,Chapter 01: Caring for Medical-Surgical Patients
b b b b b
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 6
b b b b b b
MULTIPLE CHOICE b
1. Which statement accurately describes the primary purpose of the state nurse practice act
b b b b b b b b b b b b
(NPA)?
b
a. To test and license LPN/LVNs
b b b b
b. To define the scope of LPN/LVN practice
b b b b b b
c. To improve the quality of care provided by the LPN/LVN
b b b b b b b b b
d. To limit the LPN/LVN employment placement
b b b b b
ANS: B b
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
b b b b b b b b b b b b b b b b
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
b b b b b b b b b b b b b b b b b
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: b b b b
b3 TOP: NPA
b KEY: Nursing Process Step: Implementation
b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
b b b b b b b b b b b b b b b b
vocational nurse has not been taught during her educational program. How should the
b b b b b b b b b b b b b
vocational nurse respond?
b b b
a. Ask a more experienced nurse to demonstrate the procedure.
b b b b b b b b
b. Look up the procedure in the procedure manual.
b b b b b b b
c. Attempt to perform the procedure with supervision. b b b b b b
d. Inform the charge nurse of her lack of training in this procedure.
b b b b b b b b b b b
ANS: D b
The charge nurse should be informed of the lack of training to perform the procedure, and the
b b b b b b b b b b b b b b b b
vocational nurse should seek further training to gain proficiency. Although the other options
b b b b b b b b b b b b b
might be helpful, they are not safe.
b b b b b b b
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 b b b b b
TOP: Providing Safe Care
b b KEY: Nursing Process Step: N/A b b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b b
3. Which patient statement indicates a need for further discharge teaching that the vocational
b b b b b b b b b b b b
bnurse should address?
b b
a. ―I have no idea of how this drug will affect me.‖
b b b b b b b b b b
b. ―Do you know if my physician is coming back today?‖
b b b b b b b b b
c. ―Will my insurance pay for my stay?‖ b b b b b b
d. ―Am I going to have to go to a nursing home?‖b b b b b b b b b b
ANS: A b
Lack of knowledge at discharge about medication effects and side effects is a concern that
b b b b b b b b b b b b b b
should be addressed by the vocational nurse. The other concerns in the options are the
b b b b b b b b b b b b b b b
responsibility of other departments to which the nurse might refer the patient.
b b b b b b b b b b b b
DIF: Cognitive Level: Application REF: p. 2 OBJ: b b b b
b1 TOP: Teaching KEY: Nursing Process Step: Implementation
b b b b b b
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
b b b b b b b b b b b b b b b
bfacility acts in which capacity?
b b b b
a. Working under direct supervision of an RN on the unit b b b b b b b b b
b. Working with the RN in the building b b b b b b
c. Working under general supervision by the RN available on site or by phone
b b b b b b b b b b b b
d. Working as an independent vocational nurse b b b b b
ANS: C b
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
b b b b b b b b b b b b b b b b
the general supervision of an RN available on site or by phone.
b b b b b b b b b b b b
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 b b b b b
TOP: Charge Nurse/Manager
b b KEY: Nursing Process Step: N/A b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b b
5. The nurse is educating a patient that is a member of a health maintenance organization
b b b b b b b b b b b b b b
(HMO). Which information should the nurse include?
b b b b b b b
a. Seek the opinion of an alternate health care provider.
b b b b b b b b
b. Contact the insurance company for coverage details as services may be limited.
b b b b b b b b b b b
c. Provide detailed documentation of all care received for his condition.
b b b b b b b b b
d. Wait at least 6 months to see a specialist.
b b b b b b b b
ANS: B b
HMOs are a kind of managed care. This is accomplished by paying providers to care for
b b b b b b b b b b b b b b b
groups of patients for a set capitation fee and by limiting services. Patients are not required to
b b b b b b b b b b b b b b b b b
seek a second opinion, provide documentation of care, or wait a specific time period before
b b b b b b b b b b b b b b b
visiting a specialist.
b b b
DIF: Cognitive Level: Application REF: p. 9 OBJ: 9 b b b b b b b
TOP: Charge Nurse/Manager
b KEY: Nursing Process Step: Implementation
b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b b
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the
b b b b b b b b b b b b b b b b
hospital. Which statement accurately explains a deductible?
b b b b b b b
a. An amount of money put aside for the payment of future medical bills
b b b b b b b b b b b b
b. A one-time fee for service
b b b b
c. An amount of money deducted from the bill by the insurance company
b b b b b b b b b b b
d. An annual amount of money the patient must pay out-of-pocket for medical care
b b b b b b b b b b b b
ANS: D b
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
b b b b b b b b b b b b b b
company assuming the cost. This practice improves the profit of the insurance company.
b b b b b b b b b b b b b
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9 b b b b b b b
TOP: Health Care Financing
b KEY: Nursing Process Step: Implementation
b b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b b
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
b b b b b b b b b b b b b
a. Medicare Part A covers inpatient hospital costs. b b b b b b
b. Medicare Part A covers reimbursement to the physician. b b b b b b b
, c. Medicare Part A covers outpatient hospital services. b b b b b b
d. Medicare Part A covers ambulance transportation. b b b b b
ANS: A b
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
b b b b b b b b b b b
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
b b b b b b b b b b b b
services.
b
DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 b b b b b b
OBJ: 9 b TOP: Government-Sponsored Health b b
Insurance KEY: Nursing Process Step: Implementation
b b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
b b b b b b b b b
a. Hospitals focus only on the specific diagnosis. b b b b b b
b. Hospitals treat and discharge patients quickly. b b b b b
c. Reduced cost drugs are ordered for specific diagnoses.
b b b b b b b
d. Diagnostic group classification streamlines care. b b b b
ANS: B b
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
b b b b b b b b b b b b b b b
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
b b b b b b b b b b b b b b b b
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
b b b b b b b b b b b b b b b
contained, and the patient is discharged sooner.
b b b b b b b
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: b b b b
b9 TOP: Government-Sponsored Health Insurance
b b b b
KEY: Nursing Process Step: Implementation
b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
9. The nurse is assessing a group of patients. Which patient would most likely qualify for
b b b b b b b b b b b b b b
Medicaid?
b
a. A 35-year-old unemployed single mother with diabetes
b b b b b b
b. A 70-year-old Medicare recipient with retirement income who needs to be in a
b b b b b b b b b b b b
long-term care facility b b
c. An 80-year-old blind woman living in her own home who has inadequate private
b b b b b b b b b b b b
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
b b b b b b b b b b b b
ANS: A b
Medicaid is a joint effort of federal and state governments geared primarily for low-income
b b b b b b b b b b b b b
people with no insurance.
b b b b
DIF: Cognitive Level: Application REF: p. 8, Box 1-5 b b b b b b
OBJ: 9 b TOP: Government-Sponsored Health Insurance— b b b
Medicaid KEY: Nursing Process Step: Assessment
b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through
b b b b b b b b b b b b b b
bwhich to improve the health of Americans in the second decade of the century?
b b b b b b b b b b b b b
a. Research funding b
b. Health information distribution b b
b b b b b
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 6
b b b b b b
MULTIPLE CHOICE b
1. Which statement accurately describes the primary purpose of the state nurse practice act
b b b b b b b b b b b b
(NPA)?
b
a. To test and license LPN/LVNs
b b b b
b. To define the scope of LPN/LVN practice
b b b b b b
c. To improve the quality of care provided by the LPN/LVN
b b b b b b b b b
d. To limit the LPN/LVN employment placement
b b b b b
ANS: B b
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
b b b b b b b b b b b b b b b b
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
b b b b b b b b b b b b b b b b b
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: b b b b
b3 TOP: NPA
b KEY: Nursing Process Step: Implementation
b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
b b b b b b b b b b b b b b b b
vocational nurse has not been taught during her educational program. How should the
b b b b b b b b b b b b b
vocational nurse respond?
b b b
a. Ask a more experienced nurse to demonstrate the procedure.
b b b b b b b b
b. Look up the procedure in the procedure manual.
b b b b b b b
c. Attempt to perform the procedure with supervision. b b b b b b
d. Inform the charge nurse of her lack of training in this procedure.
b b b b b b b b b b b
ANS: D b
The charge nurse should be informed of the lack of training to perform the procedure, and the
b b b b b b b b b b b b b b b b
vocational nurse should seek further training to gain proficiency. Although the other options
b b b b b b b b b b b b b
might be helpful, they are not safe.
b b b b b b b
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 b b b b b
TOP: Providing Safe Care
b b KEY: Nursing Process Step: N/A b b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b b
3. Which patient statement indicates a need for further discharge teaching that the vocational
b b b b b b b b b b b b
bnurse should address?
b b
a. ―I have no idea of how this drug will affect me.‖
b b b b b b b b b b
b. ―Do you know if my physician is coming back today?‖
b b b b b b b b b
c. ―Will my insurance pay for my stay?‖ b b b b b b
d. ―Am I going to have to go to a nursing home?‖b b b b b b b b b b
ANS: A b
Lack of knowledge at discharge about medication effects and side effects is a concern that
b b b b b b b b b b b b b b
should be addressed by the vocational nurse. The other concerns in the options are the
b b b b b b b b b b b b b b b
responsibility of other departments to which the nurse might refer the patient.
b b b b b b b b b b b b
DIF: Cognitive Level: Application REF: p. 2 OBJ: b b b b
b1 TOP: Teaching KEY: Nursing Process Step: Implementation
b b b b b b
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
b b b b b b b b b b b b b b b
bfacility acts in which capacity?
b b b b
a. Working under direct supervision of an RN on the unit b b b b b b b b b
b. Working with the RN in the building b b b b b b
c. Working under general supervision by the RN available on site or by phone
b b b b b b b b b b b b
d. Working as an independent vocational nurse b b b b b
ANS: C b
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
b b b b b b b b b b b b b b b b
the general supervision of an RN available on site or by phone.
b b b b b b b b b b b b
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 b b b b b
TOP: Charge Nurse/Manager
b b KEY: Nursing Process Step: N/A b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b b
5. The nurse is educating a patient that is a member of a health maintenance organization
b b b b b b b b b b b b b b
(HMO). Which information should the nurse include?
b b b b b b b
a. Seek the opinion of an alternate health care provider.
b b b b b b b b
b. Contact the insurance company for coverage details as services may be limited.
b b b b b b b b b b b
c. Provide detailed documentation of all care received for his condition.
b b b b b b b b b
d. Wait at least 6 months to see a specialist.
b b b b b b b b
ANS: B b
HMOs are a kind of managed care. This is accomplished by paying providers to care for
b b b b b b b b b b b b b b b
groups of patients for a set capitation fee and by limiting services. Patients are not required to
b b b b b b b b b b b b b b b b b
seek a second opinion, provide documentation of care, or wait a specific time period before
b b b b b b b b b b b b b b b
visiting a specialist.
b b b
DIF: Cognitive Level: Application REF: p. 9 OBJ: 9 b b b b b b b
TOP: Charge Nurse/Manager
b KEY: Nursing Process Step: Implementation
b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b b
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the
b b b b b b b b b b b b b b b b
hospital. Which statement accurately explains a deductible?
b b b b b b b
a. An amount of money put aside for the payment of future medical bills
b b b b b b b b b b b b
b. A one-time fee for service
b b b b
c. An amount of money deducted from the bill by the insurance company
b b b b b b b b b b b
d. An annual amount of money the patient must pay out-of-pocket for medical care
b b b b b b b b b b b b
ANS: D b
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
b b b b b b b b b b b b b b
company assuming the cost. This practice improves the profit of the insurance company.
b b b b b b b b b b b b b
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9 b b b b b b b
TOP: Health Care Financing
b KEY: Nursing Process Step: Implementation
b b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b b
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
b b b b b b b b b b b b b
a. Medicare Part A covers inpatient hospital costs. b b b b b b
b. Medicare Part A covers reimbursement to the physician. b b b b b b b
, c. Medicare Part A covers outpatient hospital services. b b b b b b
d. Medicare Part A covers ambulance transportation. b b b b b
ANS: A b
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
b b b b b b b b b b b
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
b b b b b b b b b b b b
services.
b
DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 b b b b b b
OBJ: 9 b TOP: Government-Sponsored Health b b
Insurance KEY: Nursing Process Step: Implementation
b b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
b b b b b b b b b
a. Hospitals focus only on the specific diagnosis. b b b b b b
b. Hospitals treat and discharge patients quickly. b b b b b
c. Reduced cost drugs are ordered for specific diagnoses.
b b b b b b b
d. Diagnostic group classification streamlines care. b b b b
ANS: B b
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
b b b b b b b b b b b b b b b
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
b b b b b b b b b b b b b b b b
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
b b b b b b b b b b b b b b b
contained, and the patient is discharged sooner.
b b b b b b b
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: b b b b
b9 TOP: Government-Sponsored Health Insurance
b b b b
KEY: Nursing Process Step: Implementation
b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
9. The nurse is assessing a group of patients. Which patient would most likely qualify for
b b b b b b b b b b b b b b
Medicaid?
b
a. A 35-year-old unemployed single mother with diabetes
b b b b b b
b. A 70-year-old Medicare recipient with retirement income who needs to be in a
b b b b b b b b b b b b
long-term care facility b b
c. An 80-year-old blind woman living in her own home who has inadequate private
b b b b b b b b b b b b
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
b b b b b b b b b b b b
ANS: A b
Medicaid is a joint effort of federal and state governments geared primarily for low-income
b b b b b b b b b b b b b
people with no insurance.
b b b b
DIF: Cognitive Level: Application REF: p. 8, Box 1-5 b b b b b b
OBJ: 9 b TOP: Government-Sponsored Health Insurance— b b b
Medicaid KEY: Nursing Process Step: Assessment
b b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through
b b b b b b b b b b b b b b
bwhich to improve the health of Americans in the second decade of the century?
b b b b b b b b b b b b b
a. Research funding b
b. Health information distribution b b
