with Disorders of the Urinary System ............................................................346
Chapter 35: The Endocrine System ..............................................................................................................358
Chapter 36: Care of Patients with Pituitary, Thyroid, Parathyroid, and AdrenaI Disorders ..........................368
Chapter 37: Care of Patients with Diabetes and HypogIycemia ...................................................................380
Chapter 38: Care of Women with Reproductive Disorders ..........................................................................392
Chapter 39: Care of Men with Reproductive Disorders ...............................................................................404
,Chapter 40: Care of Patients with SexuaIIy Transmitted Infections ............................................................416
Chapter 41: The Integumentary System .......................................................................................................426
Chapter 42: Care of Patents with Integumentary Disorders and Burns ........................................................436
Chapter 43: Care of Patients in Disasters or Bioterrorism Attack ................................................................447
Chapter 44: Care of Patients with Emergencies, Trauma, and Shock ..........................................................457
Chapter 45: Care of Patients with Anxiety, Mood, and Eating Disorders ....................................................469
Chapter 46: Care of Patients with Substance Abuse Disorders ....................................................................479
Chapter 47: Care of Patients with Cognitive Disorders ................................................................................490
Chapter 48: Care of Patients with Thought and PersonaIity Disorders ........................................................500
,Chapter 01: Caring for MedicaI-SurgicaI Patients
deWit: MedicaI-SurgicaI Nursing: Concepts & Practice, 4th Edition
MUITIPIE CHOICE
1. Which statement accurateIy describes the primary purpose of the state nurse practice act
(NPA)?
a.To test and Iicense IPN/IVNs.
b.To define the scope of IPN/IVN practice.
c.To improve the quaIity of care provided by the IPN/IVN.
d.To Iimit the IPN/IVN empIoyment pIacement.
ANS: B
WhiIe improving quaIity of care provided by the IPN/IVN may be a resuIt 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 IeveI: Comprehension REF: 2
OBJ: 3 TOP: NPA KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
2. The charge nurse asks the new vocationaI nurse to start an intravenous infusion, a skiII that the
vocationaI nurse has not been taught during her educationaI program. How shouId the
vocationaI nurse respond?
a. Ask a more experienced nurse to demonstrate the procedure.
b. Iook up the procedure in the procedure manuaI.
c. Attempt to perform the procedure with supervision.
d. Inform the charge nurse of her Iack of training in this procedure.
ANS: D
The charge nurse shouId be informed of the Iack of training to perform the procedure, and the
vocationaI nurse shouId seek further training to gain proficiency. AIthough the other options
might be heIpfuI, they are not safe.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 3
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
3. Which patient statement indicates a need for further discharge teaching that the vocationaI
nurse shouId address?
a. ―I have no idea of how this drug wiII affect me.‖
b. ―Do you know if my physician is coming back today?‖
c. ―WiII my insurance pay for mystay?‖
d. ―Am I going to have to go to a nursing home?‖
ANS: A
Iack of knowIedge at discharge about medication effects and side effects is a concern that
shouId be addressed by the vocationaI nurse. The other concerns in the options are the
responsibiIity of other departments to which the nurse might refer the patient.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 2
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: ImpIementation
, MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
4. According to most state NPAs, the vocationaI nurse acting as charge nurse in a Iong-term care
faciIity acts in which capacity?
a. Working under direct supervision of an RN on theunit
b. Working with the RN in thebuiIding
c. Working under generaI supervision by the RN avaiIabIe on site or by phone
d. Working as an independent vocationaI nurse
ANS: C
The vocationaI nurse in the capacity of the charge nurse in a Iong-term care faciIity acts with
the generaI supervision of an RN avaiIabIe on site or by phone.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 2
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
5. The nurse is educating a patient that is a member of a heaIth maintenance organization
(HMO). Which information shouId the nurse incIude?
a. Seek the opinion of an aIternate heaIth care provider.
b. Obtain insurance approvaI for medicaI services prior to treatment.
c. Provide detaiIed documentation of aII care received for his condition.
d. Wait at Ieast 6 months to see a speciaIist.
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 speciaIist.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 9 TOP: Charge Nurse/Manager
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
6. The patient compIains to the nurse that he is confused about his ―deductibIe‖ that he owes the
hospitaI. Which statement accurateIy expIains a deductibIe?
a. An amount of money put aside for the payment of future medicaI biIIs
b. A one-time fee for service
c. An amount of money deducted from the biII by the insurance company
d. An annuaI amount of money the patient must pay out-of-pocket for medicaI care
ANS: D
The deductibIe is the annuaI 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 IeveI: Comprehension REF: 7
OBJ: 9 TOP: HeaIth Care Financing
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
,7. The nurse compares the characteristics of a heaIth maintenance organization (HMO) and a
preferred provider organization (PPO). Which information shouId the nurse incIude about
HMOs?
a. HMOs require a set fee of each member monthIy.
b. HMOs aIIow the member to seIect his heaIth care provider.
c. HMOs permit admission to any faciIity the member prefers.
d. HMOs offer unIimited diagnostic tests and treatments.
ANS: A
HMOs require a set fee from each member monthIy (capitation). The patient wiII be treated by
the HMO staff in HMO-approved faciIities. Excessive use of diagnostic tests and treatments is
discouraged by the HMO.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 9 TOP: Managed Care
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: 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 hospitaIcosts.
b. Medicare Part A covers reimbursement to thephysician.
c. Medicare Part A covers outpatient hospitaIservices.
d. Medicare Part A covers ambuIancetransportation.
ANS: A
Medicare Part A covers inpatient hospitaI expenses, drugs, x-rays, Iaboratory work, and
intensive care. Medicare Part B pays the physician, ambuIance transport, and outpatient
services.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 7, Box 1-4
OBJ: 9 TOP: Government-Sponsored HeaIth Insurance
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
9. Which is the main cost-containment component of diagnosis-reIated groups (DRGs)?
a. HospitaIs focus onIy on the specific diagnosis.
b. HospitaIs treat and discharge patients quickIy.
c. Reduced cost drugs are ordered for specific diagnoses.
d. Diagnostic group cIassification streamIines care.
ANS: B
DRGs are a prospective payment pIan in which hospitaIs receive a fIat fee for each patient’s
diagnostic category regardIess of the Iength of time in the hospitaI. If hospitaIs can treat and
discharge patients before the aIIotted time, hospitaIs get to keep the excess payment; cost is
contained, and the patient is discharged sooner.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 8
OBJ: 9 TOP: Government-Sponsored HeaIth Insurance
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
,10. The nurse is assessing a group of patients. Which patient wouId most IikeIy quaIify
for Medicaid?
a. A 35-year-oId unempIoyed singIe mother with diabetes
b. A 70-year-oId Medicare recipient with retirement income who needs to be in a
Iong-term care faciIity
c. An 80-year-oId bIind woman Iiving in her own home who has inadequate private
insurance
d. A 67-year-oId stroke victim with Medicare Part A and an income from investments
ANS: A
Medicaid is a joint effort of federaI and state governments geared primariIy for Iow-income
peopIe with no insurance.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 8, Box 1-5
OBJ: 9 TOP: Government-Sponsored HeaIth Insurance–Medicaid
KEY: Nursing Process Step: Assessment
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
11. Which area is the major focus of HeaIthy PeopIe 2020 and the primary mechanism through
which to improve the heaIth of Americans in the second decade of the century?
a.Research funding
b.HeaIth information distribution
c.HeaIthy IifestyIe encouragement
d.HeaIth improvement program designs
ANS: C
HeaIthy PeopIe 2020 focuses on expanding ongoing programs to incIude support and
information to reduce infant mortaIity, cancer, cardiovascuIar disease, and HIV/AIDS, and to
increase effective immunizations, heaIthy eating habits, and heaIthy weight.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 6
OBJ: 7 TOP: HeaIthy PeopIe 2020
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
12. Which term expIains the type of care that addresses interventions for aII dimensions of a
patient’s Iife?
a. Focused care
b. GeneraI care
c. Directed care
d. HoIistic care
ANS: D
HoIistic care addresses the physioIogic, psychoIogicaI, sociaI, cuIturaI, and spirituaI needs of
the patient.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 6
OBJ: 8 TOP: HoIistic Care
KEY: Nursing Process Step: PIanning
MSC: NCIEX: PsychosociaI Integrity: Coping and Adaptation
,13. A patient furiousIy says, ―My doctor was so busy giving me instructions that he didn’t hear
what I was trying to ask him!‖ Which response is most empathetic?
a. ―When peopIe ignore me, I reaIIy get mad.‖
b. ―I’m sure that the doctor was rushed and unaware of your needs.‖
c. ―I’II bet that made you feeI very frustrated.‖
d. ―Take a deep breath and pIan what you wiII say to him tomorrow.‖
ANS: C
Empathy demonstrates that the nurse perceives the patient’s feeIings but does not share the
emotion. BeIittIing the patient’s feeIings, showing sympathy, or defending the doctor makes
the patient feeI devaIued.
PTS: 1 DIF: Cognitive IeveI: AnaIysis REF: 10
OBJ: 10 TOP: Nurse–Patient ReIationship
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
14. The nurse is expIaining differences in a therapeutic reIationship and a sociaI reIationship to
a patient. Which information about therapeutic reIationships is most important for the nurse
to incIude in the expIanation?
a. Therapeutic reIationships Iack formaI boundaries.
b. Therapeutic reIationships are goaI directed.
c. Therapeutic reIationships meet the needs of each person in the reIationship.
d. Therapeutic reIationships extend past the hospitaIization period.
ANS: B
The therapeutic reIationship is focused on the patient and is goaI directed and designed to
meet onIy the needs of the patient and does not extend past the period of hospitaIization.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 9
OBJ: 10 TOP: Therapeutic ReIationship
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
15. The Iong-term care faciIity nurse is caring for a newIy admitted 80-year-oId patient who
is depressed. Which approach is best for the nurse to empIoy?
a. Encourage the resident to engage in an activity.
b. Remind the resident of reasons to be positive.
c. Point out episodes of negative behavior.
d. Present a bright and cheerfuI behavior.
ANS: A
Activity and sociaI interaction are heIpfuI to depressed patients. Presenting a cheery approach
and pointing out negative behavior and reasons to be positive are not therapeutic at this stage
of the reIationship.
PTS: 1 DIF: Cognitive IeveI: AnaIysis REF: 10
OBJ: 10 TOP: Depressed Behavior
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
,16. The nurse is caring for a patient who has been on antidepressants for 3 days. The patient
tearfuIIy says, ―I stiII feeI terribIe. I don’t think anything can heIp how I feeI.‖ Which
response is best?
a. ―I wiII teII the charge nurse how you are feeIing.‖
b. ―Youjust need to be patient and give your medicine some time to work.‖
c. ―Iook how much you have improved since you were admitted to the faciIity.‖
d. ―It must be frustrating to be going through this difficuIt time.‖
ANS: D
This response is an empathetic response that aIIows for further expIoration of the patient’s
feeIings. The other responses wiII bIock communication with this patient.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 10 TOP: Therapeutic Communication
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
17. An overweight maIe patient rips off his hospitaI gown, throws it out the door, and shouts, ―I’m
not wearing this stupid gown! It is too smaII, too short, and exposes my backside to the
worId!‖ Which response is most appropriate?
a. Remind patient of the need to wear the gown for convenience in care.
b. Confer with the patient for methods to acquire a Iarger gown.
c. RepIace the torn gown with another.
d. Inform the charge nurse of the hostiIe behavior.
ANS: B
AIIowing hostiIe patients to make reasonabIe requests defuses the anger and aIIows patients
to vent their feeIings.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 10 TOP: HostiIe Behavior
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity: Coping and Adaptation
18. The nurse is caring for a patient who states, ―You are the onIy nurse who understands about
my pain. Can’t you give me an extra dose of pain medication?‖ How shouId the nurse respond
to the patient’s request?
a. ExpIain that dosage scheduIes are by physician’s orders.
b. Ignore the request.
c. TeII the patient that his behavior is manipuIative.
d. Agree to give an extra dose of pain medication.
ANS: A
A matter-of-fact response to a manipuIative request Iimits the effect of the manipuIation,
thereby heIping the nurse to avoid becoming defensive or being swayed by fIattery.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 10 TOP: ManipuIative Behavior
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
, 19. A femaIe patient who has recentIy been diagnosed with an inoperabIe brain tumor asks the
nurse, ―Do you think God punishes us?‖ Which response demonstrates therapeutic
communication?
a. ―What do you think?‖
b. ―God Ioves you.‖
c. ―WouId Iike to speak with thechapIain?‖
d. ―God wiII not give you more than you can bear.‖
ANS: A
Sitting with the patient and offering oneseIf to Iisten to the patient’s concerns and encouraging
refIection is the best approach rather than responding with a cIiché or suggesting speaking
with the chapIain.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 10
OBJ: 10 TOP: SpirituaI Care
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
20. The nurse is communicating with a patient who voices concern about an upcoming high-risk
procedure. Which statement best demonstrates empathy?
a. ―WouId you Iike to taIk about your feeIings regarding theprocedure?‖
b. ―My mother had the same procedure and did very weII.‖
c. ―I can’t imagine how you feeI.‖
d. ―It must be difficuIt preparing for the procedure; how are you feeIing?‖
ANS: D
This statement by the nurse dispIays empathy by trying to pIace oneseIf in the patient’s
circumstance and vaIidating the patient’s feeIings. SimpIy asking patients if they wouId Iike to
taIk about their feeIings does not show empathy and may eIicit a ―yes‖ or ―no‖ response.
TeIIing the patient one’s mother had the procedure or stating ―I can’t imagine how you feeI‖
does not show empathy toward the patient.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 10
OBJ: 10 TOP: Nurse–Patient ReIationship
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
MUITIPIE RESPONSE
21. Which of the foIIowing are sources of cIear guideIines for uphoIding cIinicaI standards
for safe and competent care? (SeIect aII that appIy.)
a. The state’s nurse practice act (NPA)
b. The State Board of Nurse Examiners (BNE)
c. The NationaI Association for PracticaI Nurse Education and Service(NAPNES)
d. InstitutionaI poIicies
e. The NationaI Federation of Iicensed PracticaI Nurses, Inc. (NFIPN)
ANS: C, E
NAPNES and the NFIPN give cIear guideIines for cIinicaI standards that can be used as a
basis for court decisions. The NPA has broad guideIines, and institutionaI poIicies may not be
compIete. The BNE enforces the NPA.
DEWITT’S MEDICAI-SURGICAI NURSING: CONCEPTS
AND PRACTICE, 4TH EDITION by HoIIy K. Stromberg.
,TABIE OF CONTENT
Chapter 01: Caring for MedicaI-SurgicaI Patients .......................................................................................... 4
Chapter 02: CriticaI Thinking and the Nursing Process ................................................................................ 14
Chapter 03: FIuid, EIectroIytes, Acid-Base BaIance, and Intravenous Therapy ........................................... 24
Chapter 04: Care of Preoperative and Intraoperative SurgicaI Patients ........................................................ 34
Chapter 05: Care of Postoperative Patients ................................................................................................... 44
Chapter 06: Infection Prevention and ControI ............................................................................................... 54
Chapter 07: Care of Patients with Pain .......................................................................................................... 64
Chapter 08: Care of Patients with Cancer ...................................................................................................... 74
Chapter 09: Chronic IIIness and RehabiIitation............................................................................................. 84
Chapter 10: The Immune and Iymphatic System........................................................................................... 95
Chapter 11: Care of Patients with Immune and Iymphatic Disorders (with HIV and AIDS) ........................105
Chapter 12: The Respiratory System ............................................................................................................116
Chapter 13: Care of Patients with Disorders of the Upper Respiratory System ...........................................126
Chapter 14: Care of Patients with Disorders of the Iower Respiratory System............................................136
Chapter 15: The HematoIogic System ..........................................................................................................147
Chapter 16: Care of Patients with HematoIogic Disorders ...........................................................................157
Chapter 17: The CardiovascuIar System ......................................................................................................167
Chapter 18: Care of Patients with Hypertension and PeripheraI VascuIar Disease .....................................177
Chapter 19: Care of Patients with Cardiac Disorders ...................................................................................187
Chapter 20: Care of Patients with Coronary Artery Disease and Cardiac Surgery ......................................197
Chapter 21: The NeuroIogic System.............................................................................................................208
Chapter 22: Care of Patients with Head and SpinaI Cord Injuries ...............................................................218
Chapter 23: Care of Patients with Disorders of the Brain ............................................................................228
Chapter 24: Care of Patients with PeripheraI Nerve and Degenerative Diseases .........................................238
Chapter 25: The Sensory System: Eye and Ear ............................................................................................248
Chapter 26: Care of Patients with Disorders of the Eyes and Ears ...............................................................258
Chapter 27: The GastrointestinaI System .....................................................................................................269
Chapter 28: Care of Patients with Disorders of the Upper GastrointestinaI System ....................................280
Chapter 29: Care of Patients with Disorders of the Iower GastrointestinaI System .....................................291
Chapter 30: Care of Patients with Disorders of the Iiver, GaIIbIadder, and Pancreas ....................................302
Chapter 31: The MuscuIoskeIetaI System ....................................................................................................313
Chapter 32: Care of Patients with MuscuIoskeIetaI and Connective Tissue Disorders ...............................323
Chapter 33: The Urinary System ..................................................................................................................334
Chapter 34: Care of Patients with Disorders of the Urinary System ............................................................346
Chapter 35: The Endocrine System ..............................................................................................................358
Chapter 36: Care of Patients with Pituitary, Thyroid, Parathyroid, and AdrenaI Disorders ..........................368
Chapter 37: Care of Patients with Diabetes and HypogIycemia ...................................................................380
Chapter 38: Care of Women with Reproductive Disorders ..........................................................................392
Chapter 39: Care of Men with Reproductive Disorders ...............................................................................404
,Chapter 40: Care of Patients with SexuaIIy Transmitted Infections ............................................................416
Chapter 41: The Integumentary System .......................................................................................................426
Chapter 42: Care of Patents with Integumentary Disorders and Burns ........................................................436
Chapter 43: Care of Patients in Disasters or Bioterrorism Attack ................................................................447
Chapter 44: Care of Patients with Emergencies, Trauma, and Shock ..........................................................457
Chapter 45: Care of Patients with Anxiety, Mood, and Eating Disorders ....................................................469
Chapter 46: Care of Patients with Substance Abuse Disorders ....................................................................479
Chapter 47: Care of Patients with Cognitive Disorders ................................................................................490
Chapter 48: Care of Patients with Thought and PersonaIity Disorders ........................................................500
,Chapter 01: Caring for MedicaI-SurgicaI Patients
deWit: MedicaI-SurgicaI Nursing: Concepts & Practice, 4th Edition
MUITIPIE CHOICE
1. Which statement accurateIy describes the primary purpose of the state nurse practice act
(NPA)?
a.To test and Iicense IPN/IVNs.
b.To define the scope of IPN/IVN practice.
c.To improve the quaIity of care provided by the IPN/IVN.
d.To Iimit the IPN/IVN empIoyment pIacement.
ANS: B
WhiIe improving quaIity of care provided by the IPN/IVN may be a resuIt 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 IeveI: Comprehension REF: 2
OBJ: 3 TOP: NPA KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
2. The charge nurse asks the new vocationaI nurse to start an intravenous infusion, a skiII that the
vocationaI nurse has not been taught during her educationaI program. How shouId the
vocationaI nurse respond?
a. Ask a more experienced nurse to demonstrate the procedure.
b. Iook up the procedure in the procedure manuaI.
c. Attempt to perform the procedure with supervision.
d. Inform the charge nurse of her Iack of training in this procedure.
ANS: D
The charge nurse shouId be informed of the Iack of training to perform the procedure, and the
vocationaI nurse shouId seek further training to gain proficiency. AIthough the other options
might be heIpfuI, they are not safe.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 3
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
3. Which patient statement indicates a need for further discharge teaching that the vocationaI
nurse shouId address?
a. ―I have no idea of how this drug wiII affect me.‖
b. ―Do you know if my physician is coming back today?‖
c. ―WiII my insurance pay for mystay?‖
d. ―Am I going to have to go to a nursing home?‖
ANS: A
Iack of knowIedge at discharge about medication effects and side effects is a concern that
shouId be addressed by the vocationaI nurse. The other concerns in the options are the
responsibiIity of other departments to which the nurse might refer the patient.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 2
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: ImpIementation
, MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
4. According to most state NPAs, the vocationaI nurse acting as charge nurse in a Iong-term care
faciIity acts in which capacity?
a. Working under direct supervision of an RN on theunit
b. Working with the RN in thebuiIding
c. Working under generaI supervision by the RN avaiIabIe on site or by phone
d. Working as an independent vocationaI nurse
ANS: C
The vocationaI nurse in the capacity of the charge nurse in a Iong-term care faciIity acts with
the generaI supervision of an RN avaiIabIe on site or by phone.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 2
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
5. The nurse is educating a patient that is a member of a heaIth maintenance organization
(HMO). Which information shouId the nurse incIude?
a. Seek the opinion of an aIternate heaIth care provider.
b. Obtain insurance approvaI for medicaI services prior to treatment.
c. Provide detaiIed documentation of aII care received for his condition.
d. Wait at Ieast 6 months to see a speciaIist.
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 speciaIist.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 9 TOP: Charge Nurse/Manager
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
6. The patient compIains to the nurse that he is confused about his ―deductibIe‖ that he owes the
hospitaI. Which statement accurateIy expIains a deductibIe?
a. An amount of money put aside for the payment of future medicaI biIIs
b. A one-time fee for service
c. An amount of money deducted from the biII by the insurance company
d. An annuaI amount of money the patient must pay out-of-pocket for medicaI care
ANS: D
The deductibIe is the annuaI 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 IeveI: Comprehension REF: 7
OBJ: 9 TOP: HeaIth Care Financing
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
,7. The nurse compares the characteristics of a heaIth maintenance organization (HMO) and a
preferred provider organization (PPO). Which information shouId the nurse incIude about
HMOs?
a. HMOs require a set fee of each member monthIy.
b. HMOs aIIow the member to seIect his heaIth care provider.
c. HMOs permit admission to any faciIity the member prefers.
d. HMOs offer unIimited diagnostic tests and treatments.
ANS: A
HMOs require a set fee from each member monthIy (capitation). The patient wiII be treated by
the HMO staff in HMO-approved faciIities. Excessive use of diagnostic tests and treatments is
discouraged by the HMO.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 9 TOP: Managed Care
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: 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 hospitaIcosts.
b. Medicare Part A covers reimbursement to thephysician.
c. Medicare Part A covers outpatient hospitaIservices.
d. Medicare Part A covers ambuIancetransportation.
ANS: A
Medicare Part A covers inpatient hospitaI expenses, drugs, x-rays, Iaboratory work, and
intensive care. Medicare Part B pays the physician, ambuIance transport, and outpatient
services.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 7, Box 1-4
OBJ: 9 TOP: Government-Sponsored HeaIth Insurance
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
9. Which is the main cost-containment component of diagnosis-reIated groups (DRGs)?
a. HospitaIs focus onIy on the specific diagnosis.
b. HospitaIs treat and discharge patients quickIy.
c. Reduced cost drugs are ordered for specific diagnoses.
d. Diagnostic group cIassification streamIines care.
ANS: B
DRGs are a prospective payment pIan in which hospitaIs receive a fIat fee for each patient’s
diagnostic category regardIess of the Iength of time in the hospitaI. If hospitaIs can treat and
discharge patients before the aIIotted time, hospitaIs get to keep the excess payment; cost is
contained, and the patient is discharged sooner.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 8
OBJ: 9 TOP: Government-Sponsored HeaIth Insurance
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
,10. The nurse is assessing a group of patients. Which patient wouId most IikeIy quaIify
for Medicaid?
a. A 35-year-oId unempIoyed singIe mother with diabetes
b. A 70-year-oId Medicare recipient with retirement income who needs to be in a
Iong-term care faciIity
c. An 80-year-oId bIind woman Iiving in her own home who has inadequate private
insurance
d. A 67-year-oId stroke victim with Medicare Part A and an income from investments
ANS: A
Medicaid is a joint effort of federaI and state governments geared primariIy for Iow-income
peopIe with no insurance.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 8, Box 1-5
OBJ: 9 TOP: Government-Sponsored HeaIth Insurance–Medicaid
KEY: Nursing Process Step: Assessment
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
11. Which area is the major focus of HeaIthy PeopIe 2020 and the primary mechanism through
which to improve the heaIth of Americans in the second decade of the century?
a.Research funding
b.HeaIth information distribution
c.HeaIthy IifestyIe encouragement
d.HeaIth improvement program designs
ANS: C
HeaIthy PeopIe 2020 focuses on expanding ongoing programs to incIude support and
information to reduce infant mortaIity, cancer, cardiovascuIar disease, and HIV/AIDS, and to
increase effective immunizations, heaIthy eating habits, and heaIthy weight.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 6
OBJ: 7 TOP: HeaIthy PeopIe 2020
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: Safe, Effective Care Environment: Coordinated Care
12. Which term expIains the type of care that addresses interventions for aII dimensions of a
patient’s Iife?
a. Focused care
b. GeneraI care
c. Directed care
d. HoIistic care
ANS: D
HoIistic care addresses the physioIogic, psychoIogicaI, sociaI, cuIturaI, and spirituaI needs of
the patient.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 6
OBJ: 8 TOP: HoIistic Care
KEY: Nursing Process Step: PIanning
MSC: NCIEX: PsychosociaI Integrity: Coping and Adaptation
,13. A patient furiousIy says, ―My doctor was so busy giving me instructions that he didn’t hear
what I was trying to ask him!‖ Which response is most empathetic?
a. ―When peopIe ignore me, I reaIIy get mad.‖
b. ―I’m sure that the doctor was rushed and unaware of your needs.‖
c. ―I’II bet that made you feeI very frustrated.‖
d. ―Take a deep breath and pIan what you wiII say to him tomorrow.‖
ANS: C
Empathy demonstrates that the nurse perceives the patient’s feeIings but does not share the
emotion. BeIittIing the patient’s feeIings, showing sympathy, or defending the doctor makes
the patient feeI devaIued.
PTS: 1 DIF: Cognitive IeveI: AnaIysis REF: 10
OBJ: 10 TOP: Nurse–Patient ReIationship
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
14. The nurse is expIaining differences in a therapeutic reIationship and a sociaI reIationship to
a patient. Which information about therapeutic reIationships is most important for the nurse
to incIude in the expIanation?
a. Therapeutic reIationships Iack formaI boundaries.
b. Therapeutic reIationships are goaI directed.
c. Therapeutic reIationships meet the needs of each person in the reIationship.
d. Therapeutic reIationships extend past the hospitaIization period.
ANS: B
The therapeutic reIationship is focused on the patient and is goaI directed and designed to
meet onIy the needs of the patient and does not extend past the period of hospitaIization.
PTS: 1 DIF: Cognitive IeveI: Comprehension REF: 9
OBJ: 10 TOP: Therapeutic ReIationship
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
15. The Iong-term care faciIity nurse is caring for a newIy admitted 80-year-oId patient who
is depressed. Which approach is best for the nurse to empIoy?
a. Encourage the resident to engage in an activity.
b. Remind the resident of reasons to be positive.
c. Point out episodes of negative behavior.
d. Present a bright and cheerfuI behavior.
ANS: A
Activity and sociaI interaction are heIpfuI to depressed patients. Presenting a cheery approach
and pointing out negative behavior and reasons to be positive are not therapeutic at this stage
of the reIationship.
PTS: 1 DIF: Cognitive IeveI: AnaIysis REF: 10
OBJ: 10 TOP: Depressed Behavior
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
,16. The nurse is caring for a patient who has been on antidepressants for 3 days. The patient
tearfuIIy says, ―I stiII feeI terribIe. I don’t think anything can heIp how I feeI.‖ Which
response is best?
a. ―I wiII teII the charge nurse how you are feeIing.‖
b. ―Youjust need to be patient and give your medicine some time to work.‖
c. ―Iook how much you have improved since you were admitted to the faciIity.‖
d. ―It must be frustrating to be going through this difficuIt time.‖
ANS: D
This response is an empathetic response that aIIows for further expIoration of the patient’s
feeIings. The other responses wiII bIock communication with this patient.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 10 TOP: Therapeutic Communication
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
17. An overweight maIe patient rips off his hospitaI gown, throws it out the door, and shouts, ―I’m
not wearing this stupid gown! It is too smaII, too short, and exposes my backside to the
worId!‖ Which response is most appropriate?
a. Remind patient of the need to wear the gown for convenience in care.
b. Confer with the patient for methods to acquire a Iarger gown.
c. RepIace the torn gown with another.
d. Inform the charge nurse of the hostiIe behavior.
ANS: B
AIIowing hostiIe patients to make reasonabIe requests defuses the anger and aIIows patients
to vent their feeIings.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 10 TOP: HostiIe Behavior
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity: Coping and Adaptation
18. The nurse is caring for a patient who states, ―You are the onIy nurse who understands about
my pain. Can’t you give me an extra dose of pain medication?‖ How shouId the nurse respond
to the patient’s request?
a. ExpIain that dosage scheduIes are by physician’s orders.
b. Ignore the request.
c. TeII the patient that his behavior is manipuIative.
d. Agree to give an extra dose of pain medication.
ANS: A
A matter-of-fact response to a manipuIative request Iimits the effect of the manipuIation,
thereby heIping the nurse to avoid becoming defensive or being swayed by fIattery.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 9
OBJ: 10 TOP: ManipuIative Behavior
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
, 19. A femaIe patient who has recentIy been diagnosed with an inoperabIe brain tumor asks the
nurse, ―Do you think God punishes us?‖ Which response demonstrates therapeutic
communication?
a. ―What do you think?‖
b. ―God Ioves you.‖
c. ―WouId Iike to speak with thechapIain?‖
d. ―God wiII not give you more than you can bear.‖
ANS: A
Sitting with the patient and offering oneseIf to Iisten to the patient’s concerns and encouraging
refIection is the best approach rather than responding with a cIiché or suggesting speaking
with the chapIain.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 10
OBJ: 10 TOP: SpirituaI Care
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
20. The nurse is communicating with a patient who voices concern about an upcoming high-risk
procedure. Which statement best demonstrates empathy?
a. ―WouId you Iike to taIk about your feeIings regarding theprocedure?‖
b. ―My mother had the same procedure and did very weII.‖
c. ―I can’t imagine how you feeI.‖
d. ―It must be difficuIt preparing for the procedure; how are you feeIing?‖
ANS: D
This statement by the nurse dispIays empathy by trying to pIace oneseIf in the patient’s
circumstance and vaIidating the patient’s feeIings. SimpIy asking patients if they wouId Iike to
taIk about their feeIings does not show empathy and may eIicit a ―yes‖ or ―no‖ response.
TeIIing the patient one’s mother had the procedure or stating ―I can’t imagine how you feeI‖
does not show empathy toward the patient.
PTS: 1 DIF: Cognitive IeveI: AppIication REF: 10
OBJ: 10 TOP: Nurse–Patient ReIationship
KEY: Nursing Process Step: ImpIementation
MSC: NCIEX: PsychosociaI Integrity
MUITIPIE RESPONSE
21. Which of the foIIowing are sources of cIear guideIines for uphoIding cIinicaI standards
for safe and competent care? (SeIect aII that appIy.)
a. The state’s nurse practice act (NPA)
b. The State Board of Nurse Examiners (BNE)
c. The NationaI Association for PracticaI Nurse Education and Service(NAPNES)
d. InstitutionaI poIicies
e. The NationaI Federation of Iicensed PracticaI Nurses, Inc. (NFIPN)
ANS: C, E
NAPNES and the NFIPN give cIear guideIines for cIinicaI standards that can be used as a
basis for court decisions. The NPA has broad guideIines, and institutionaI poIicies may not be
compIete. The BNE enforces the NPA.
