TEST BANK deWit's Medical-Surgical Nursing, Concepts and Practice, 4th Edition (Stromberg, 2023) Chapters 1 - 49 /// Medical-Surgical Nursing, Concepts and Practice

TEST BANK deWit's Medical-Surgical Nursing, Concepts and Practice, 4th Edition (Stromberg, 2023) Chapters 1 - 49 /// Medical-Surgical Nursing, Concepts and Practice Medical-Surgical Nursing, Concepts and Practice Medical-Surgical Nursing, Concepts and Practice Chapter 01: Caring for Medical-Surgical PatientsMULTIPLE CHOE 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 ANSWER: 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. DIF: Cognitive Level: Comprehension TOP: NPA REF: p. 3 KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care OBJ: 3 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. ANSWER: 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. DIF: Cognitive Level: Application Providing Safe Care REF: p. 3 OBJ: 1 TOP: 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?‖ ANSWER: 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. Medical-Surgical Nursing, Concepts and Practice DIF: Cognitive Level: Application REF: p. 2 TOP: Teaching KEY: Nursing Process Step: Implementation OBJ: 1 Medical-Surgical Nursing, Concepts and Practice 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 ANSWER: 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. DIF: Cognitive Level: Comprehension Charge Nurse/Manager REF: p. 3 OBJ: 1 TOP: 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. Contact the insurance company for coverage details as services may be limited. c. Provide detailed documentation of all care received for his condition. d. Wait at least 6 months to see a specialist. ANSWER: B HMOs are a kind of managed care. This is accomplished by paying providers to care for groups of patients for a set capitation fee and by limiting services. Patients are not required to seek a second opinion, provide documentation of care, or wait a specific time period before visiting a specialist. DIF: Cognitive Level: Application TOP: Charge Nurse/Manager REF: p. 9 OBJ: 9 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 ANSWER: 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. DIF: Cognitive Level: Comprehension TOP: Health Care Financing REF: p. 7 OBJ: 9 KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 7. A patient asks the nurse what Medicare Part A covers. Which response is correct? Medical-Surgical Nursing, Concepts and Practice a. Medicare Part A covers inpatient hospital costs. b. Medicare Part A covers reimbursement to the physician. Medical-Surgical Nursing, Concepts and Practice c. Medicare Part A covers outpatient hospital services. d. Medicare Part A covers ambulance transportation. ANSWER: 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. DIF: Cognitive Level: Comprehension OBJ: 9 REF: p. 8, Box 1-4 TOP: Government-Sponsored Health Insurance KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 8. 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. ANSWER: 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. DIF: Cognitive Level: Comprehension REF: p. 8 TOP: Government-Sponsored Health Insurance KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care OBJ: 9 9. 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 ANSWER: A Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no insurance. DIF: Cognitive Level: Application OBJ: 9 REF: p. 8, Box 1-5 TOP: Government-Sponsored Health Insurance—Medicaid KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 10. 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 Medical-Surgical Nursing, Concepts and Practice b. Health information distribution Medical-Surgical Nursing, Concepts and Practice c. Healthy lifestyle encouragement d. Health improvement program designs ANSWER: 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. DIF: Cognitive Level: Comprehension TOP: Healthy People 2020 REF: p. 6 OBJ: 7 KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care 11. 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 ANSWER: D Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the patient. DIF: Cognitive Level: Comprehension TOP: Holistic Care REF: p. 9 OBJ: 8 KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 12. A patient furiously 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 people ignore me, I really get mad.‖ b. ―I’m sure that the doctor was rushed and unaware of your needs.‖ c. ―That sounds really frustrating.‖ d. ―Take a deep breath and plan what you will say to him tomorrow.‖ ANSWER: C Empathy demonstrates that the nurse perceives the patient’s feelings but does not share the emotion. Belittling the patient’s feelings, showing sympathy, or defending the doctor makes the patient feel devalued. DIF: Cognitive Level: Analysis TOP: Nurse-Patient Relationship MSC: NCLEX: Psychosocial Integrity REF: p. 10 OBJ: 10 KEY: Nursing Process Step: Implementation 13. The nurse is explaining differences in a therapeutic relationship and a social relationship to a patient. Which information about therapeutic relationships is most important for the nurse to include in the explanation? a. Therapeutic relationships lack formal boundaries. b. Therapeutic relationships are goal directed. c. Therapeutic relationships meet the needs of each person in the relationship. d. Therapeutic relationships extend past the hospitalization period. Medical-Surgical Nursing, Concepts and Practice ANSWER: B Medical-Surgical Nursing, Concepts and Practice The therapeutic relationship is focused on the patient and is goal directed and designed to meet only the needs of the patient and does not extend past the period of hospitalization. DIF: Cognitive Level: Comprehension TOP: Therapeutic Relationship MSC: NCLEX: Psychosocial Integrity REF: p. 9 OBJ: 10 KEY: Nursing Process Step: Implementation 14. The nurse is caring for a patient who has been on antidepressants for 3 days. The patient tearfully says, ―I still feel terrible. I don’t think anything can help how I feel.‖ Which response is best? a. ―I will te l the charge nurse how you are feeling.‖ b. ―You just need to be patient and give your medicine some time to work.‖ c. ―Look how much you have improved since you were admitted to the facility.‖ d. ―It must be frustrating to be going through this difficult time.‖ ANSWER: D This response is an empathetic response that allows for further exploration of the patient’s feelings. The other responses will block communication with this patient. DIF: Cognitive Level: Application TOP: Therapeutic Communication MSC: NCLEX: Psychosocial Integrity REF: p. 9 OBJ: 10 KEY: Nursing Process Step: Implementation 15. An overweight male patient rips off his hospital gown, throws it out the door, and shouts, ―I’m not wearing this stupid gown! It is too small, too short, and exposes my backside to the world!‖ 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 larger gown. c. Replace the torn gown with another. d. Inform the charge nurse of the hostile behavior. ANSWER: B Allowing hostile patients to make reasonable requests defuses the anger and allows patients to vent their feelings. DIF: Cognitive Level: Application TOP: Hostile Behavior REF: p. 10 OBJ: 10 KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 16. The nurse is caring for a patient who states, ―You are the only nurse who understands about my pain. Can’t you give me an extra dose of pain medication?‖ How should the nurse respond to the patient’s request? a. Explain that dosage schedules are by physician’s orders. b. Ignore the request. c. Tell the patient that his behavior is manipulative. d. Agree to give an extra dose of pain medication. ANSWER: A A matter-of-fact response to a manipulative request limits the effect of the manipulation, thereby helping the nurse to avoid becoming defensive or being swayed by flattery. Medical-Surgical Nursing, Concepts and Practice