Chapter 01: Caring for Medical-Surgical Patients
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deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
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,
,MULTIPLE CHOICE tt
1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
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a. To tt test and license LPN/LVNs. tt tt tt
b. To tt define the scope of LPN/LVN practice. tt tt tt tt tt
c. To tt improve the quality of care provided by the LPN/LVN. tt tt tt tt tt tt tt tt
d. To tt limit the LPN/LVN employment placement. tt tt tt tt
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
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state defines the scope of nursing practice in that state.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 tt tt
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care tt tt tt tt tt tt
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the vocational nurse has
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notbeen taught during her educational program. How should the vocational nurse respond?
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a. Ask a more experienced nurse to demonstrate the procedure.
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b. Look up the procedure in the procedure manual. tt tt tt tt tt tt tt
c. Attempt to perform the procedure with supervision. tt tt tt tt tt tt
d. Inform the charge nurse of her lack of training in this tt tt tt tt tt tt tt tt tt tt
procedure.tt
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should seek
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further training to gain proficiency. Although the other options might be helpful, they are not safe.
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PTS: 1 DIF: Cognitive Level: Application REF: 3 tt tt t t
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A tt tt tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care tt tt tt tt tt tt
3. Which patient statement indicates a need for further discharge teaching that the vocational nurse should address?
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a. ―I have no idea of how this drug will affect me.‖
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b. ―Do you know if my physician is coming back
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today?‖ tt
c. ―Will my insurance pay for my stay?‖ tt tt tt tt tt tt
d. ―Am I going to have to go to a nursing home?‖ tt tt tt tt tt tt tt tt tt tt
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that should be addressed by the
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vocationalnurse. The other concerns in the options are the responsibility of other departments to which the nurse might refer the
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patient.
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PTS: 1 DIF: Cognitive Level: Application REF: 2 tt tt tt tt t t
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation t t tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care tt tt tt tt tt tt
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
which capacity?
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a. Working under direct supervision of an RN on the unit tt tt tt tt tt tt tt tt tt
b. Working with the RN in the building tt tt tt tt tt tt
c. Working under general supervision by the RN available on site or by tt tt tt tt tt tt tt tt tt tt tt
phone tt
d. Working as an independent vocational nurse tt tt tt tt tt
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
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available on site or by phone.
tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 tt tt
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care tt tt tt tt tt tt
, 5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
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informationshould the nurse include?
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a. Seek the opinion of an alternate health care provider.
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b. Obtain insurance approval for medical services prior to treatment.
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c. Provide detailed documentation of all care received for his
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condition.
tt
d. Wait at least 6 months to see a specialist.
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ANS: B
Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion, provide
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documentation of care, or wait a specific time period before visiting a specialist.
tt tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Application REF: 9 tt tt t t
OBJ: 9 TOP: Charge Nurse/Manager tt
KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
tt tt tt tt tt tt
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the hospital.
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Whichstatement accurately explains a deductible?
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a. An amount of money put aside for the payment of future medical bills
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b. A one-time fee for service
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c. An amount of money deducted from the bill by the insurance company
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d. An annual amount of money the patient must pay out-of-pocket for medical
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care tt
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company assuming the cost. This
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practice improves the profit of the insurance company.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: tt tt 7
OBJ: 9 TOP: Health Care Financing tt tt
KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
tt tt tt tt tt tt
7. The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred
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providerorganization (PPO). Which information should the nurse include about HMOs?
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a. HMOs require a set fee of each member monthly.
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b. HMOs allow the member to select his health care provider.
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c. HMOs permit admission to any facility the member prefers.
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d. HMOs offer unlimited diagnostic tests and treatments.
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ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated by the HMO staff in HMO-approved
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
tt tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Application REF: 9 tt tt t t
OBJ: 9 TOP: Managed Care tt
KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
tt tt tt tt tt tt
8. A patient asks the nurse what Medicare Part A covers. Which response is correct?
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a. Medicare Part A covers inpatient hospital costs. tt tt tt tt tt tt
b. Medicare Part A covers reimbursement to the physician.
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c. Medicare Part A covers outpatient hospital services.
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d. Medicare Part A covers ambulance transportation. tt tt tt tt tt
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B pays the
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physician, ambulance transport, and outpatient services.
tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Comprehension REF: tt tt 7, Box 1-4 tt tt
OBJ: 9 TOP: Government-Sponsored Health Insurance tt tt
KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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9. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
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tt tt tt tt tt
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
tt tt tt tt tt tt tt
,
,MULTIPLE CHOICE tt
1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
tt tt tt tt tt tt tt tt tt tt tt tt tt
a. To tt test and license LPN/LVNs. tt tt tt
b. To tt define the scope of LPN/LVN practice. tt tt tt tt tt
c. To tt improve the quality of care provided by the LPN/LVN. tt tt tt tt tt tt tt tt
d. To tt limit the LPN/LVN employment placement. tt tt tt tt
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
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
state defines the scope of nursing practice in that state.
tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 tt tt
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care tt tt tt tt tt tt
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the vocational nurse has
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
notbeen taught during her educational program. How should the vocational nurse respond?
tt t tt tt tt tt tt tt tt tt tt tt tt
a. Ask a more experienced nurse to demonstrate the procedure.
tt tt tt tt tt tt tt tt
b. Look up the procedure in the procedure manual. tt tt tt tt tt tt tt
c. Attempt to perform the procedure with supervision. tt tt tt tt tt tt
d. Inform the charge nurse of her lack of training in this tt tt tt tt tt tt tt tt tt tt
procedure.tt
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should seek
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
further training to gain proficiency. Although the other options might be helpful, they are not safe.
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Application REF: 3 tt tt t t
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A tt tt tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care tt tt tt tt tt tt
3. Which patient statement indicates a need for further discharge teaching that the vocational nurse should address?
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
a. ―I have no idea of how this drug will affect me.‖
tt tt tt tt tt tt tt tt tt tt
b. ―Do you know if my physician is coming back
tt tt tt tt tt tt tt tt
today?‖ tt
c. ―Will my insurance pay for my stay?‖ tt tt tt tt tt tt
d. ―Am I going to have to go to a nursing home?‖ tt tt tt tt tt tt tt tt tt tt
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that should be addressed by the
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
vocationalnurse. The other concerns in the options are the responsibility of other departments to which the nurse might refer the
tt t tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
patient.
tt
PTS: 1 DIF: Cognitive Level: Application REF: 2 tt tt tt tt t t
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation t t tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care tt tt tt tt tt tt
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
which capacity?
tt tt
a. Working under direct supervision of an RN on the unit tt tt tt tt tt tt tt tt tt
b. Working with the RN in the building tt tt tt tt tt tt
c. Working under general supervision by the RN available on site or by tt tt tt tt tt tt tt tt tt tt tt
phone tt
d. Working as an independent vocational nurse tt tt tt tt tt
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
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
available on site or by phone.
tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 tt tt
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care tt tt tt tt tt tt
, 5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
informationshould the nurse include?
tt t tt tt tt
a. Seek the opinion of an alternate health care provider.
tt tt tt tt tt tt tt tt
b. Obtain insurance approval for medical services prior to treatment.
tt tt tt tt tt tt tt tt
c. Provide detailed documentation of all care received for his
tt tt tt tt tt tt tt tt
condition.
tt
d. Wait at least 6 months to see a specialist.
tt tt tt tt tt tt tt tt
ANS: B
Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion, provide
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
documentation of care, or wait a specific time period before visiting a specialist.
tt tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Application REF: 9 tt tt t t
OBJ: 9 TOP: Charge Nurse/Manager tt
KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
tt tt tt tt tt tt
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the hospital.
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
Whichstatement accurately explains a deductible?
tt t tt tt tt tt
a. An amount of money put aside for the payment of future medical bills
tt tt tt tt tt tt tt tt tt tt tt tt
b. A one-time fee for service
tt tt tt tt
c. An amount of money deducted from the bill by the insurance company
tt tt tt tt tt tt tt tt tt tt tt
d. An annual amount of money the patient must pay out-of-pocket for medical
tt tt tt tt tt tt tt tt tt tt tt
care tt
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company assuming the cost. This
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
practice improves the profit of the insurance company.
tt tt tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Comprehension REF: tt tt 7
OBJ: 9 TOP: Health Care Financing tt tt
KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
tt tt tt tt tt tt
7. The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred
tt tt tt tt tt tt tt tt tt tt tt tt tt
providerorganization (PPO). Which information should the nurse include about HMOs?
tt t tt tt tt tt tt tt tt tt tt
a. HMOs require a set fee of each member monthly.
tt tt tt tt tt tt tt tt
b. HMOs allow the member to select his health care provider.
tt tt tt tt tt tt tt tt tt
c. HMOs permit admission to any facility the member prefers.
tt tt tt tt tt tt tt tt
d. HMOs offer unlimited diagnostic tests and treatments.
tt tt tt tt tt tt
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated by the HMO staff in HMO-approved
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
tt tt tt tt tt tt tt tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Application REF: 9 tt tt t t
OBJ: 9 TOP: Managed Care tt
KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
tt tt tt tt tt tt
8. A patient asks the nurse what Medicare Part A covers. Which response is correct?
tt tt tt tt tt tt tt tt tt tt tt tt tt
a. Medicare Part A covers inpatient hospital costs. tt tt tt tt tt tt
b. Medicare Part A covers reimbursement to the physician.
tt tt tt tt tt tt tt
c. Medicare Part A covers outpatient hospital services.
tt tt tt tt tt tt
d. Medicare Part A covers ambulance transportation. tt tt tt tt tt
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B pays the
tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt tt
physician, ambulance transport, and outpatient services.
tt tt tt tt tt tt
PTS: 1 DIF: Cognitive Level: Comprehension REF: tt tt 7, Box 1-4 tt tt
OBJ: 9 TOP: Government-Sponsored Health Insurance tt tt
KEY: Nursing Process Step: Implementation tt tt tt
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
tt tt tt tt tt tt
9. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
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