Medical-Surgical Nursing Review anRed sMedical-Surgical Nursing 4th Edition with 2019 Addendum

,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 v




1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
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a. To test and license LPN/LVNs.
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b. To define the scope of LPN/LVN practice.
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c. To improve the quality of care provided by the LPN/LVN.
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d. To limit the LPN/LVN employment placement.
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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
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each state defines the scope of nursing practice in that state.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 v v


OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation v v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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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.
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c. Attempt to perform the procedure with supervision. v v v v v v


d. Inform the charge nurse of her lack of training in this procedure.
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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 v v v


OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A v v v v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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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 today?”
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c. “Will my insurance pay for my stay?”v v v v v v


d. “Am I going to have to go to a nursing home?”
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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 v v vv v


OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation v v v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in
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which capacity?
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a. Working under direct supervision of an RN on the unit v v v v v v v v v


b. Working with the RN in the building v v v v v v


c. Working under general supervision by the RN available on site or by phone
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d. Working as an independent vocational nurse v v v v v




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.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 v v


OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A v v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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,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 condition.
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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.
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PTS: 1 DIF: Cognitive Level: Application REF: 9 v v v


OBJ: 9 TOP: Charge Nurse/Manager v


KEY: Nursing Process Step: Implementationv v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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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 care
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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: v v 7
OBJ: 9 TOP: Health Care Financing v v


KEY: Nursing Process Step: Implementationv v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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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-
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approved facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
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PTS: 1 DIF: Cognitive Level: Application REF: 9 v v v


OBJ: 9 TOP: Managed Care v


KEY: Nursing Process Step: Implementationv v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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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.
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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.
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ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B pays
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the physician, ambulance transport, and outpatient services.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: v v 7, Box 1-4 v v


OBJ: 9 TOP: Government-Sponsored Health Insurance v v


KEY: Nursing Process Step: Implementationv v v


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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, a. Hospitals focus only on the specific diagnosis. v v v v v v


b. Hospitals treat and discharge patients quickly. v v v v v


c. Reduced cost drugs are ordered for specific diagnoses.
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d. Diagnostic group classification streamlines care. v v v v




ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless of the
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length of time in the hospital. If hospitals can treat and discharge patients before the allotted time, hospitals get to keep the
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excess payment; cost is contained, and the patient is discharged sooner.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: v v 8
OBJ: 9 TOP: Government-Sponsored Health Insurance v v


KEY: vvvvv v Nursing Process Step: Implementation v v v


MSC: vvvv v NCLEX: Safe, Effective Care Environment: Coordinated Care
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10. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
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a. A 35-year-old unemployed single mother with diabetes
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b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-term care facility
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c. An 80-year-old blind woman living in her own home who has inadequate private insurance
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d. A 67-year-old stroke victim with Medicare Part A and an income from investments
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ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no insurance.
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PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1- v v vv v v v


5OBJ:
v 9 TOP: Government-Sponsored Health Insurance–Medicaid v v


KEY:
v Nursing Process Step: Assessment v v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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11. Which area is the major focus of Healthy People 2020 and the primary mechanism through which to improve the
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healthof Americans in the second decade of the century?
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a. Research funding v


b. Health information distribution v v


c. Healthy lifestyle encouragement v v


d. Health improvement program designs v v v




ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant mortality,
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cancer, cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits, and healthy
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weight.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: v v 6
OBJ: 7 TOP: Healthy People 2020 v v


KEY: Nursing Process Step: Implementation v v v


MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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12. Which term explains the type of care that addresses interventions for all dimensions of a patient’s life?
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a. Focused care v


b. General care v


c. Directed care v


d. Holistic care v




ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the patient.
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PTS: 1 DIF: Cognitive Level: Comprehension v v REF: 6
OBJ: 8 TOP: Holistic Care v


KEY: Nursing Process Step: Planning v v v


MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
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13. A patient furiously says, “My doctor was so busy giving me instructions that he didn’t hear what I was trying to
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askhim!” Which response is most empathetic?
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a. “When people ignore me, I really get mad.”v v v v v v v