,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 zz
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. zz zz zz zz
b. To define the scope of LPN/LVN practice.
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c. To improve the quality of care provided by the
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LPN/LVN. zz
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
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of each state defines the scope of nursing practice in that state.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 zz zz
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation zz zz zz
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
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has
zz zz 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.
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d. Inform the charge nurse of her lack of training in this
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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
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seek 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 zz zz z z
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A zz zz zz zz zz
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
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today?‖ zz
c. ―Will my insurance pay for my stay?‖ zz zz zz zz zz zz
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
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refer the patient.
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PTS: 1 DIF: Cognitive Level: Application REF: 2 zz zz zz zz z z
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation z z zz zz zz
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 zz zz zz zz zz zz zz zz zz
b. Working with the RN in the building zz zz zz zz zz zz
c. Working under general supervision by the RN available on site or by
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phone zz
d. Working as an independent vocational nurse zz zz zz zz zz
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
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RN available on site or by phone.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 zz zz
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A zz zz zz
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
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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 zz zz z z
OBJ: 9 TOP: Charge Nurse/Manager zz
KEY: Nursing Process Step: Implementation
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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
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care zz
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company assuming the cost.
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This practice improves the profit of the insurance company.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: zz zz 7
OBJ: 9 TOP: Health Care Financing zz zz
KEY: Nursing Process Step: Implementation
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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
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provider.
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c. HMOs permit admission to any facility the member
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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 zz zz z z
OBJ: 9 TOP: Managed Care zz
KEY: Nursing Process Step: Implementation
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MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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8. A patient zz zz asks the nurse what Medicare Part A covers. Which response is correct?
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a. Medicare Part zz zz A covers inpatient hospital costs.
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b. Medicare Part zz zz A covers reimbursement to the
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physician.
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c. Medicare Part zz zz A covers outpatient hospital services.
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d. Medicare Part zz zz 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: zz zz 7, Box 1-4
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OBJ: 9 TOP: Government-Sponsored Health Insurance zz zz
KEY: Nursing Process Step: Implementation
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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. zz zz zz zz zz zz
b. Hospitals treat and discharge patients quickly. zz zz zz zz zz
c. Reduced cost drugs are ordered for specific zz zz zz zz zz zz
diagnoses.
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d. Diagnostic group classification streamlines care. zz zz zz zz
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless
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of the length of time in the hospital. If hospitals can treat and discharge patients before the allotted time, hospitals get to
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keep the excess payment; cost is contained, and the patient is discharged sooner.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: zz zz 8
OBJ: 9 TOP: Government-Sponsored Health Insurance zz zz
KEY: zz zz zz zz zz z z Nursing Process Step: Implementation zz zz zz
MSC: zz zz zz zz z z 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
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facility zz
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- zz zz zz zz z z zz zz
5OBJ:z 9 TOP: Government-Sponsored Health Insurance–Medicaid zz zz
KEY:
zz Nursing Process Step: Assessment zz zz zz
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 zz
b. Health information distribution zz zz
c. Healthy lifestyle encouragement zz zz
d. Health improvement program zz zz
designs zz
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant
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mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits,
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and healthy weight.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: zz zz 6
OBJ: 7 TOP: Healthy People 2020 zz zz
KEY: Nursing Process Step: Implementationzz zz zz
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 zz
b. General care zz
c. Directed care zz
d. Holistic care zz
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 zz zz REF: 6
OBJ: 8 TOP: Holistic Care zz
KEY: Nursing Process Step: Planning zz zz zz
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
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trying to askhim!‖ Which response is most empathetic?
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a. ―When people ignore me, I really get mad.‖ zz zz zz zz zz zz zz
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deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
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MULTIPLE CHOICE zz
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. zz zz zz zz
b. To define the scope of LPN/LVN practice.
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c. To improve the quality of care provided by the
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LPN/LVN. zz
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
zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz
of each state defines the scope of nursing practice in that state.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 zz zz
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation zz zz zz
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
zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz
has
zz zz 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.
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d. Inform the charge nurse of her lack of training in this
zz zz zz zz zz zz zz zz zz zz
procedure.
zz
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should
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seek 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 zz zz z z
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A zz zz zz zz zz
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
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today?‖ zz
c. ―Will my insurance pay for my stay?‖ zz zz zz zz zz zz
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
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refer the patient.
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PTS: 1 DIF: Cognitive Level: Application REF: 2 zz zz zz zz z z
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation z z zz zz zz
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
zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz
which capacity?
zz zz
a. Working under direct supervision of an RN on the unit zz zz zz zz zz zz zz zz zz
b. Working with the RN in the building zz zz zz zz zz zz
c. Working under general supervision by the RN available on site or by
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phone zz
d. Working as an independent vocational nurse zz zz zz zz zz
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
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RN available on site or by phone.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 zz zz
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A zz zz zz
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
zz zz zz zz zz zz
,5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz
informationshould the nurse include?
zz z zz zz zz
a. Seek the opinion of an alternate health care provider.
zz zz zz zz zz zz zz zz
b. Obtain insurance approval for medical services prior to treatment.
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c. Provide detailed documentation of all care received for his
zz zz zz zz zz zz zz zz
condition.
zz
d. Wait at least 6 months to see a specialist.
zz zz zz zz zz zz zz zz
ANS: B
Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion, provide
zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz
documentation of care, or wait a specific time period before visiting a specialist.
zz zz zz zz zz zz zz zz zz zz zz zz zz
PTS: 1 DIF: Cognitive Level: Application REF: 9 zz zz z z
OBJ: 9 TOP: Charge Nurse/Manager zz
KEY: Nursing Process Step: Implementation
zz zz zz
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.
zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz
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
zz zz zz zz
c. An amount of money deducted from the bill by the insurance company
zz zz zz zz zz zz zz zz zz zz zz
d. An annual amount of money the patient must pay out-of-pocket for medical
zz zz zz zz zz zz zz zz zz zz zz
care zz
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company assuming the cost.
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This practice improves the profit of the insurance company.
zz zz zz zz zz zz zz zz zz
PTS: 1 DIF: Cognitive Level: Comprehension REF: zz zz 7
OBJ: 9 TOP: Health Care Financing zz zz
KEY: Nursing Process Step: Implementation
zz zz zz
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
zz zz zz zz zz zz
7. The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred
zz zz zz zz zz zz zz zz zz zz zz zz zz
providerorganization (PPO). Which information should the nurse include about HMOs?
zz z zz zz zz zz zz zz zz zz zz
a. HMOs require a set fee of each member monthly.
zz zz zz zz zz zz zz zz
b. HMOs allow the member to select his health care
zz zz zz zz zz zz zz zz
provider.
zz
c. HMOs permit admission to any facility the member
zz zz zz zz zz zz zz
prefers.
zz
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-
zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz zz
approved facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
zz zz zz zz zz zz zz zz zz zz zz zz zz
PTS: 1 DIF: Cognitive Level: Application REF: 9 zz zz z z
OBJ: 9 TOP: Managed Care zz
KEY: Nursing Process Step: Implementation
zz zz zz
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
zz zz zz zz zz zz
8. A patient zz zz asks the nurse what Medicare Part A covers. Which response is correct?
zz zz zz zz zz zz zz zz zz zz zz
a. Medicare Part zz zz A covers inpatient hospital costs.
zz zz zz zz
b. Medicare Part zz zz A covers reimbursement to the
zz zz zz zz
physician.
zz
c. Medicare Part zz zz A covers outpatient hospital services.
zz zz zz zz
d. Medicare Part zz zz A covers ambulance transportation.
zz zz zz
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.
zz zz zz zz zz zz zz
PTS: 1 DIF: Cognitive Level: Comprehension REF: zz zz 7, Box 1-4
zz zz
OBJ: 9 TOP: Government-Sponsored Health Insurance zz zz
KEY: Nursing Process Step: Implementation
zz zz zz
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
zz zz zz zz zz zz
9. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
zz zz zz zz zz zz zz zz zz
, a. Hospitals focus only on the specific diagnosis. zz zz zz zz zz zz
b. Hospitals treat and discharge patients quickly. zz zz zz zz zz
c. Reduced cost drugs are ordered for specific zz zz zz zz zz zz
diagnoses.
zz
d. Diagnostic group classification streamlines care. zz zz zz zz
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless
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of the length of time in the hospital. If hospitals can treat and discharge patients before the allotted time, hospitals get to
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keep the excess payment; cost is contained, and the patient is discharged sooner.
zz zz zz zz zz zz zz zz zz zz zz zz zz
PTS: 1 DIF: Cognitive Level: Comprehension REF: zz zz 8
OBJ: 9 TOP: Government-Sponsored Health Insurance zz zz
KEY: zz zz zz zz zz z z Nursing Process Step: Implementation zz zz zz
MSC: zz zz zz zz z z 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
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facility zz
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- zz zz zz zz z z zz zz
5OBJ:z 9 TOP: Government-Sponsored Health Insurance–Medicaid zz zz
KEY:
zz Nursing Process Step: Assessment zz zz zz
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 zz
b. Health information distribution zz zz
c. Healthy lifestyle encouragement zz zz
d. Health improvement program zz zz
designs zz
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant
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mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits,
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and healthy weight.
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PTS: 1 DIF: Cognitive Level: Comprehension REF: zz zz 6
OBJ: 7 TOP: Healthy People 2020 zz zz
KEY: Nursing Process Step: Implementationzz zz zz
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 zz
b. General care zz
c. Directed care zz
d. Holistic care zz
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 zz zz REF: 6
OBJ: 8 TOP: Holistic Care zz
KEY: Nursing Process Step: Planning zz zz zz
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
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trying to askhim!‖ Which response is most empathetic?
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a. ―When people ignore me, I really get mad.‖ zz zz zz zz zz zz zz
