Test Bank for Medical-Surgical Nursing: Concepts & Practice 3rd Edition by Susan C. deWit, Holly K. Stromberg & Carol Dallred

TEST BANK : MEDICAL SURGICAL NURSING: CONCEPTS & PRACTICE 3RD EDITION BY deWit (CHAPTER 1-48)Chapter 01: Caring for Medical-Surgical Patients Chapter 02: Critical Thinking and the Nursing Process Chapter 03: Fluid, Electrolytes, Acid-Base Balance, and Intravenous Therapy Chapter 04: Care of Preoperative and Intraoperative Surgical Patients Chapter 05: Care of Postoperative Patients Chapter 06: Infection Prevention and Control Chapter 07: Care of Patients with Pain Chapter 08: Care of Patients with Cancer Chapter 09: Chronic Illness and Rehabilitation Chapter 10: The Immune and Lymphatic System Chapter 11: Care of Patients with Immune and Lymphatic Disorders (with HIV and AIDS) Chapter 12: The Respiratory System Chapter 13: Care of Patients with Disorders of the Upper Respiratory System Chapter 14: Care of Patients with Disorders of the Lower Respiratory System Chapter 15: The Hematologic System Chapter 16: Care of Patients with Hematologic Disorders Chapter 17: The Cardiovascular System Chapter 18: Care of Patients with Hypertension and Peripheral Vascular Disease Chapter 19: Care of Patients with Cardiac Disorders Chapter 20: Care of Patients with Coronary Artery Disease and Cardiac Surgery Chapter 21: The Neurologic System Chapter 22: Care of Patients with Head and Spinal Cord Injuries Chapter 23: Care of Patients with Disorders of the Brain Chapter 24: Care of Patients with Peripheral Nerve and Degenerative Diseases Chapter 25: The Sensory System: Eye and Ear Chapter 26: Care of Patients with Disorders of the Eyes and Ears Chapter 27: The Gastrointestinal System Chapter 28: Care of Patients with Disorders of the Upper Gastrointestinal System Chapter 29: Care of Patients with Disorders of the Lower Gastrointestinal System Chapter 30: Care of Patients with Disorders of the Liver, Gallbladder, and Pancreas Chapter 31: The Musculoskeletal System Chapter 32: Care of Patients with Musculoskeletal and Connective Tissue Disorders Chapter 33: The Urinary System Chapter 34: Care of Patients with Disorders of the Urinary System Chapter 35: The Endocrine System Chapter 36: Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders Chapter 37: Care of Patients with Diabetes and Hypoglycemia Chapter 38: Care of Women with Reproductive Disorders Chapter 39: Care of Men with Reproductive Disorders Chapter 40: Care of Patients with Sexually Transmitted Infections Chapter 41: The Integumentary System Chapter 42: Care of Patents with Integumentary Disorders and Burns Chapter 43: Care of Patients in Disasters or Bioterrorism Attack Chapter 44: Care of Patients with Emergencies, Trauma, and Shock Chapter 45: Care of Patients with Anxiety, Mood, and Eating Disorders Chapter 46: Care of Patients with Substance Abuse Disorders Chapter 47: Care of Patients with Cognitive Disorders Chapter 48: Care of Patients with Thought and Personality Disorders 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 13. 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. “I’ll bet that made you feel very frustrated.” d. “Take a deep breath and plan what you will say to him tomorrow.” ANS: 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. PTS: 1 DIF: Cognitive Level: Analysis REF: 10 OBJ: 10 TOP: Nurse–Patient Relationship KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 14. 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. ANS: B 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 9 OBJ: 10 TOP: Therapeutic Relationship KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 15. The long-term care facility nurse is caring for a newly admitted 80-year-old patient who is depressed. Which approach is best for the nurse to employ? 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 cheerful behavior. ANS: A Activity and social interaction are helpful 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 relationship. PTS: 1 DIF: Cognitive Level: Analysis REF: 10 OBJ: 10 TOP: Depressed Behavior KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 16. 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 tell 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.” ANS: 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. PTS: 1 DIF: Cognitive Level: Application REF: 9 OBJ: 10 TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 17. 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. ANS: B Allowing hostile patients to make reasonable requests defuses the anger and allows patients to vent their feelings. PTS: 1 DIF: Cognitive Level: Application REF: 9 OBJ: 10 TOP: Hostile Behavior KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 18. 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. ANS: 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. PTS: 1 DIF: Cognitive Level: Application REF: 9 OBJ: 10 TOP: Manipulative Behavior KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 19. A female patient who has recently been diagnosed with an inoperable brain tumor asks the nurse, “Do you think God punishes us?” Which response demonstrates therapeutic communication? a. “What do you think?” b. “God loves you.” c. “Would like to speak with the chaplain?” d. “God will not give you more than you can bear.” ANS: A Sitting with the patient and offering oneself to listen to the patient’s concerns and encouraging reflection is the best approach rather than responding with a cliché or suggesting speaking with the chaplain. PTS: 1 DIF: Cognitive Level: Application REF: 10 OBJ: 10 TOP: Spiritual Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 20. The nurse is communicating with a patient who voices concern about an upcoming high-risk procedure. Which statement best demonstrates empathy? a. “Would you like to talk about your feelings regarding the procedure?” b. “My mother had the same procedure and did very well.” c. “I can’t imagine how you feel.” d. “It must be difficult preparing for the procedure; how are you feeling?” ANS: D This statement by the nurse displays empathy by trying to place oneself in the patient’s circumstance and validating the patient’s feelings. Simply asking patients if they would like to talk about their feelings does not show empathy and may elicit a “yes” or “no” response. Telling the patient one’s mother had the procedure or stating “I can’t imagine how you feel” does not show empathy toward the patient. PTS: 1 DIF: Cognitive Level: Application REF: 10 OBJ: 10 TOP: Nurse–Patient Relationship KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity