INTRODUCTORY MEDICAL SURGICAL NURSING 12TH EDITION TIMBY SMITH TEST BANK

INTRODUCTORY MEDICAL SURGICAL NURSING 12TH EDITION TIMBY SMITH TEST BANK [Author name] [COMPANY NAME] [Company address] INTRODUCTORY MEDICAL SURGICAL NURSING 12TH EDITION TIMBY SMITH TEST BANK 1. CHAPTER 1 Managed care organizations are insurers that carefully plan and closely supervise the distribution of healthcare services. What is one of the goals of managed care? A) Preventing illness through screening and promotion of health activities B) Improving training of healthcare professionals C) Eliminating health disparities between segments of the population D) Providing hospice or home hospice care Ans: A Feedback: Preventing illness through screening and promotion of health activities is one of the goals of managed care. Improved training of healthcare professionals is the priority for international health and not the goal of managed care. Eliminating health disparities between the segments of population is a goal of Healthy People 2020. Providing hospice or home hospice care is only for terminally ill clients. 2. In an effort to cut costs, hospitals have instituted many changes. Which of these cost-cutting factors is most likely to jeopardize the quality of care? A) Using unlicensed assistive personnel B) Increasing numbers of clients in hospitals C) Not devoting enough time to the client D) The rise of medical care costs in healthcare systems Ans: A Feedback: Hospitals are using unlicensed assistive personnel to perform some duties practical and registered nurses once provided. Many are concerned that the use of unlicensed assistive personnel will jeopardize the quality of care. Increasing numbers of clients in hospitals, not devoting enough time to the client, or the rise of medical costs are less likely to jeopardize the quality of care. 3. Since losing his right leg years ago, Mr. Smith and his wife have formed a community walking group to raise money for the homeless in his area. Which of the following has contributed to him being viewed as “healthy”? A) The client is married and is moving on. B) The client is experiencing high quality of life within the limits of the physical condition. C) The client is facing various states of health and illness. D) The client is physiologically and psychologically stable. Ans: B Feedback: Clients adapt physically, emotionally, and socially, enabling them to maintain comfort, stability, and self-expression. Clients with chronic illness can achieve a high level of wellness and experience high quality of life. Marriage is an aspect of quality of life but does not define the quality of the client's life. All clients experience various states of health and illness. Page 1 4. A 17-year-old client is having protected sex one to two times a week in a monogamous relationship. What is the client participating in? A) Health promotion B) Health maintenance C) Illness prevention D) Wellness Ans: B Feedback: Protecting one's current level of health by practicing safe sex to prevent illness is an example of a health maintenance activity. Health promotion strategies are used to enhance health, such as eating a diet high in fiber. Illness prevention includes identifying risk factors such as hypertension. Wellness is the balance of total well-being. 5. A client complaining of bloody urine has scheduled an appointment with a family practitioner. What type of care is the client receiving? A) Tertiary B) Secondary C) Skilled nursing care D) Primary Ans: D Feedback: The first provider that clients contact about a health need provides primary care; this person is typically a family practitioner or nurse practitioner. Secondary care includes referrals to facilities for additional testing. Tertiary care focuses on more complex medical and surgical intervention. Skilled nursing care occurs in facilities or units that offer prolonged health maintenance or rehabilitative services. 6. The hospital is having a problem with healthcare-associated infections. A committee has been established to study the problem and make recommendations. The nurse working on the committee knows that this work addresses what? A) Inpatient quality indicators B) Prevention quality indicators C) National Patient Safety Goals D) Patient safety indicators Ans: C Feedback: The Joint Commission has established National Patient Safety Goals that are updated annually. These safety goals have changed how patients are identified and prevent adverse effects. Some of the 2012 goals include reducing the risk of healthcare-associated infections. Patient safety indicators reflect the quality of care in hospitals but focus on potentially avoidable complications. Prevention indicators identify hospital admissions that could be avoided through high-quality outpatient care. Inpatient indicators reflect quality of care inside the hospital. 7. After hip surgery, a client is admitted to the rehabilitation hospital. What type of care is the client receiving? A) Secondary B) Tertiary C) Rehabilitation D) Primary Ans: B Feedback: Hospitals where specialized technology is available provide tertiary care. Primary care is the initial contact that a client has, such as an appointment with a family practitioner. Secondary care includes referrals for additional testing. Rehabilitation is aimed at restoring a person to his or her fullest ability. Page 3 WWW.NURSYLAB.COM Page 3 of 1010 8. An older man has been sick for 3 weeks but will not seek medical help even though he is able to get to the doctor's office. The client does not know what his insurance will cover. The client has many medical bills from treatments not covered and does not want to be faced with more. Why is this client waiting to obtain medical treatment? A) Cost B) Language C) Accessibility D) Culture Ans: A Feedback: Many groups, such as ethnic minorities and older adults, are underserved; many do not seek early services because they cannot afford to pay for them. Accessibility is not an issue because the client is able to get to the office. No cultural or language barrier is mentioned. 9. The Healthy People 2020 initiative targets the improvement of health for all. In addition to eliminating health disparities, what are the broad goals of this plan? A) Increasing technological innovations B) Preventing treatable problems C) Applying a systematic approach to health improvement D) Increasing the quality and length of a healthy life Ans: D Feedback: Two broad goals of the Healthy People 2020 initiative are to increase quality and years of healthy life and eliminate health disparities. Healthy People 2020 initiatives will help with treatable problems but will not prevent problems. The initiative does not apply a systematic approach to health improvement or increase technological innovations. Page 4 WWW.NURSYLAB.COM Page 4 of 1010 10. What method for financing healthcare is based on the ability to keep clients healthy and out of the hospital through periodic screening, health education, and preventive services? A) Managed care B) Preferred provider organization C) Health maintenance organization D) Point-of-service organization Ans: C Feedback: Health maintenance organizations strive to keep their costs low and members out of the hospital through periodic screenings, health education, and preventive services. Managed care organizations are insurers who carefully plan and closely supervise the distribution of healthcare services. Preferred provider organizations are a community network of providers who are willing to discount their fees for service in exchange for a steady stream of referral customers. Point-of-service organizations involve a network of providers; clients select a primary care physician within the group who then serves as the gatekeeper for other healthcare services. 11. The LPN is leading a cardiac rehabilitation support group. How can the nurse best demonstrate meeting the clients need holistically? A) Lead an exercise, show a video about healthy lifestyle changes, and invite a spiritual leader to talk with the group. B) Have the clients share various healthy low-cholesterol recipes and participate in a cooking class. C) Have the clients discuss ways to relieve stress and practice stress reduction. D) Demonstrate low-impact aerobic exercise to the group and bring in a lecturer on Tai Chi. Ans: A Feedback: Nurses practice from the perspective of holism, which is viewing a person's health as a state balance between body, mind, and spirit. Option A addresses all aspects of holism in caring for clients. Options B, C, and D address only one aspect of this level of care. Page 5 WWW.NURSYLAB.COM Page 5 of 1010 12. A client is brought into the emergency department by the rescue squad after involvement in a motorcycle accident with a severe spinal cord injury. What type of illness does the LPN view this event? A) Terminal B) Acute C) Chronic D) Catastrophic Ans: D Feedback: Illness refers to a state of being sick and can be viewed as catastrophic or a sudden, traumatic illness, which has occurred with this client. The client has suffered a traumatic accident with serious injury and would be classified as catastrophic. This event is not chronic, terminal, or acute. 13. A client with chronic obstructive pulmonary disease visits a local long-term care facility once a week to lead a bingo game for the residents. How does the LPN determine that this client is achieving a high level of wellness? A) The client enjoys the activity that she provides to the clients. B) The client finds satisfaction in socialization with the residents. C) The client is achieving a high quality of life within the limits of her illness. D) The client needs to feel a part of a group setting. Ans: C Feedback: Clients with chronic illness can achieve a high level of wellness if they can experience a high quality of life within the limits of that illness. This client would be considered healthy because she is engaged in a personal and social activity weekly. Although the client may enjoy the activity, find satisfaction in socialization, or need to feel a part of a group, the larger scope of wellness is option C. Page 6 WWW.NURSYLAB.COM Page 6 of 1010 14. The LPN is providing a program at the local YMCA about stress-reduction techniques combined with a 1-mile walk around the indoor track once a week. What does this type of program address for the community? A) Health promotion B) Health maintenance C) Illness prevention D) Early detection of illness Ans: A Feedback: Health promotion refers to engaging in strategies to enhance health such as eating a diet high in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress-reduction techniques. Illness prevention involves identifying risk factors such as a family history of hypertension or diabetes and reducing the effects of risk factors on one's health. Early detection uses screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Health maintenance refers to protecting one's current level of health by preventing illness or deterioration, such as by complying with medication regimens, being screened for diseases such as breast and colon cancers, or practicing safe sex. 15. The LPN is collecting data at the clinic from a new client who is being seen for an employee physical. The client informs the nurse that both parents have a history of high blood pressure and his father had a stroke at age 52 years. The nurse discusses diet and exercise programs that may benefit the client. What is the nurse displaying with this information? A) Early detection B) Health maintenance C) Health promotion D) Illness prevention Ans: D Feedback: Illness prevention involves identifying risk factors such as family history of hypertension or diabetes and reducing the effects of risk factors on one's health. Early detection uses screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Health maintenance refers to protecting one's current level of health by preventing illness or deterioration, such as by complying with medication regimens, being screened for diseases such as breast and colon cancers, or practicing safe sex. Health promotion refers to engaging in strategies to enhance health such as eating a diet high in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress-reduction techniques. Page 7 WWW.NURSYLAB.COM Page 7 of 1010 16. The LPN informs the secretary that a client is expected to come in for lab work. The secretary inquires about why the nurse refers to the individual as a client. What is the best response by the nurse? A) “We should refer to everyone as a client. They pay for our service.” B) “That's how the physician wants us to refer to them.” C) “Using the term client implies that they are an active partner in nursing care.” D) “Using the term client is more respectful that using the term patient.” Ans: C Feedback: A client is an active partner in nursing care, and the person receiving healthcare services should no longer play a passive, ill role. The use of the term client reflects the attitude of personal responsibility for health. Options A, B, and D do not address the reason for the term used. 17. The LPN is making a referral to physical therapy for a client who has had a hip replacement and is going to be discharged in 2 days. The nurse understands that having physical therapy included in the care of the client includes them in what discipline? A) Part of the healthcare team B) A discipline unto themselves C) Part of the administrative team D) The same discipline as the prescribing physician only Ans: A Feedback: The healthcare team consists of specially trained personnel who work together to help clients meet their healthcare needs. The team includes physicians, nurses, psychologists, pharmacists, dietitians, social workers, respiratory and physical therapists, occupational therapists, nursing assistants, technicians, and insurance company staff. Because physical therapists are part of the healthcare team, options B, C, and D would be incorrect. Page 8 WWW.NURSYLAB.COM Page 8 of 1010 18. The client is referred from the physician to a cardiologist for a cardiac catheterization to determine if the client has coronary artery disease. What type of care does the nurse understand that this is? A) Primary care B) Secondary care C) Tertiary care D) Acute care Ans: B Feedback: Secondary care includes referrals to facilities for additional testing such as cardiac catheterization, consultation, and diagnosis as well as emergency and acute care interventions. This client falls into this category due to the referral to the cardiologist for the cardiac catheterization. The client does not fall into the acute care category. Primary care would include being seen by the client's primary physician. Tertiary care focuses more on complex medical and surgical interventions, cancer care, rehabilitative services, long-term care such as burn care, and palliative and hospice care. 19. A client with terminal cancer is being referred to hospice services to assist with care of the client and the family in the home environment. What type of care does the nurse determine this is? A) Primary care B) Secondary care C) Tertiary care D) Acute care Ans: C Feedback: Tertiary care focuses more on complex medical and surgical interventions, cancer care, rehabilitative services, long-term care such as burn care, and palliative and hospice care. This patient is terminally ill and being referred for hospice service. Secondary care includes referrals to facilities for additional testing such as cardiac catheterization, consultation, and diagnosis as well as emergency and acute care interventions. The client does not fall into the acute care category. Primary care would include being seen by the client's primary physician. Page 9 WWW.NURSYLAB.COM Page 9 of 1010 20. A client comes to the clinic with the complaint that he has been ill for several weeks but do not have insurance and have delayed care. What does the LPN understand about the overall healthcare reform goals that will address issues such as this client? A) The goal of healthcare reform is to provide care to women, infants, and children. B) The goal of healthcare reform is to provide more healthcare programs to address illness. C) The goal of healthcare reform is to provide quality healthcare for those that can afford it. D) The goal of healthcare reform is to provide affordable healthcare to more citizens. Ans: D Feedback: The overall goal of healthcare reform is to provide affordable healthcare to more U.S. citizens. Other goals are to reduce the insurance companies' control of healthcare and to provide more assistance to senior citizens on fixed incomes. The other answers address other individual programs but not the broader terms of the healthcare initiative. 21. A 72-year-old client who is hospitalized will be going on anticoagulant therapy and will require home healthcare nurses to visit once weekly to draw blood for coagulation studies. What coverage does the client have that will cover this service? A) Medicaid B) Medicare Part A C) Medicare Part B D) Medicare Part C Ans: B Feedback: Medicare covers individuals who are 65 years of age or older, permanently disabled workers of any age with specific disabilities, and persons with end-stage renal disease. Medicare Part A covers hospital care, skilled care, hospice, and home health services. Medicare Part B covers medically necessary services such as physician services that are not covered under Part A. Medicare Part C is the Medicare Advantage Plan and includes Parts A and B. Medicaid coverage is coverage for indigent patients that are unable to afford healthcare and qualify financially. Page 10 WWW.NURSYLAB.COM Page 10 of 1010 22. A 65-year-old client is prescribed multiple medications for diabetes, hypertension, and angina and is going to the pharmacy to have the prescriptions filled. What coverage will the client use to assist with financial coverage of the medication? A) Medicare Part A B) Medicare Part B C) Medicare Part C D) Medicare Part D Ans: D Feedback: Medicare Part D is Medicare Prescription Drug Coverage and helps to cover and possibly reduce prescription drug costs and protect against catastrophic drug expenses. Medicare Part A covers hospital care, skilled care, hospice, and home health services. Medicare Part B covers medically necessary services such as physician services that are not covered under Part A. Medicare Part C is the Medicare Advantage Plan and includes Parts A and B. 23. A client informs the nurse that she is a single parent with four children and cannot afford to pay for medical insurance for her and her family. What coverage does the nurse understand this client and her family may be eligible for? A) Medicare B) Medigap insurance C) Prospective payment system D) Medicaid Ans: D Feedback: Medicaid is a federally funded, state-run program that provides medical assistance for individuals with limited incomes and resources. Qualifications vary from state to state, but, typically, clients qualify if they have children and a limited income. Medicare covers individuals who are 65 years of age or older, permanently disabled workers of any age with specific disabilities, and persons with end-stage renal disease. Prospective payment system is a method of reimbursement in which healthcare providers receive payment for services based on a predetermined, fixed rate. Medigap insurance policies are for people that have adequate resources to cover copayments and deductibles. Page 11 WWW.NURSYLAB.COM Page 11 of 1010 24. A client is a member of a group insurance plan in which he pays a preset, fixed fee for healthcare services. What type of insurance plan does the nurse understand the client to have? A) A preferred provider organization (PPO) B) A health maintenance organization (HMO) C) Medicare D) Medicaid Ans: B Feedback: An HMO is a group insurance plan in which participants pay a preset, fixed fee in exchange for healthcare services. The fee is not based on the number of services provided but rather is projected to the number of participants and expected services. A PPO operates on the principle that competition can control costs. Acting as agents for health insurance companies, PPOs create a community network of providers who are willing to discount their fees for service in exchange for a steady stream of referred customers. Medicare is for people that are age 65 years and older or disabled. Medicaid is coverage for those clients who are unable to afford healthcare. 25. An HMO client obtained a second opinion regarding a diagnosis of colon cancer. There was no authorization obtained for this second opinion from the client or primary care provider. What is the consequence of this action? A) The client will be responsible for the entire bill for the second opinion. B) The client will still receive full coverage. C) The client will be dropped from the HMO for breaking the rules. D) The client will be fined by the HMO for not using the authorization process. Ans: A Feedback: Members of an HMO must receive authorization for secondary care, such as second opinions from specialists or diagnostic testing. If members obtain unauthorized care, they are responsible for the entire bill. In this way, HMOs serve as gatekeepers for healthcare services. The member will not be fined or dropped from the program but will not receive coverage for the service rendered from the second opinion. Page 12 WWW.NURSYLAB.COM Page 12 of 1010 26. What does the nurse understand is the focus of healthcare when a client receives services from a health maintenance organization (HMO)? A) Avoiding coverage for needed services B) Health promotion and maintenance C) To offer discounted services to all patients D) High-quality service and contain cost Ans: B Feedback: If the HMO does not require much high-cost care, providers make money; if members use many high-cost resources, providers lose money. This method of financing provides the strongest incentives for limiting use of expensive services and focusing healthcare on health maintenance and promotion. If services such as diagnostic testing are required, the HMO will cover this and not avoid payment. Services are not discounted for patient's that are nonmembers or members. The goals of a physician hospital organization (PHO) are to maintain high-quality service and contain costs while fostering group contracts, collaboration, and capitation. 27. The LPN has been asked to assist in gathering data regarding the incidence of falls in the hospital as part of a project that is geared toward identifying avoidable contributing factors and their effects. What type of quality indicators (QI) is this considered? A) Prevention QI B) Inpatient QI C) Patient safety QI D) Pediatric QI Ans: C Feedback: Patient safety QIs reflect quality of care within hospitals but focus on potentially avoidable complications and adverse effects. Prevention QIs identify hospital admissions that could be avoided through high-quality outpatient care. Inpatient QIs reflect quality of care inside hospitals, including inpatient mortality for medical conditions and surgical events. Page 13 WWW.NURSYLAB.COM Page 13 of 1010 28. A client undergoing a surgical procedure at the hospital died related to complications during the procedure. The LPN is required to collect data about the event so that a cause can be determined. What type of quality indicators would be used in this incident? A) Prevention QIs B) Inpatient QIs C) Patient safety QIs D) Pediatric QIs Ans: B Feedback: Inpatient QIs reflect quality of care inside hospitals, including inpatient mortality for medical conditions and surgical procedures. Prevention QIs identify hospital admissions that could be avoided through high-quality outpatient care. Patient safety QIs also reflect quality of care within hospitals but focus on potentially avoidable complications and adverse events. Pediatric QIs reflect quality of care inside hospitals and identify potentially avoidable hospitalization among children. 29. The LPN is working with a team of nurses in order to develop protocols for managing care of clients who are having peritoneal dialysis on their unit. What type of care mapping would the nurse use for the development of these standards? A) Nursing care plan B) Standing orders C) Recipe for care D) Clinical pathways Ans: D Feedback: Protocols (also known as guidelines or standards) for managing care have been developed. Multidisciplinary teams use clinical pathways or care mapping for specific diagnoses or procedures, which standardize important aspects of care such as diagnostic workups, nursing care, education, physical therapy, and discharge planning across the estimated length of stay. A nursing care plan is individualized to meet the needs of each client and is not standardized. There is no “recipe” for care that will meet the needs of clients. Standing orders reflect a physician's order that is standardized for patients with a specific diagnosis or procedure. Page 14 WWW.NURSYLAB.COM Page 14 of 1010 30. The LPN is assisting with the development of a program to administer flu shots to a group of senior citizens. What type of prevention does this program reflect? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Prevalence Ans: A Feedback: Primary prevention is prevention of the development of disease in a susceptible or potentially susceptible population and includes health promotion and immunization. Secondary prevention is the early diagnosis and treatment to shorten duration and severity of an illness, reduce contagion, and limit complications. Tertiary prevention is healthcare to limit the degree of disability or promote rehabilitation in chronic, irreversible diseases. Prevalence is the number of cases of a disease in a specific population during a specific period. 31. The LPN working in the clinic has had several incidence of positive chlamydia cultures return in women with pelvic pain. The nurse understands that early diagnosis and treatment are essential measures in which to reduce contagion and limit the complications related to this infection. What type of prevention will the nurse use when these infections are treated? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Prevalence Ans: B Feedback: Secondary prevention is the early diagnosis and treatment to shorten duration and severity of an illness, reduce contagion, and limit complications. Tertiary prevention is healthcare to limit the degree of disability or promote rehabilitation in chronic, irreversible diseases. Prevalence is the number of cases of a disease in a specific population during a specific period. Primary prevention is prevention of the development of disease in a susceptible or potentially susceptible population and includes health promotion and immunization. Page 15 WWW.NURSYLAB.COM Page 15 of 1010 32. The LPN is working for a physician who participates in an HMO and will be assisting with the billing. What type of information regarding capitation does the nurse need to understand? A) Fees are not based on the number of services provided but rather are projected to the number of participants and expected services. B) Fees are based on the number of services that the primary care provider bills for. C) The HMO makes money based on the degree of illness and number of diagnostic tests that are done. D) The fees that are charged are different even with the same diagnosis. Ans: A Feedback: With an HMO, the fee is not based on the number of services provided but rather is projected to the number of participants and expected services. This type of financial management is referred to as capitation, which refers to the actual head or person count. Option A is incorrect because HMO is based on the number of participants and expected services. The HMO makes money by keeping people healthy and out of the hospital. The fees are the same regardless of the actual service or frequency of care provided. 33. An LPN has applied for a position in the hospital emergency department and is told that the facility only hires RNs and unlicensed assistive personnel (UAPs) in the emergency department. What concern does the LPN have with the practice of hiring UAPs in place of LPNs? A) LPNs will be phased out of the healthcare field altogether when more UAPs are hired. B) UAPs are performing some of the duties that practical nurses typically provide and may jeopardize the quality of care. C) UAPs will replace nurses because they deliver a better quality of care. D) State boards of nursing will begin to credential UAPs. Ans: B Feedback: Changes in the healthcare industry have also affected employment for healthcare workers. Hospitals employ UAPs to perform some duties that practical and registered nurses once provided. Many are concerned that the use of UAPs will jeopardize the quality of care. There is no evidence to indicate that LPNs will be phased out of the healthcare system or will replace nurses. State boards of nursing cannot credential an unlicensed person that does not go through a formal education program. Page 16 WWW.NURSYLAB.COM Page 16 of 1010 34. What statement by the LPN shows an understanding of the ultimate goal of Healthy People 2020? A) “The ultimate goal is that they will find a cure for diabetes.” B) “The ultimate goal is that they provide an overall action plan to improve health and quality of life.” C) “The ultimate goal is that everyone be within a normal weight.” D) “The ultimate goal is that everyone will exercise once daily.” Ans: B Feedback: The Healthy People 2020 campaign provides an overall action plan to improve the health and quality of life for people living the United States. The U.S. Department of Health and Human Services identified the four overarching health goals: Attain high quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Health People 2020 is not focused on an individual disease process, a “normal” weight, or exercise for the individual as the overall goal. 35. The LPN is aware of the various changes in the healthcare field. What important factor remains the same in this time of change? A) Nurses must provide safe, high-quality, cost-effective care to individuals, families, and communities. B) Nurses must inform clients that they will have to use facilities that are within their service area. C) Clients must become actively involved in the process of standardizing care. D) Nurses will have to work in unsafe conditions in order to provide care to clients. Ans: A Feedback: In the midst of these dramatic changes and challenges, nurses must continue to provide safe, high-quality, cost-effective care to individuals, families, and communities. It is also imperative that nurses distinguish and communicate to clients the various choices that the clients may make about their healthcare. Clients have a choice as to location of care providers and are not limited to local facilities. Clients are not involved in standardizing care; this is a healthcare provider function. Nurses will not have to work in unsafe conditions in order to provide care to clients. Page 17 WWW.NURSYLAB.COM Page 17 of 1010 1. CHAPTER 2 Which of the following describes the role of the nurse as defined by Florence Nightingale? A) Helping people to carry out activities that contribute to health and recovery B) Putting the patient in the best condition for nature to act upon him or her C) Diagnosing and treating human responses to actual or potential health problems D) Promoting a caring relationship that facilitates health and healing Ans: B Feedback: Florence Nightingale (1859) described the role of the nurse as putting “the patient in the best condition for nature to act upon him.” Virginia Henderson envisioned the nurse's role as helping people (sick or well) to carry out activities that contribute to health, recovery, or a peaceful death. The American Nurses Association (ANA) traditionally defined nursing as “the diagnosis and treatment of human responses to actual or potential health problems.” In response to an increased emphasis on the science of care, the ANA now acknowledges “promotion of a caring relationship that facilitates health and healing” as one of the four essential features of contemporary nursing practice. 2. Which setting has been the traditional site for the nursing work force? A) Dialysis units B) Inpatient units C) Same-day surgery units D) Clinics Ans: B Feedback: Although hospitals include all levels of outpatient areas (e.g., dialysis units, clinics, same-day surgery units, related diagnostic departments), inpatient units have been the traditional site for much of the nursing work force. 3. Which type of care is used for clients with terminal illness who have a life expectancy of less than 6 months? A) Hospice care B) Ambulatory care C) Skilled nursing care D) Intermediate care Ans: A Feedback: Hospices provide care for clients with terminal illness whose life expectancy is less than 6 months. Ambulatory care is also called outpatient care. Skilled nursing care facilities provide skilled nursing and rehabilitative care to people who have the potential to regain function but need skilled observation and nursing care during an acute illness. Intermediate care facilities are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Page 1 WWW.NURSYLAB.COM Page 18 of 1010 4. Freestanding apartments are an example of which type of alternative healthcare setting? A) Skilled nursing care B) Assisted living C) Congregate housing D) Boarding homes Ans: C Feedback: Congregate housing provides independent living or minimal assistance for seniors or disabled adults. Skilled nursing care facilities provide skilled nursing and rehabilitative care to people who have the potential to regain function but need skilled observation and nursing care during an acute illness. Assisted living facilities provide care to residents who need assistance with up to three activities of daily living. Boarding homes are usually small homes with individual rooms where residents pay for room and board and minimal nursing services. 5. In which setting is total care often practiced? A) Assisted living B) Intensive care units C) Boarding homes D) Congregate nursing Ans: B Feedback: Total care is often practiced in intensive care units where nurses are assigned one or two clients. Assisted living facilities provide care to residents who need assistance with up to three activities of daily living. Boarding homes are usually small homes with individual rooms where residents pay for room and board and minimal nursing services. Congregate housing provides independent living or minimal assistance for seniors or disabled adults. 6. Which of the following describes the goal of alternative care facilities? A) An RN and one or more assistive personnel care for a group of patients. B) An RN assumes all care for a small group of patients. C) There is 24-hour accountability by an RN. D) The facility provides the least restrictive living arrangement. Ans: D Feedback: The goal of alternative care facilities is to provide the least restrictive living arrangement while maintaining safety and quality. Patient-focused care uses an RN partnered with one or more assistive personnel to care for a group of clients. Total care refers to assignments in which a nurse assumes all the care for a small group of clients. In primary nursing, an RN assumes 24-hour accountability for the client's care and has total responsibility for the nursing care of assigned clients during his or her shift. Page 2 WWW.NURSYLAB.COM Page 19 of 1010 7. Which nursing theorist stated that clients are open systems in constant interaction with their environment? A) Florence Nightingale B) Virginia Henderson C) Imogene King D) Dorothea Orem Ans: C Feedback: Imogene King stated that clients are open systems in constant interaction with their environment. Florence Nightingale described the role of the nurse as putting “the patient in the best condition for nature to act upon him.” Virginia Henderson envisioned the nurse's role as helping people (sick or well) to carry out activities contributing to health, recovery, or a peaceful death that they would do for themselves if they had the necessary strength, will, or knowledge. Dorothea Orem was a proponent of the self-care deficit theory. 8. Veterans' hospitals are an example of which type of ownership? A) For-profit B) Government-owned C) Proprietary D) Nonprofit Ans: B Feedback: Veterans' hospitals are an example of government-owned healthcare institutions. For-profit agencies (proprietary) are owned and operated by corporate groups with investors and stockholders. Nonprofit institutions include universities and religious organizations. 9. A religious organization is an example of this type of ownership? A) Government-owned B) Proprietary agency C) Nonprofit agency D) Public facility Ans: C Feedback: Nonprofit institutions include universities and religious organizations. Veterans' hospitals are an example of government-owned or public healthcare institutions, which receive at least some tax support. For-profit agencies (proprietary) are owned and operated by corporate groups with investors and stockholders. Page 3 WWW.NURSYLAB.COM Page 20 of 1010 10. Which type of length of stay includes emergency department visits? A) Long-term care B) Acute care C) Short stay D) In-and-out care Ans: D Feedback: An example of in-and-out care is an emergency department visit. Long-term care provides care to residents for the remainder of their lives. Acute care occurs in hospitals where clients stay more than 24 hours but less than 30 days. Short stay provides care to clients who suffer from acute conditions or need treatments that entail less than 24 hours of care and monitoring. 11. A student nurse asks the nursing instructor, “What will my role as a nurse encompass after I graduate?” What is the best response by the nursing instructor? A) “You will take care of clients who are ill in a hospital or long-term care facility.” B) “You will care for individuals and families and play a role in health education, illness prevention, and promotion.” C) “You will care for a variety of clients of all ages when they are ill.” D) “It will all depend on where you want to work when you graduate. Nurses do different things in healthcare.” Ans: B Feedback: Nursing is concerned with caring for individuals, families, or groups. Nurses not only care for clients when they are ill but also play a significant role in health education, illness prevention, and promotion. Nurses attend to client needs related to hygiene; activity; diet; the environment; medical treatment; and physical, emotional, and spiritual comfort. Answer A only identifies a small portion of nursing and does not recognize health promotion, prevention, or education. Answer C and D are very narrow views of nursing and doesn't answer the question that the student is asking. Page 4 WWW.NURSYLAB.COM Page 21 of 1010 12. The LPN is caring for clients at the hospital's medical unit. What role does the LPN/LVN have in the care of clients on this unit? A) The LPN/LVN may provide care to clients who have a well-defined, common problem. B) The LPN/LVN may manage and coordinate the care of a group of clients. C) The LPN/LVN has a high level of competency in assessment skills. D) The LPN/LVN encourages clients and family members to develop self-care skills. Ans: A Feedback: The LPN/LVN provides care to clients under the direction of a registered nurse (RN), advanced practice nurse (APRN), or physician in a structured healthcare setting. LPN/LVNs care for clients with well-defined, common problems that often require a high level of technical competency and expertise. The other answers are all roles that an RN would have. 13. An LPN says to an RN, “I don't understand why I get paid less, yet we do the same thing here at work.” What role does the RN have in the healthcare setting that the LPN does not? A) The RN only cares for clients with well-defined, common problems. B) The RN's role is more complex and involves management and coordination of all the care provided to a group of clients. C) The RN is responsible for everything that the LPN does in the healthcare setting. D) The RN is the only provider that cares for clients with common problems that require a high level of technical competency and expertise. Ans: B Feedback: The RN's role is more complex, involving the management and coordination of all the care provided to a group of clients. LPN/LVNs care for clients with well-defined, common problems that often require a high level of technical competency and expertise. LPNs are responsible for their own actions and must work within their scope of practice. Page 5 WWW.NURSYLAB.COM Page 22 of 1010 14. The charge nurse is making assignments for a group of clients on a medical unit. When reviewing the acuity of the clients, the charge nurse assigns the RN to the clients with higher acuity levels. Why would the charge nurse assign the RN to the patient's with a higher acuity? A) LPNs do not understand how to care for clients with complex disorders. B) Assigning an LPN would allow them to provide care out of their scope of practice. C) Higher acuity clients request the services of an RN versus other care providers. D) A higher acuity client requires a greater need for highly skilled care. Ans: D Feedback: Generally, higher acuity requires a greater need for highly skilled care. Clients with complicated or high-risk surgery, massive trauma, or critical illness will be cared for in an acute care hospital, where a high level of professional, skilled, and technological care is available. RNs are instrumental in caring for these clients. LPNs may understand how to care for clients with complex disorders, but RNs are instrumental in the client care. There are no guidelines about practicing for LPNs and the acuity of clients. Clients generally do not request care by a specific provider. 15. A client who is receiving respiratory support with a tracheostomy and mechanical ventilation after a stroke is being discharged from the acute care facility. Family members state that they will not be able to care for the client at home to provide the care that is required. What type of care may this client be a candidate for after discharge? A) Long-term acute care B) Subacute care C) Intermediate care facility D) Rehabilitation care Ans: A Feedback: Clients who require ventilator support or who have other conditions that are potentially unstable but do not have rapid changes may receive care in a long-term acute care facility. Subacute care refers to care that is more intense than traditional long-term care but less intense than acute inpatient care. Intermediate care facilities (ICFs) are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Rehabilitation centers provide physical and occupational therapy to clients and families to help individuals regain as much independence with ADLs as possible. Page 6 WWW.NURSYLAB.COM Page 23 of 1010 16. A client is going to be in a subacute care unit for approximately 30 days. The client will require frequent assessments and periodic review of the client's progress. What role will the registered nurse have in the care of this client? A) The RN will provide direct care for the client. B) The RN will ensure that the client eats 100% of the meals. C) The RN will order the various treatments for the client. D) The RN will coordinate the client's care. Ans: D Feedback: RNs coordinate clients' care, and LPN/LVNs provide and oversee care provided by unlicensed assistive personnel (UAPs). The RN does not generally provide the direct care, and this would include overseeing meals. It is beyond the scope of practice for RNs to order treatments and medications. 17. An older adult client is being transferred to another facility in order to continue physical therapy after having a total right hip replacement. What type of facility will provide skilled nursing and rehabilitative care for this patient who will go home after the rehabilitation? A) Acute care facility B) Long-term acute care C) Skilled nursing care D) Intermediate care facility Ans: C Feedback: Skilled nursing care facilities provide skilled nursing and rehabilitative care to people who have the potential to regain function but need skilled observation and nursing care during an acute illness. Acute care facilities are for clients who have a higher level of acuity. Long-term acute care are for clients who require long-term wound care of ventilator support or who have other conditions that are potentially unstable but do not have rapid changes. Intermediate care facilities provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Page 7 WWW.NURSYLAB.COM Page 24 of 1010 18. An LPN just received her license to practice and applied for a position at a skilled nursing care facility. While being interviewed, the LPN asks what her role will be at the facility. What is the best answer by the interviewer? A) “You will be organizing and coordinating the care of the clients.” B) “You will be participating in the care of the clients.” C) “You will be in charge of a unit and have 24-hour accountability.” D) “You will be responsible for developing and implementing a plan of care for the clients.” Ans: B Feedback: An RN must be in charge of client's care, although other healthcare providers, particularly LPN/LVNs, participate in their care. The other answers are all under the scope of practice of an RN. 19. A client who has mental disabilities has recently lost his remaining parent and is unable to care for himself at home. What facility would best meet the needs of this client? A) Acute care facility B) Rehabilitation care C) Intermediate care facility D) Ambulatory care Ans: C Feedback: Intermediate care facilities (ICFs) are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Clients must meet specific criteria related to an inability to meet their own activities of daily living (ADL). Rehabilitation centers provide physical and occupational therapy to clients and families to help individuals regain as much independence with ADLs as possible. Acute care facilities care for clients with a higher acuity level. Ambulatory care is also referred to as outpatient care and is a short stay. Page 8 WWW.NURSYLAB.COM Page 25 of 1010 20. A client experienced a stroke approximately 2 weeks previously and has residual left side hemiparesis. What facility would best meet the needs of this client in order to help regain independence with activities of daily living? A) Rehabilitation care B) Hospice care C) Ambulatory care D) Acute care Ans: A Feedback: Rehabilitation care provides physical and occupational therapy to clients and families to help individuals regain as much independence with ADLs as possible. Hospices provide care for clients diagnosed with a terminal illness whose life expectancy is fewer than 6 months. Ambulatory care is also a short-term outpatient care. Acute care facilities are facilities that provide care to clients of higher acuity. 21. A client has end-stage chronic obstructive pulmonary disease (COPD) and is terminally ill. The family wants the client to spend her last days in a facility that will be able to keep the patient comfortable and control her severe dyspnea. What facility will meet the needs of the client and family? A) Rehabilitation care B) Hospice care C) Intermediate care facilities D) Ambulatory care Ans: B Feedback: Hospice provides care for clients diagnosed with a terminal illness whose life expectancy is fewer than 6 months. Hospices allow terminally ill clients to live as fully as possible while managing pain, discomfort, and other symptoms. Rehabilitation centers provide physical and occupational therapy to clients and families to help individuals regain as much independence with ADLs as possible. Intermediate care facilities (ICFs) are nursing homes that provide custodial care for people who cannot care for themselves because of mental or physical disabilities. Ambulatory care is also outpatient care. Page 9 WWW.NURSYLAB.COM Page 26 of 1010 22. Home health nurses will be caring for a debilitated client in the home. The client will be discharged from an acute care facility to the care of family members. The client will require twice daily wound care for a large sacral decubitus ulcer. What will be the goal of the home health nurses in the care of this client? A) To have the client admitted to a long-term care facility if the ulcer does not heal in a timely manner B) To have client come to the home care agency twice daily for dressing changes C) To continue to see the patient twice daily for dressing changes until the wound heals D) To encourage family members to develop self-care skills and perform dressing changes Ans: D Feedback: The RN encourages clients and family members to develop self-care skills, with support from community resources. The home health nurse's goal is to allow the client to be cared for in their home and not in a long-term care facility if that is not what the client wishes. The client's condition does not enable self-care. The goal for the family will be to perform dressing changes and the nurse will continue to monitor the condition of the wound. 23. A client is living in congregate housing and informs the LPN at the clinic that they do not like living there. When the nurse asks why they are unhappy with current living arrangements, the client states, “It is a nice place but I am unable to do anything because I hardly have money for my medicines or food.” What is an issue related to congregate housing? A) Residents may find that congregate housing is unaffordable. B) Residents may not have any other resources to purchase extra services or goods. C) Residents are not assured of appropriate housing and may be evicted at any time. D) Residents must be financially able to participate in outside activities. Ans: B Feedback: Congregate housing is affordable, but residents may not have any other resources to purchase extra services or goods. They are assured of appropriate housing but may lack the resources, ability, or opportunity to participate in outside activities. Page 10 WWW.NURSYLAB.COM Page 27 of 1010 24. A client who is mentally disabled is working at an adult activity center. The client is unable to live independently, and the family member they are living with can no longer assist with supervised care. What option for living arrangements would be ideal for this person? A) Congregate housing B) Boarding home C) Long-term acute care facility D) Acute care facility Ans: B Feedback: Boarding homes usually are small homes with individual rooms where residents pay for room and board and minimal nursing services. Residents often share rooms, have a common dining area for all meals, and also oversee employment for disabled adults and provide a stable environment for those who cannot live independently. Congregate housing provides independent living for seniors or disabled adults who need minimal to no assistance. Long-term care facilities are for clients who require long-term wound care or ventilator support or who have other conditions that are potentially unstable but do not have rapid changes. Acute care facilities are for those clients who are of high illness acuity. 25. A client is unable to care for her needs and requires assistance with activities of daily living. The son calls the clinic and informs the LPN that he wants his mother to be able to remain in her home but must work and is unable to care for her 24 hours per day. What options can the LPN suggest for the care of his mother? A) Employ private duty nurses to care for the parent. B) He must admit his mother to a nursing home. C) He will have to quit his job and stay home to care for her. D) Take her to an adult day care center. Ans: A Feedback: A modern version of the case method is private duty nurse where care is provided in the home and many household duties are performed as well. The son does not have to admit his parent to the nursing home if he chooses not to, and he will not have to quit his job if he can have a nurse come into the home. Adult day care would not assist with after-hour care. Page 11 WWW.NURSYLAB.COM Page 28 of 1010 26. The LPN has been assigned to a medical floor and to do all of the dressing changes and other treatments. The RN will make the rounds with the physicians, transcribe orders, and administer all of the IV medications. Another LPN will administer medications. What type of nursing is this group providing? A) Team nursing B) Total care C) Functional nursing D) Primary nursing Ans: C Feedback: Functional nursing is a task-oriented method, and distinct duties are assigned to specific personnel. Total care refers to assignments in which a nurse assumes all the care for a small group of clients. In team nursing, teams made up of an RN team leader, other RNs, LPN/LVNs, and nursing assistants provide care to a group of clients. Primary nursing is when the RN assumes 24-hour accountability for the client's care and has total responsibility for the nursing care of assigned clients during his or her shift. 27. The LPN is part of a group of nurses that has an RN team leader as well as another LPN and two nursing assistants who will be providing care to a group of clients. What type of nursing method is this considered? A) Functional nursing B) Total care C) Case method D) Team nursing Ans: D Feedback: Team nursing is composed of an RN team leader, other RNs, LPN/LVNs, and nursing assistants who provide care to a group of clients. Functional nursing is a task-oriented method where everyone in the group is assigned to specific tasks. Case method is the same as private duty nursing. Total care refers to assignments in which a nurse assumes all the care for a small group of clients. Page 12 WWW.NURSYLAB.COM Page 29 of 1010 28. The RN is assuming all of the care for a small group of clients, and an LPN is assigned to another group of clients with a lower acuity. What type of nursing is this considered? A) Total care B) Team nursing C) Functional nursing D) Primary nursing Ans: A Feedback: Total care refers to assignments in which a nurse assumes all the care for a small group of clients. Team nursing are teams made up of an RN team leader, other RNs, LPN/LVNs, and nursing assistants, and they provide care to a group of clients. Functional nursing is a task-oriented method of nursing. Primary nursing is when an RN assumes 24-hour accountability for the client's care and has total responsibility for the nursing care of assigned clients during his or her shift. 29. An RN has been assigned to care for three clients on the medical unit and will assume 24-hour accountability for those clients' care. When the nurse goes off duty, the plan of care will be continued by a secondary nurse. What type of nursing model is this considered? A) Team nursing B) Case method C) Functional nursing D) Primary nursing Ans: D Feedback: In primary nursing, the RN assumes 24-hour accountability for the client's care and has total responsibility for the nursing care of assigned clients during his or her shift. Team nursing is made up of an RN team leader, other RNs, LPN/LVNs, and nursing assistants who provide care to a group of clients. The case method is the same as a private duty nurse. In functional nursing, distinct duties are assigned to specific personnel. Page 13 WWW.NURSYLAB.COM Page 30 of 1010 30. The nurse manager of a telemetry unit is considering changing from a team model of nursing to a primary nursing model. When considering this decision, what advantage does the manager understand the primary nursing model brings to nursing care? A) The RN will partner with one or more assistive personnel to care for a group of clients. B) Caregivers see to all their clients' needs, thus providing holistic and comprehensive care. C) Tasks are divided, and clients see several people during the shift. D) The RN will be the team leader and direct the care that is provided by all of the other personnel. Ans: B Feedback: In primary nursing, an RN assumes 24-hour accountability for the client's care and has total responsibility. An advantage is that the client has a caregiver who sees to all of his or her needs and who provides holistic and comprehensive care. Option A refers to a patient-care focused model. Option C refers to a total care model, and option D is a team approach. 31. A hospital unit has been using a functional nursing model for delivery of care for several years. The manager has been discussing with the staff the idea of a change to total care because functional nursing has some disadvantages to the clients. What disadvantage is the manager referring to? A) It is expensive because it only uses RNs. B) Some nurses work harder than others to provide care. C) It fragments care and is confusing for the clients. D) Nurses are accountable for the client's care 24 hours per day. Ans: C Feedback: Although efficient, functional nursing fragments care and is confusing for clients. Primary nursing is expensive because it uses RNs only. Nurses are designated certain tasks if functional nursing is employed, so the care is divided. Nurses are accountable for client care in a primary nursing model. Page 14 WWW.NURSYLAB.COM Page 31 of 1010 32. A client is admitted to an acute care facility after having a stroke. The client will require a variety of healthcare services throughout the hospital stay as well as coordination of care prior to discharge. What referral would be a priority for overseeing the client's care? A) Case management B) Physical therapy C) Occupational therapy D) Dietary services Ans: A Feedback: The person responsible for overseeing the client's care, usually an RN with a bachelor's or master's degree or another highly experienced health professional, is called the case manager. Physical therapy, occupational therapy, and dietary services are all important care disciplines but do not encompass all of the client's needs. 33. A client in an acute care facility is assigned a case manager to oversee and coordinate care. What important function does a case manager have? A) Provide early, thorough discharge planning. B) Make sure the client is administered medications. C) Provide care to the client who is terminally ill and has less than 6 months to live. D) Make home visits to see that the patient is taken care of after discharge. Ans: A Feedback: An important function of case managers is to provide early, thorough discharge planning. The case manager is not responsible for the administration of medications. Hospice care provides care to the client who is terminally ill. The case manager oversees the care of the clients while they are hospitalized. Referrals to community agencies and home healthcare will be made for home visits. 34. A client arrives at the physician's clinic in order to receive care for a cough and fever. What type of healthcare institute classification is this client attending? A) Short stay B) Acute care C) Long-term care D) In-and-out care Ans: D Feedback: Contact with the client is measured in minutes versus hours. Typical examples are office visits, emergency department visits, and therapy sessions with in-and-out care. Short stays provides care to clients who suffer from acute conditions or need treatments that require fewer than 24 hours of care and monitoring. Long-term care provides care to residents for the remainder of their lives. Acute care traditionally occurs in hospitals where clients stay more than 24 hours. Page 15 WWW.NURSYLAB.COM Page 32 of 1010 35. A client will be discharged from an acute care facility but will require home health services to assess the need for assistive devices to aid in activities of daily living and identify issues related to fine motor movements and muscle retraining after a stroke. What referral will home health services make? A) Physical therapy B) Homemakers C) Occupational therapy D) Speech therapy Ans: C Feedback: Occupational therapy will assess the need for assistive devices to aid in activities of daily living and identify issues related to fine motor movements and muscle retraining. Physical therapy will assess the client's mobility after orthopedic surgery, injury, or stroke. Homemaker services will clean, do laundry, and shop for groceries. Speech therapy will provide rehabilitation to clients with speech or swallowing disorders. Page 16 WWW.NURSYLAB.COM Page 33 of 1010 1. Chapter 3 Which of the following is a true statement about critical thinking in nursing? A) It involves purposeful, outcome-directed thinking. B) It shows trends and patterns in client status. C) It makes judgments based on conjecture. D) It supplies validation for reimbursement. Ans: A Feedback: In nursing, critical thinking involves purposeful, outcome-directed thinking. Critical thinking makes judgments based on evidence rather than conjecture. Providing a foundation for evaluation and quality improvement and showing trends and patterns in client status are functions served by documentation. 2. Which of the following is involved in the implementation step of the nursing process? A) Selecting nursing interventions B) Documenting nursing care and client responses C) Documenting the plan of care D) Identifying measurable outcomes Ans: B Feedback: The implementation step in the nursing process involves documenting nursing care and client responses. Planning involves selecting nursing interventions, documenting the plan of care, and identifying measurable outcomes. 3. Which of the following is an important element of implementation? A) Client database B) Critical thinking C) Nursing orders D) Documentation Ans: D Feedback: An important element of implementation is documentation. The client database includes all the information obtained from the medical and nursing history. Physical examination and diagnostic studies are not an important element of implementation. Critical thinking is intentional, contemplative, and outcome-directed thinking. Developing good critical thinking skills will make nurses more efficient and effective at resolving situations necessitating multiple interventions. Nursing orders are specific nursing directions so that all healthcare team members understand what to do for the client; therefore, they are not an important element of implementation. Page 1 WWW.NURSYLAB.COM Page 34 of 1010 4. Which of the following pieces of information is included in the client database? A) Nursing care B) Diagnostic studies C) Plan of care D) Collaborative problems Ans: B Feedback: The client database includes all the information obtained from the medical and nursing history, physical examination, and diagnostic studies. The client database does not include nursing care, plan of care, or collaborative problems. 5. Which type of nursing diagnosis statement begins with the stem readiness for enhanced and does not include related factors or supporting data? A) Health promotion B) Syndrome C) Risk D) Actual Ans: A Feedback: Health promotio