,Chapter 01: Caring for Medical-Surgical Patients
q q q q q
Stromberg: Medical-Surgical Nursing: Concepts and Practice 6th Edition
q q q q q
MULTIPLE CHOICE q
1. Which statement accurately describes the primary purpose of the state nurse practice act
q q q q q q q q q q q q
(NPA)?
q
a. To test and license LPN/LVNs
q q q q
b. To define the scope of LPN/LVN practice
q q q q q q
c. To improve the quality of care provided by the LPN/LVN
q q q q q q q q q
d. To limit the LPN/LVN employment placement
q q q q q
ANS: B q
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
q q q q q q q q q q q q q q q q
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
q q q q q q q q q q q q q q q q q
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: q q q q
q3 TOP: NPA
q KEY: Nursing Process Step: Implementation
q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
q q q q q q q q q q q q q q q q
vocational nurse has not been taught during her educational program. How should the
q q q q q q q q q q q q q
vocational nurse respond?
q q q
a. Ask a more experienced nurse to demonstrate the procedure.
q q q q q q q q
b. Look up the procedure in the procedure manual.
q q q q q q q
c. Attempt to perform the procedure with supervision. q q q q q q
d. Inform the charge nurse of her lack of training in this procedure.
q q q q q q q q q q q
ANS: D q
The charge nurse should be informed of the lack of training to perform the procedure, and the
q q q q q q q q q q q q q q q q
vocational nurse should seek further training to gain proficiency. Although the other options
q q q q q q q q q q q q q
might be helpful, they are not safe.
q q q q q q q
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 q q q q q
TOP: Providing Safe Care
q q KEY: Nursing Process Step: N/A q q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q q
3. Which patient statement indicates a need for further discharge teaching that the vocational
q q q q q q q q q q q q
qnurse should address?
q q
a. ―I have no idea of how this drug will affect me.‖
q q q q q q q q q q
b. ―Do you know if my physician is coming back today?‖
q q q q q q q q q
c. ―Will my insurance pay for my stay?‖ q q q q q q
d. ―Am I going to have to go to a nursing home?‖q q q q q q q q q q
ANS: A q
Lack of knowledge at discharge about medication effects and side effects is a concern that
q q q q q q q q q q q q q q
should be addressed by the vocational nurse. The other concerns in the options are the
q q q q q q q q q q q q q q q
responsibility of other departments to which the nurse might refer the patient.
q q q q q q q q q q q q
DIF: Cognitive Level: Application REF: p. 2 OBJ: q q q q
q1 TOP: Teaching KEY: Nursing Process Step: Implementation
q q q q q q
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
q q q q q q q q q q q q q q q
qfacility acts in which capacity?
q q q q
a. Working under direct supervision of an RN on the unit q q q q q q q q q
b. Working with the RN in the building q q q q q q
c. Working under general supervision by the RN available on site or by phone
q q q q q q q q q q q q
d. Working as an independent vocational nurse q q q q q
ANS: C q
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
q q q q q q q q q q q q q q q q
the general supervision of an RN available on site or by phone.
q q q q q q q q q q q q
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 q q q q q
TOP: Charge Nurse/Manager
q q KEY: Nursing Process Step: N/A q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q q
5. The nurse is educating a patient that is a member of a health maintenance organization
q q q q q q q q q q q q q q
(HMO). Which information should the nurse include?
q q q q q q q
a. Seek the opinion of an alternate health care provider.
q q q q q q q q
b. Contact the insurance company for coverage details as services may be limited.
q q q q q q q q q q q
c. Provide detailed documentation of all care received for his condition.
q q q q q q q q q
d. Wait at least 6 months to see a specialist.
q q q q q q q q
ANS: B q
HMOs are a kind of managed care. This is accomplished by paying providers to care for
q q q q q q q q q q q q q q q
groups of patients for a set capitation fee and by limiting services. Patients are not required to
q q q q q q q q q q q q q q q q q
seek a second opinion, provide documentation of care, or wait a specific time period before
q q q q q q q q q q q q q q q
visiting a specialist.
q q q
DIF: Cognitive Level: Application REF: p. 9 OBJ: 9 q q q q q q q
TOP: Charge Nurse/Manager
q KEY: Nursing Process Step: Implementation
q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q q
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the
q q q q q q q q q q q q q q q q
hospital. Which statement accurately explains a deductible?
q q q q q q q
a. An amount of money put aside for the payment of future medical bills
q q q q q q q q q q q q
b. A one-time fee for service
q q q q
c. An amount of money deducted from the bill by the insurance company
q q q q q q q q q q q
d. An annual amount of money the patient must pay out-of-pocket for medical care
q q q q q q q q q q q q
ANS: D q
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
q q q q q q q q q q q q q q
company assuming the cost. This practice improves the profit of the insurance company.
q q q q q q q q q q q q q
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9 q q q q q q q
TOP: Health Care Financing
q KEY: Nursing Process Step: Implementation
q q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q q
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
q q q q q q q q q q q q q
a. Medicare Part A covers inpatient hospital costs. q q q q q q
b. Medicare Part A covers reimbursement to the physician. q q q q q q q
, c. Medicare Part A covers outpatient hospital services. q q q q q q
d. Medicare Part A covers ambulance transportation. q q q q q
ANS: A q
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
q q q q q q q q q q q
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
q q q q q q q q q q q q
services.
q
DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 q q q q q q
OBJ: 9 q TOP: Government-Sponsored Health q q
Insurance KEY: Nursing Process Step: Implementation
q q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
q q q q q q q q q
a. Hospitals focus only on the specific diagnosis. q q q q q q
b. Hospitals treat and discharge patients quickly. q q q q q
c. Reduced cost drugs are ordered for specific diagnoses.
q q q q q q q
d. Diagnostic group classification streamlines care. q q q q
ANS: B q
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
q q q q q q q q q q q q q q q
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
q q q q q q q q q q q q q q q q
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
q q q q q q q q q q q q q q q
contained, and the patient is discharged sooner.
q q q q q q q
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: q q q q
q9 TOP: Government-Sponsored Health Insurance
q q q q
KEY: Nursing Process Step: Implementation
q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
9. The nurse is assessing a group of patients. Which patient would most likely qualify for
q q q q q q q q q q q q q q
Medicaid?
q
a. A 35-year-old unemployed single mother with diabetes
q q q q q q
b. A 70-year-old Medicare recipient with retirement income who needs to be in a
q q q q q q q q q q q q
long-term care facility q q
c. An 80-year-old blind woman living in her own home who has inadequate private
q q q q q q q q q q q q
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
q q q q q q q q q q q q
ANS: A q
Medicaid is a joint effort of federal and state governments geared primarily for low-income
q q q q q q q q q q q q q
people with no insurance.
q q q q
DIF: Cognitive Level: Application REF: p. 8, Box 1-5 q q q q q q
OBJ: 9 q TOP: Government-Sponsored Health Insurance— q q q
Medicaid KEY: Nursing Process Step: Assessment
q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through
q q q q q q q q q q q q q q
qwhich to improve the health of Americans in the second decade of the century?
q q q q q q q q q q q q q
a. Research funding q
b. Health information distribution q q
q q q q q
Stromberg: Medical-Surgical Nursing: Concepts and Practice 6th Edition
q q q q q
MULTIPLE CHOICE q
1. Which statement accurately describes the primary purpose of the state nurse practice act
q q q q q q q q q q q q
(NPA)?
q
a. To test and license LPN/LVNs
q q q q
b. To define the scope of LPN/LVN practice
q q q q q q
c. To improve the quality of care provided by the LPN/LVN
q q q q q q q q q
d. To limit the LPN/LVN employment placement
q q q q q
ANS: B q
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
q q q q q q q q q q q q q q q q
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
q q q q q q q q q q q q q q q q q
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: q q q q
q3 TOP: NPA
q KEY: Nursing Process Step: Implementation
q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
q q q q q q q q q q q q q q q q
vocational nurse has not been taught during her educational program. How should the
q q q q q q q q q q q q q
vocational nurse respond?
q q q
a. Ask a more experienced nurse to demonstrate the procedure.
q q q q q q q q
b. Look up the procedure in the procedure manual.
q q q q q q q
c. Attempt to perform the procedure with supervision. q q q q q q
d. Inform the charge nurse of her lack of training in this procedure.
q q q q q q q q q q q
ANS: D q
The charge nurse should be informed of the lack of training to perform the procedure, and the
q q q q q q q q q q q q q q q q
vocational nurse should seek further training to gain proficiency. Although the other options
q q q q q q q q q q q q q
might be helpful, they are not safe.
q q q q q q q
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 q q q q q
TOP: Providing Safe Care
q q KEY: Nursing Process Step: N/A q q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q q
3. Which patient statement indicates a need for further discharge teaching that the vocational
q q q q q q q q q q q q
qnurse should address?
q q
a. ―I have no idea of how this drug will affect me.‖
q q q q q q q q q q
b. ―Do you know if my physician is coming back today?‖
q q q q q q q q q
c. ―Will my insurance pay for my stay?‖ q q q q q q
d. ―Am I going to have to go to a nursing home?‖q q q q q q q q q q
ANS: A q
Lack of knowledge at discharge about medication effects and side effects is a concern that
q q q q q q q q q q q q q q
should be addressed by the vocational nurse. The other concerns in the options are the
q q q q q q q q q q q q q q q
responsibility of other departments to which the nurse might refer the patient.
q q q q q q q q q q q q
DIF: Cognitive Level: Application REF: p. 2 OBJ: q q q q
q1 TOP: Teaching KEY: Nursing Process Step: Implementation
q q q q q q
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
q q q q q q q q q q q q q q q
qfacility acts in which capacity?
q q q q
a. Working under direct supervision of an RN on the unit q q q q q q q q q
b. Working with the RN in the building q q q q q q
c. Working under general supervision by the RN available on site or by phone
q q q q q q q q q q q q
d. Working as an independent vocational nurse q q q q q
ANS: C q
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
q q q q q q q q q q q q q q q q
the general supervision of an RN available on site or by phone.
q q q q q q q q q q q q
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 q q q q q
TOP: Charge Nurse/Manager
q q KEY: Nursing Process Step: N/A q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q q
5. The nurse is educating a patient that is a member of a health maintenance organization
q q q q q q q q q q q q q q
(HMO). Which information should the nurse include?
q q q q q q q
a. Seek the opinion of an alternate health care provider.
q q q q q q q q
b. Contact the insurance company for coverage details as services may be limited.
q q q q q q q q q q q
c. Provide detailed documentation of all care received for his condition.
q q q q q q q q q
d. Wait at least 6 months to see a specialist.
q q q q q q q q
ANS: B q
HMOs are a kind of managed care. This is accomplished by paying providers to care for
q q q q q q q q q q q q q q q
groups of patients for a set capitation fee and by limiting services. Patients are not required to
q q q q q q q q q q q q q q q q q
seek a second opinion, provide documentation of care, or wait a specific time period before
q q q q q q q q q q q q q q q
visiting a specialist.
q q q
DIF: Cognitive Level: Application REF: p. 9 OBJ: 9 q q q q q q q
TOP: Charge Nurse/Manager
q KEY: Nursing Process Step: Implementation
q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q q
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the
q q q q q q q q q q q q q q q q
hospital. Which statement accurately explains a deductible?
q q q q q q q
a. An amount of money put aside for the payment of future medical bills
q q q q q q q q q q q q
b. A one-time fee for service
q q q q
c. An amount of money deducted from the bill by the insurance company
q q q q q q q q q q q
d. An annual amount of money the patient must pay out-of-pocket for medical care
q q q q q q q q q q q q
ANS: D q
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
q q q q q q q q q q q q q q
company assuming the cost. This practice improves the profit of the insurance company.
q q q q q q q q q q q q q
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9 q q q q q q q
TOP: Health Care Financing
q KEY: Nursing Process Step: Implementation
q q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q q
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
q q q q q q q q q q q q q
a. Medicare Part A covers inpatient hospital costs. q q q q q q
b. Medicare Part A covers reimbursement to the physician. q q q q q q q
, c. Medicare Part A covers outpatient hospital services. q q q q q q
d. Medicare Part A covers ambulance transportation. q q q q q
ANS: A q
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
q q q q q q q q q q q
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
q q q q q q q q q q q q
services.
q
DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 q q q q q q
OBJ: 9 q TOP: Government-Sponsored Health q q
Insurance KEY: Nursing Process Step: Implementation
q q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
q q q q q q q q q
a. Hospitals focus only on the specific diagnosis. q q q q q q
b. Hospitals treat and discharge patients quickly. q q q q q
c. Reduced cost drugs are ordered for specific diagnoses.
q q q q q q q
d. Diagnostic group classification streamlines care. q q q q
ANS: B q
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
q q q q q q q q q q q q q q q
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
q q q q q q q q q q q q q q q q
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
q q q q q q q q q q q q q q q
contained, and the patient is discharged sooner.
q q q q q q q
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: q q q q
q9 TOP: Government-Sponsored Health Insurance
q q q q
KEY: Nursing Process Step: Implementation
q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
9. The nurse is assessing a group of patients. Which patient would most likely qualify for
q q q q q q q q q q q q q q
Medicaid?
q
a. A 35-year-old unemployed single mother with diabetes
q q q q q q
b. A 70-year-old Medicare recipient with retirement income who needs to be in a
q q q q q q q q q q q q
long-term care facility q q
c. An 80-year-old blind woman living in her own home who has inadequate private
q q q q q q q q q q q q
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
q q q q q q q q q q q q
ANS: A q
Medicaid is a joint effort of federal and state governments geared primarily for low-income
q q q q q q q q q q q q q
people with no insurance.
q q q q
DIF: Cognitive Level: Application REF: p. 8, Box 1-5 q q q q q q
OBJ: 9 q TOP: Government-Sponsored Health Insurance— q q q
Medicaid KEY: Nursing Process Step: Assessment
q q q q q
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
q q q q q q q
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through
q q q q q q q q q q q q q q
qwhich to improve the health of Americans in the second decade of the century?
q q q q q q q q q q q q q
a. Research funding q
b. Health information distribution q q
