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,Chapter01:Caring forMedical-Surgical Patients
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Stromberg:Medical-Surgical Nursing:ConceptsandPractice,5thEdition i ii i i i i i
MULTIPLE CHOICE ii
1. Whichstatement accuratelydescribesthe primarypurpose ofthe state nurse
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practice act (NPA)?
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a. Totest and license LPN/LVNs i ii i ii
b. Todefine thescope of LPN/LVNpractice i ii i i ii i
c. Toimprove the qualityof care provided bythe LPN/LVN
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d. TolimittheLPN/LVNemployment placement i i i i ii
ANS: B ii
While improving quality of care provided by the LPN/LVN may be a result of
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the NPA, the primarypurpose of the NPA of each state defines the scope of
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nursing practice in that state.
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DIF: Cognitive Level: Comprehension REF: p. 3 OBJ:3 ii ii i i ii i
TOP: NPA
ii KEY: Nursing Process Step: Implementation
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iMSC: 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
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nurse has not been taught during her educational program. How should the vocational nurse respond?
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a. Aska more experienced nursetodemonstrate theprocedure. i ii ii ii i i ii i
b. Lookup the procedure inthe procedure manual. i ii ii ii i ii ii
c. Attempttoperformthe procedure withsupervision. i i i ii ii i
d. Informthecharge nurse ofherlackof trainingin thisprocedure. i i ii i i i i ii i ii i
ANS: D ii
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational
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nurse should seek further training to gain proficiency. Although the other options might be helpful, they
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are not safe.
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DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 ii ii i i ii ii
TOP: Providing Safe Care
ii KEY: NursingProcess Step: N/A
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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
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should address?
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a. "Ihave no idea of howthisdrugwill affect me."
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b. "Do you know if myphysician is comingbacktoday?" ii ii ii ii i ii ii i i
c. "Will myinsurance payformystay?" ii i ii i i i
d. "AmIgoingto have to go to a nursinghome?" i i i ii ii ii ii ii ii i
ANS: A ii
Lack of knowledge at discharge about medication effects and side effects is a concern that should be
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addressed by the vocational nurse. The other concerns in the options are the responsibility of other
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departments to which the nurse might refer the patient.
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DIF: Cognitive Level: Application REF: p. 2 OBJ:1 ii ii i i ii i
TOP: Teaching
ii KEY: Nursing Process Step: Implementation
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iMSC: 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
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in which capacity?
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a. Workingunder direct supervision of an RNon theunit i ii ii ii ii ii i ii i
b. Workingwith the RNin thebuilding i ii ii i ii i
c. Workingunder general supervision bythe RNavailable on site or byphone i i ii ii i ii i ii ii ii ii i
d. Workingas anindependentvocational nurse i ii i i ii
ANS: C ii
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with the general
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supervision of an RN available on site or by phone.
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DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 ii ii i i ii ii
TOP: Charge Nurse/Manager
ii i i KEY: NursingProcess Step: N/A ii ii i ii ii
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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information should the nurse include?
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a. Seekthe opinion of an alternate healthcareprovider. i ii ii ii i ii i i
b. Contacttheinsurance companyfor coverage details asservices maybelimited. i i ii i i ii ii i ii i i
c. Providedetailed documentationof all carereceived forhiscondition. i ii i ii ii i ii i i
d. Wait at least 6 months to see a specialist. ii ii ii ii ii ii ii ii
ANS: B ii
HMOs are a kind of managed care. This is accomplished by paying providers to care for groups of
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patients for a set capitation fee and by limiting services. Patients are not required to seek a second
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opinion, provide documentation of care, or wait a specific time period before visiting a specialist.
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DIF: CognitiveLevel: Application
i i iREF: p. 9
i OBJ: 9 i ii i i i i ii i i
TOP: Charge Nurse/Manager i i KEY: NursingProcess Step: Implementation ii ii i ii ii
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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Which statement accurately explains a deductible?
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a. An amount of moneyput asideforthepayment of future medical bills
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b. Aone-time fee forservice
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c. An amount of moneydeductedfromthe bill bythe insurancecompany
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d. Anannual amount of moneythe patient must payout-of-pocket for medicalcare
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ANS: D ii
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company
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assuming the cost. This practice improves the profit of the insurance company.
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DIF: Cognitive Level: Comprehension
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i i OBJ: 9 ii ii i i i i i i i i ii i i
TOP: Health Care Financing i KEY: NursingProcess Step: Implementation
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MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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7. Apatientasks the nurse what Medicare Part Acovers.Which responseiscorrect?
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a. Medicare Part Acoversinpatient hospitalcosts. ii ii i i ii i
b. Medicare Part Acoversreimbursement tothephysician. ii ii i i ii i i
c. MedicarePart Acoversoutpatient hospitalservices. i ii i i ii i
d. Medicare Part Acovers ambulancetransportation. ii ii i i i
ANS: A ii
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care.
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Medicare Part B pays the physician, ambulance transport, and outpatient services.
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, DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 i ii ii ii ii ii
OBJ: 9 TOP:Government-SponsoredHealthInsurance
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KEY: Nursing Process Step: Implementation
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MSC:NCLEX:Safe,EffectiveCareEnvironment:CoordinatedCare
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8. Whichisthemaincost-containment component of diagnosis-related groups(DRGs)?
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a. Hospitalsfocus onlyon thespecificdiagnosis. i i i ii i i
b. Hospitals treat and discharge patientsquickly. i ii ii ii i
c. Reducedcost drugs are orderedforspecificdiagnoses. i ii ii ii i i i
d. Diagnosticgroupclassificationstreamlinescare. i i i i
ANS: B ii
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient's diagnostic
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category regardless of the length of time in the hospital. If hospitals can treat and discharge patients before
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the allotted time, hospitals get to keep the excess payment; cost is contained, and the patient is discharged
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sooner.
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DIF: Cognitive Level: Comprehension REF: p. 8 OBJ:9 ii ii i i ii i
TOP: Government-Sponsored Health Insurance
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KEY:NursingProcessStep: Implementation
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MSC:NCLEX:Safe,EffectiveCareEnvironment:CoordinatedCare
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9. Thenurseisassessinga groupof patients.Which patient would most likelyqualifyforMedicaid?
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a. A35-year-oldunemployedsinglemother withdiabetes
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b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-term
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care facility
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c. An 80-year-old blind woman living in her own home who has inadequate private
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insurance ii
d. A67-year-oldstroke victimwithMedicare Part Aandan income frominvestments
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ANS: A ii
Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no
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insurance.
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DIF: CognitiveLevel:Application REF: p. 8, Box 1-5 i i ii ii ii ii
OBJ: 9 TOP: Government-Sponsored Health Insurance—Medicaid
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KEY: Nursing Process Step: Assessment
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MSC:NCLEX:Safe,EffectiveCareEnvironment:CoordinatedCare
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10. Which area is the major focus of Healthy People 2020 and the primary mechanism through which to
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improve the health of Americans in the second decade of the century?
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a. Researchfunding i
b. Health information distribution ii ii
c. Healthylifestyle encouragement i ii
d. Health improvement program designs ii ii i
ANS: C ii
Healthy People 2020 focuses on expanding ongoing programs to include support and information to
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reduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective
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immunizations, healthy eating habits, and healthy weight.
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DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 7 i ii i i i i ii i i
TOP: Healthy People 2020 i KEY: NursingProcess Step: Implementation
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MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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