TEST BANK
,Chapter 01: Caring for Medical-Surgical Patients
Stromberg: Medical-Surgical Nursing: Concepts and 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\ primarypurpose\ of\ the\ NPA\ of\ each\ state\ defines\ the\ scope\
of\ nursing\ practice\ in\ that\ state.
DIF: Cognitive\ Level:\ Comprehension REF:\ p.\ 3 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.
DIF: Cognitive\ Level:\ Application REF:\ p.\ 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.
DIF: Cognitive\ Level:\ Application REF:\ p.\ 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.
DIF: Cognitive\ Level:\ Comprehension REF:\ p.\ 3 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. 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.
ANS:\ 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 REF:\ \ p.\ 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.
DIF:\ \ Cognitive\ Level:\ Comprehension\ \ REF:\ \ p.\ 7 OBJ:\ 9
TOP:\ Health\ Care\ Financing 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?
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.
, DIF: Cognitive\ Level:\ Comprehension REF:\ p.\ 8,\ Box\ 1-4
OBJ:\ 9 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.
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.
DIF: Cognitive\ Level:\ Comprehension REF:\ p.\ 8 OBJ:\9\
TOP:\ Government-Sponsored\ Health\ Insurance
KEY:\ Nursing\Process \ Step:\ Implementation
MSC:\ NCLEX:\ Safe,\ Effective\ Care\ Environment:\ Coordinated\ Care
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
ANS:\ A
Medicaid\ is\ a\ joint\ effort\ of\ federal\ and\ state\ governments\ geared\ primarily\ for\ low-income\ people\
with\ no\ insurance.
DIF: Cognitive\Level:\ Application REF:\ p.\ 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
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
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.
DIF: Cognitive\ Level:\ Comprehension REF:\ \ p.\ 6 OBJ:\ 7
TOP:\ Healthy\ People\ 2020 KEY:\ Nursing\ Process\ Step:\ Implementation\
MSC:\ NCLEX:\ Safe,\ Effective\ Care\ Environment:\ Coordinated\ Care
,Chapter 01: Caring for Medical-Surgical Patients
Stromberg: Medical-Surgical Nursing: Concepts and 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\ primarypurpose\ of\ the\ NPA\ of\ each\ state\ defines\ the\ scope\
of\ nursing\ practice\ in\ that\ state.
DIF: Cognitive\ Level:\ Comprehension REF:\ p.\ 3 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.
DIF: Cognitive\ Level:\ Application REF:\ p.\ 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.
DIF: Cognitive\ Level:\ Application REF:\ p.\ 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.
DIF: Cognitive\ Level:\ Comprehension REF:\ p.\ 3 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. 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.
ANS:\ 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 REF:\ \ p.\ 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.
DIF:\ \ Cognitive\ Level:\ Comprehension\ \ REF:\ \ p.\ 7 OBJ:\ 9
TOP:\ Health\ Care\ Financing 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?
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.
, DIF: Cognitive\ Level:\ Comprehension REF:\ p.\ 8,\ Box\ 1-4
OBJ:\ 9 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.
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.
DIF: Cognitive\ Level:\ Comprehension REF:\ p.\ 8 OBJ:\9\
TOP:\ Government-Sponsored\ Health\ Insurance
KEY:\ Nursing\Process \ Step:\ Implementation
MSC:\ NCLEX:\ Safe,\ Effective\ Care\ Environment:\ Coordinated\ Care
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
ANS:\ A
Medicaid\ is\ a\ joint\ effort\ of\ federal\ and\ state\ governments\ geared\ primarily\ for\ low-income\ people\
with\ no\ insurance.
DIF: Cognitive\Level:\ Application REF:\ p.\ 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
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
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.
DIF: Cognitive\ Level:\ Comprehension REF:\ \ p.\ 6 OBJ:\ 7
TOP:\ Healthy\ People\ 2020 KEY:\ Nursing\ Process\ Step:\ Implementation\
MSC:\ NCLEX:\ Safe,\ Effective\ Care\ Environment:\ Coordinated\ Care
