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