Chapter 01: Caring for Medical-Surgical Patients
g g g g g
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition
g g g g g g g
MULTIPLE CHOICE
g
,1. Which statement accurately describes the primary purpose of the state nurse
g g g g g g g g g g
practice act (NPA)?
g g g
a. To test and license LPN/LVNs
g g g g
b. To define the scope of LPN/LVN practice
g g g g g g
c. To improve the quality of care provided by the LPN/LVN
g g g g g g g g g
d. To limit the LPN/LVN employment placement
g g g g g
ANS: B g
While improving quality of care provided by the LPN/LVN may be a
g g g g g g g g g g g
resultof the NPA, the primarypurpose of the NPA of each state defines the
g g g g g g g g g g g g g g
scopeof nursing practice in that state.
g g g g g g g
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 3 g g gg g g g
TOP: NPA
g KEY: Nursing Process Step: Implementation
g g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
g g g g g g g g g g g g g g g g
vocational nurse has not been taught during her educational program. How should the vocational
g g g g g g g g g g g g g g
nurserespond?
g g
a. Ask a more experienced nurse to demonstrate the procedure.
g g g g g g g g
b. Look up the procedure in the procedure manual.
g g g g g g g
c. Attempt to perform the procedure with supervision. g g g g g g
d. Inform the charge nurse of her lack of training in this procedure.
g g g g g g g g g g g
ANS: D g
The charge nurse should be informed of the lack of training to perform the procedure, and the
g g g g g g g g g g g g g g g g
vocational nurse should seek further training to gain proficiency. Although the other options might
g g g g g g g g g g g g g g
behelpful, they are not safe.
g g g g g g
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 g g gg g g g
TOP: Providing Safe Care
g g KEY: Nursing Process Step: g g g g g
N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
3. Which patient statement indicates a need for further discharge teaching that the vocational
g g g g g g g g g g g g
nurseshould address?
g g g
a. "I have no idea of how this drug will affect me."
g g g g g g g g g g
b. "Do you know if my physician is coming back today?"
g g g g g g g g g
c. "Will my insurance pay for my stay?" g g g g g g
d. "Am I going to have to go to a nursing home?"
g g g g g g g g g g
ANS: A g
Lack of knowledge at discharge about medication effects and side effects is a concern that should
g g g g g g g g g g g g g g g
beaddressed by the vocational nurse. The other concerns in the options are the responsibility of
g g g g g g g g g g g g g g g g
other departments to which the nurse might refer the patient.
g g g g g g g g g g
DIF: Cognitive Level: Application REF: p. 2 OBJ: 1 g g gg g g g
TOP: Teaching
g KEY: Nursing Process Step: Implementation
g g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g
,4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
g g g g g g g g g g g g g g g
facilityacts in which capacity?
g g g g g
a. Working under direct supervision of an RN on the unit g g g g g g g g g
b. Working with the RN in the building g g g g g g
c. Working under general supervision by the RN available on site or by phone
g g g g g g g g g g g g
d. Working as an independent vocational nurse g g g g g
ANS: C g
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
g g g g g g g g g g g g g g g g
thegeneral supervision of an RN available on site or by phone.
g g g g g g g g g g g g
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 g g gg g g g
TOP: Charge Nurse/Manager
g g KEY: Nursing Process Step: g g g g
N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
5. The nurse is educating a patient that is a member of a health maintenance organization (HMO).
g g g g g g g g g g g g g g g
Whichinformation should the nurse include?
g g g g g g
a. Seek the opinion of an alternate health care provider.
g g g g g g g g
b. Contact the insurance company for coverage details as services may be limited.
g g g g g g g g g g g
c. Provide detailed documentation of all care received for his condition.
g g g g g g g g g
d. Wait at least 6 months to see a specialist.
g g g g g g g g
ANS: B g
HMOs are a kind of managed care. This is accomplished by paying providers to care for groups
g g g g g g g g g g g g g g g g
of patients for a set capitation fee and by limiting services. Patients are not required to seek a
g g g g g g g g g g g g g g g g g g
second opinion, provide documentation of care, or wait a specific time period before visiting a
g g g g g g g g g g g g g g g
specialist.
g
DIF: Cognitive Level: Application
gg g REF: p. 9 OBJ: 9 g g gg g g g
TOP: Charge Nurse/Manager g KEY: Nursing Process Step: g g g g
ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
6. The patient complains to the nurse that he is confused about his "deductible" that he owes the
g g g g g g g g g g g g g g g g
hospital.Which statement accurately explains a deductible?
g g g g g g g
a. An amount of money put aside for the payment of future medical bills
g g g g g g g g g g g g
b. A one-time fee for service
g g g g
c. An amount of money deducted from the bill by the insurance company
g g g g g g g g g g g
d. An annual amount of money the patient must pay out-of-pocket for medical care
g g g g g g g g g g g g
ANS: D g
The deductible is the annual amount the insured must pay out-of-pocket prior to the
g g g g g g g g g g g g g
insurancecompany assuming the cost. This practice improves the profit of the insurance
g g g g g g g g g g g g g
company.
g
DIF: Cognitive Level: Comprehension
gg g REF: p. 7 OBJ: 9 g g gggg g gg g g g
TOP: Health Care Financing g KEY: Nursing Process Step: g g g g g
ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
g g g g g g g g g g g g g
a. Medicare Part A covers inpatient hospital costs. g g g g g g
b. Medicare Part A covers reimbursement to the physician. g g g g g g g
c. Medicare Part A covers outpatient hospital services. g g g g g g
d. Medicare Part A covers ambulance transportation. g g g g g
ANS: A g
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive
g g g g g g g g g g g g
care.Medicare Part B pays the physician, ambulance transport, and outpatient services.
g g g g g g g g g g g g
, DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 g g g g g g
OBJ: 9 gg g TOP: Government-Sponsored Health g g
InsuranceKEY: Nursing Process Step: Implementation
g g g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
g g g g g g g g g
a. Hospitals focus only on the specific diagnosis. g g g g g g
b. Hospitals treat and discharge patients quickly. g g g g g
c. Reduced cost drugs are ordered for specific diagnoses.
g g g g g g g
d. Diagnostic group classification streamlines care. g g g g
ANS: B g
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient's
g g g g g g g g g g g g g g g
diagnosticcategory regardless of the length of time in the hospital. If hospitals can treat and
g g g g g g g g g g g g g g g g
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
g g g g g g g g g g g g g g g
contained, and the patient is discharged sooner.
g g g g g g g
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: 9 g g gg g g g
TOP: Government-Sponsored Health Insurance
g g g g
KEY: Nursing Process Step: Implementation
g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g
9. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
g g g g g g g g g g g g g g g
a. A 35-year-old unemployed single mother with diabetes
g g g g g g
b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-
g g g g g g g g g g g g g
termcare facility g g
c. An 80-year-old blind woman living in her own home who has inadequate
g g g g g g g g g g g
privateinsurance
g g
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
g g g g g g g g g g g g
ANS: A g
Medicaid is a joint effort of federal and state governments geared primarily for low-income
g g g g g g g g g g g g g
peoplewith no insurance.
g g g g
DIF: Cognitive Level: Application REF: p. 8, Box 1-5 g g g g g g
OBJ: 9 gg g TOP: Government-Sponsored Health Insurance—Medicaid g g g
KEY: Nursing Process Step: Assessment
g g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through which
g g g g g g g g g g g g g g g
toimprove the health of Americans in the second decade of the century?
g g g g g g g g g g g g g
a. Research funding g
b. Health information distribution g g
c. Healthy lifestyle encouragement g g
d. Health improvement program designs g g g
ANS: C g
Healthy People 2020 focuses on expanding ongoing programs to include support and information
g g g g g g g g g g g g
toreduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective
g g g g g g g g g g g g g
immunizations, healthy eating habits, and healthy weight.
g g g g g g g
DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 7 g g gg g g g
TOP: Healthy People 2020
g KEY: Nursing Process Step: g g g g g
ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
g g g g g
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition
g g g g g g g
MULTIPLE CHOICE
g
,1. Which statement accurately describes the primary purpose of the state nurse
g g g g g g g g g g
practice act (NPA)?
g g g
a. To test and license LPN/LVNs
g g g g
b. To define the scope of LPN/LVN practice
g g g g g g
c. To improve the quality of care provided by the LPN/LVN
g g g g g g g g g
d. To limit the LPN/LVN employment placement
g g g g g
ANS: B g
While improving quality of care provided by the LPN/LVN may be a
g g g g g g g g g g g
resultof the NPA, the primarypurpose of the NPA of each state defines the
g g g g g g g g g g g g g g
scopeof nursing practice in that state.
g g g g g g g
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 3 g g gg g g g
TOP: NPA
g KEY: Nursing Process Step: Implementation
g g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
g g g g g g g g g g g g g g g g
vocational nurse has not been taught during her educational program. How should the vocational
g g g g g g g g g g g g g g
nurserespond?
g g
a. Ask a more experienced nurse to demonstrate the procedure.
g g g g g g g g
b. Look up the procedure in the procedure manual.
g g g g g g g
c. Attempt to perform the procedure with supervision. g g g g g g
d. Inform the charge nurse of her lack of training in this procedure.
g g g g g g g g g g g
ANS: D g
The charge nurse should be informed of the lack of training to perform the procedure, and the
g g g g g g g g g g g g g g g g
vocational nurse should seek further training to gain proficiency. Although the other options might
g g g g g g g g g g g g g g
behelpful, they are not safe.
g g g g g g
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 g g gg g g g
TOP: Providing Safe Care
g g KEY: Nursing Process Step: g g g g g
N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
3. Which patient statement indicates a need for further discharge teaching that the vocational
g g g g g g g g g g g g
nurseshould address?
g g g
a. "I have no idea of how this drug will affect me."
g g g g g g g g g g
b. "Do you know if my physician is coming back today?"
g g g g g g g g g
c. "Will my insurance pay for my stay?" g g g g g g
d. "Am I going to have to go to a nursing home?"
g g g g g g g g g g
ANS: A g
Lack of knowledge at discharge about medication effects and side effects is a concern that should
g g g g g g g g g g g g g g g
beaddressed by the vocational nurse. The other concerns in the options are the responsibility of
g g g g g g g g g g g g g g g g
other departments to which the nurse might refer the patient.
g g g g g g g g g g
DIF: Cognitive Level: Application REF: p. 2 OBJ: 1 g g gg g g g
TOP: Teaching
g KEY: Nursing Process Step: Implementation
g g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g
,4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
g g g g g g g g g g g g g g g
facilityacts in which capacity?
g g g g g
a. Working under direct supervision of an RN on the unit g g g g g g g g g
b. Working with the RN in the building g g g g g g
c. Working under general supervision by the RN available on site or by phone
g g g g g g g g g g g g
d. Working as an independent vocational nurse g g g g g
ANS: C g
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
g g g g g g g g g g g g g g g g
thegeneral supervision of an RN available on site or by phone.
g g g g g g g g g g g g
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 g g gg g g g
TOP: Charge Nurse/Manager
g g KEY: Nursing Process Step: g g g g
N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
5. The nurse is educating a patient that is a member of a health maintenance organization (HMO).
g g g g g g g g g g g g g g g
Whichinformation should the nurse include?
g g g g g g
a. Seek the opinion of an alternate health care provider.
g g g g g g g g
b. Contact the insurance company for coverage details as services may be limited.
g g g g g g g g g g g
c. Provide detailed documentation of all care received for his condition.
g g g g g g g g g
d. Wait at least 6 months to see a specialist.
g g g g g g g g
ANS: B g
HMOs are a kind of managed care. This is accomplished by paying providers to care for groups
g g g g g g g g g g g g g g g g
of patients for a set capitation fee and by limiting services. Patients are not required to seek a
g g g g g g g g g g g g g g g g g g
second opinion, provide documentation of care, or wait a specific time period before visiting a
g g g g g g g g g g g g g g g
specialist.
g
DIF: Cognitive Level: Application
gg g REF: p. 9 OBJ: 9 g g gg g g g
TOP: Charge Nurse/Manager g KEY: Nursing Process Step: g g g g
ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
6. The patient complains to the nurse that he is confused about his "deductible" that he owes the
g g g g g g g g g g g g g g g g
hospital.Which statement accurately explains a deductible?
g g g g g g g
a. An amount of money put aside for the payment of future medical bills
g g g g g g g g g g g g
b. A one-time fee for service
g g g g
c. An amount of money deducted from the bill by the insurance company
g g g g g g g g g g g
d. An annual amount of money the patient must pay out-of-pocket for medical care
g g g g g g g g g g g g
ANS: D g
The deductible is the annual amount the insured must pay out-of-pocket prior to the
g g g g g g g g g g g g g
insurancecompany assuming the cost. This practice improves the profit of the insurance
g g g g g g g g g g g g g
company.
g
DIF: Cognitive Level: Comprehension
gg g REF: p. 7 OBJ: 9 g g gggg g gg g g g
TOP: Health Care Financing g KEY: Nursing Process Step: g g g g g
ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
g g g g g g g g g g g g g
a. Medicare Part A covers inpatient hospital costs. g g g g g g
b. Medicare Part A covers reimbursement to the physician. g g g g g g g
c. Medicare Part A covers outpatient hospital services. g g g g g g
d. Medicare Part A covers ambulance transportation. g g g g g
ANS: A g
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive
g g g g g g g g g g g g
care.Medicare Part B pays the physician, ambulance transport, and outpatient services.
g g g g g g g g g g g g
, DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 g g g g g g
OBJ: 9 gg g TOP: Government-Sponsored Health g g
InsuranceKEY: Nursing Process Step: Implementation
g g g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
g g g g g g g g g
a. Hospitals focus only on the specific diagnosis. g g g g g g
b. Hospitals treat and discharge patients quickly. g g g g g
c. Reduced cost drugs are ordered for specific diagnoses.
g g g g g g g
d. Diagnostic group classification streamlines care. g g g g
ANS: B g
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient's
g g g g g g g g g g g g g g g
diagnosticcategory regardless of the length of time in the hospital. If hospitals can treat and
g g g g g g g g g g g g g g g g
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
g g g g g g g g g g g g g g g
contained, and the patient is discharged sooner.
g g g g g g g
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: 9 g g gg g g g
TOP: Government-Sponsored Health Insurance
g g g g
KEY: Nursing Process Step: Implementation
g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g
9. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
g g g g g g g g g g g g g g g
a. A 35-year-old unemployed single mother with diabetes
g g g g g g
b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-
g g g g g g g g g g g g g
termcare facility g g
c. An 80-year-old blind woman living in her own home who has inadequate
g g g g g g g g g g g
privateinsurance
g g
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
g g g g g g g g g g g g
ANS: A g
Medicaid is a joint effort of federal and state governments geared primarily for low-income
g g g g g g g g g g g g g
peoplewith no insurance.
g g g g
DIF: Cognitive Level: Application REF: p. 8, Box 1-5 g g g g g g
OBJ: 9 gg g TOP: Government-Sponsored Health Insurance—Medicaid g g g
KEY: Nursing Process Step: Assessment
g g g g g
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through which
g g g g g g g g g g g g g g g
toimprove the health of Americans in the second decade of the century?
g g g g g g g g g g g g g
a. Research funding g
b. Health information distribution g g
c. Healthy lifestyle encouragement g g
d. Health improvement program designs g g g
ANS: C g
Healthy People 2020 focuses on expanding ongoing programs to include support and information
g g g g g g g g g g g g
toreduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective
g g g g g g g g g g g g g
immunizations, healthy eating habits, and healthy weight.
g g g g g g g
DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 7 g g gg g g g
TOP: Healthy People 2020
g KEY: Nursing Process Step: g g g g g
ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
g g g g g g g g g
