,Chapter 01: Caring for Medical-Surgical Patients
deWit: Medical-Surgical Nursing: Concepts & Practice, 5th 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: mNCLEX: mSafe, mEffective mCare mEnvironment: mCoordinated mCare
6. The mpatient mcomplains mto mthe mnurse mthat mhe mis mconfused mabout mhis
m“deductible” mthat m he m owes m the m hospital. m Which m statement m accurately
m explains m a mdeductible?
a. An mamount mof mmoney mput maside mfor mthe mpayment
mof
future mmedical mbills
b. A mone-time mfee mfor mservice
c. An mamount mof mmoney mdeducted mfrom mthe mbill mby
mthe
insurance mcompany
d. An mannual mamount mof mmoney mthe mpatient mmust mpay
out-of-pocket mfor mmedical mcare
ANS: m D
The mdeductible mis mthe mannual mamount mthe minsured mmust mpay mout-of-pocket mprior
mto mthe m insurance m company m assuming m the m cost. m This m practice m improves m the m profit
m of m the m insurance m company.
PTS: 1 DIF: mCognitive mLevel: mComprehension mREF: 7
mOBJ: 9 TOP: mHealth mCare mFinancing
KEY: mNursing mProcess mStep: mImplementation
MSC: mNCLEX: mSafe, mEffective mCare mEnvironment: mCoordinated mCare
7. The mnurse mcompares mthe mcharacteristics mof ma mhealth mmaintenance
m organization m (HMO) mand ma mpreferred mprovider morganization m(PPO). mWhich
minformation mshould m the m nurse m include m about mHMOs?
a. HMOs mrequire ma mset mfee mof meach
member mmonthly.
b. HMOs mallow mthe mmember mto mselect
mhis
health mcare mprovider.
c. HMOs mpermit madmission mto many
facility mthe mmember mprefers.
d. HMOs moffer munlimited mdiagnostic
mtests
and mtreatments.
, ANS: m A
HMOs mrequire ma mset mfee mfrom meach mmember mmonthly m(capitation). mThe mpatient
mwill m be m treated m by m the m HMO m staff m in mHMO-approved mfacilities. mExcessive
muse m of mdiagnostic m tests m and mtreatments m is m discouraged m by m the mHMO.
PTS: 1 DIF: mCognitive mLevel: mApplication mREF:
m 9 mOBJ: 9 TOP: mManaged mCare
KEY: mNursing mProcess mStep: mImplementation
MSC: mNCLEX: mSafe, mEffective mCare mEnvironment: mCoordinated mCare
8. A mpatient masks mthe mnurse mwhat mMedicare mPart mA mcovers. mWhich
mresponse mis m correct?
a. Medicare mPart mA mcovers minpatient
hospital mcosts.
b. Medicare mPart mA mcovers
reimbursement mto mthe mphysician.
c. Medicare mPart mA mcovers moutpatient
hospital mservices.
d. Medicare mPart mA mcovers
mambulance
transportation.
ANS: m A
Medicare mPart mA mcovers minpatient mhospital mexpenses, mdrugs, mx-rays, mlaboratory
mwork, m and m intensive m care. m Medicare m Part m B m pays m the m physician, m ambulance
m transport, m and m outpatient m services.
PTS: 1 DIF: mCognitive mLevel: mComprehension m REF: 7, mBox m1-
4 mOBJ: 9 TOP:
m Government-Sponsored m Health m Insurance
KEY: mNursing mProcess mStep: mImplementation
MSC: mNCLEX: mSafe, mEffective mCare mEnvironment: mCoordinated mCare
9. Which mis mthe mmain mcost-containment mcomponent mof mdiagnosis-related
mgroups m (DRGs)?
a. Hospitals mfocus monly mon mthe
specific mdiagnosis.
, b. Hospitals mtreat mand mdischarge
patients mquickly.
c. Reduced mcost mdrugs mare mordered
mfor
specific mdiagnoses.
d. Diagnostic mgroup mclassification
streamlines mcare.
ANS: m B
DRGs mare ma mprospective mpayment mplan min mwhich mhospitals mreceive ma mflat mfee mfor
meach m patient’s m diagnostic m category m regardless m of m the m length m of m time m in m the
mhospital. m If mhospitals m can m treat m and m discharge m patients m before m the m allotted
m time, m hospitals m get m to m keep m the m excess m payment; m cost m is m contained, mand m the
mpatient m is m discharged m sooner.
PTS: 1 DIF: mCognitive mLevel: mComprehension mREF: 8
mOBJ: 9 TOP: mGovernment-Sponsored mHealth mInsurance
m KEY: mNursing m Process m Step: m Implementation
MSC: mNCLEX: mSafe, mEffective mCare mEnvironment: mCoordinated mCare
10. The mnurse mis massessing ma mgroup mof mpatients. mWhich mpatient mwould mmost
mlikely m qualify m for m Medicaid?
a. A m35-year-old munemployed msingle mmother mwith mdiabetes
b. A m70-year-old mMedicare mrecipient mwith mretirement mincome mwho
needs mto mbe min ma mlong-term mcare mfacility
c. An m80-year-old mblind mwoman mliving min mher mown mhome mwho mhas
inadequate mprivate minsurance
d. A m67-year-old mstroke mvictim mwith mMedicare mPart mA mand man
mincome
from minvestments
ANS: m A
Medicaid mis ma mjoint meffort mof mfederal mand mstate mgovernments mgeared
mprimarily mfor m low-income m people m with m no m insurance.
PTS: 1 DIF: mCognitive mLevel: mApplication mREF: m 8, mBox m1-5
OBJ: 9 TOP: mGovernment-Sponsored mHealth m Insurance–Medicaid
, KEY: mNursing mProcess mStep: mAssessment
MSC: mNCLEX: mSafe, mEffective mCare mEnvironment: mCoordinated mCare
11. Which marea mis mthe mmajor mfocus mof mHealthy mPeople m2020 mand mthe
mprimary m mechanism mthrough mwhich mto mimprove mthe mhealth mof mAmericans
min mthe msecond m decade m of m the m century?
a. Research mfunding
b. Health minformation
distribution
c. Healthy mlifestyle
encouragement
d. Health improvement
program mdesigns
ANS: m C
Healthy mPeople m2020 mfocuses mon mexpanding mongoing mprograms mto minclude
msupport m and minformation m to m reduce m infant m mortality, m cancer, m cardiovascular
mdisease, m and mHIV/AIDS, m and m to m increase m effective m immunizations, m healthy
m eating m habits, m and m healthy m weight.
PTS: 1 DIF: mCognitive mLevel: mComprehension mREF: 6
mOBJ: 7 TOP: mHealthy mPeople m2020
KEY: mNursing mProcess mStep: mImplementation
MSC: mNCLEX: mSafe, mEffective mCare mEnvironment: mCoordinated mCare
12. Which mterm mexplains mthe mtype mof mcare mthat maddresses minterventions
mfor mall m dimensions m of m a m patient’s mlife?
a. Focused
care
b. General
care
c. Directed
care
d. Holistic
care
, ANS: m D
Holistic mcare maddresses mthemphysiologic, mpsychological, msocial, mcultural, mand
mspiritual m needs m of m the m patient.
PTS: 1 DIF: mCognitive mLevel: mComprehension mREF: 6
mOBJ: 8 TOP: mHolistic mCare
KEY: mNursing mProcess mStep: mPlanning
MSC:mNCLEX:mPsychosocial mIntegrity: mCoping mand mAdaptation
13. A mpatient mfuriously msays, m“My mdoctor mwas mso mbusy mgiving mme minstructions
mthat mhe m didn’t mhear mwhat m I mwas m trying m to m ask mhim!” m Which m response m is
m most m empathetic?
a. “When mpeople mignore mme, mI mreally mget
mad.”
b. “I’m msure mthat mthe mdoctor mwas mrushed mand
unaware mof myour mneeds.”
c. “I’ll mbet mthat mmade myou mfeel mvery
frustrated.”
d. “Take ma mdeep mbreath mand mplan mwhat myou
will msay mto mhim mtomorrow.”
ANS: m C
Empathy mdemonstrates mthat mthe mnurse mperceives mthe mpatient’s mfeelings mbut mdoes
mnot m share m the m emotion. m Belittling mthe m patient’s mfeelings, m showing m sympathy,
m or m defending m the m doctor m makes m the m patient mfeel m devalued.
PTS: 1 DIF: mCognitive mLevel: mAnalysis mREF:
m10 mOBJ: 10 TOP: mNurse–Patient
mRelationship m KEY:Nursing m Process m Step:
m Implementation
MSC: mNCLEX: mPsychosocial m Integrity
14. The mnurse mis mexplaining mdifferences min ma mtherapeutic mrelationship
mand ma m social m relationship m to m a m patient. m Which
, information mabout mtherapeutic mrelationships mis mmost mimportant mfor mthe mnurse mto
m include m in m the m explanation?
a. Therapeutic mrelationships mlack mformal
boundaries.
b. Therapeutic mrelationships maremgoal mdirected.
c. Therapeutic mrelationships mmeet mthe mneeds mof
each mperson min mthe mrelationship.
d. Therapeutic mrelationships m extend mpast mthe
hospitalization mperiod.
ANS: m B
The mtherapeutic mrelationship mis mfocused mon mthe mpatient mand mis mgoal mdirected
mand m designed mto mmeet monly mthe mneeds mof mthe mpatient mand mdoes mnot mextend mpast
mthe mperiod m of mhospitalization.
PTS: 1 DIF: mCognitive mLevel: mComprehension mREF: 9
mOBJ: m 10 TOP: m Therapeutic m Relationship
KEY: mNursing mProcess mStep: mImplementation
m MSC: mNCLEX: m Psychosocial m Integrity
15. The mlong-term mcare mfacility mnurse mis mcaring mfor ma mnewly madmitted m80-year-old
mpatient m who m is m depressed. m Which mapproach m is m best m for m the m nurse m to memploy?
a. Encourage mthe mresident mto
engage min man mactivity.
b. Remind mthe mresident mof
reasons mto mbe mpositive.
c. Point mout mepisodes mof
mnegative
behavior.
d. Present ma mbright mand mcheerful
behavior.
ANS: m A