,Chapter 01: Caring for Medical-Surgical Patients
b b b b b
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
b b b b b b b
MULTIPLE CHOICE b
1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
b b b b b b b b b b b b 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
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
b b b b b b b b b b b b b b b b b b b b b b b
state defines the scope of nursing practice in that state.
b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 b b
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the vocational nurse has not
b b b b b b b b b b b b b b b b b b b b
been taught during her educational program. How should the vocational nurse respond?
b b b b b b b b b 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
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should seek further
b b b b b b b b b b b b b b b b b b b b b
training to gain proficiency. Although the other options might be helpful, they are not safe.
b b b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: b b b b 3
OBJ: 1 TOP: Providing Safe Care KEY: b b Nursing Process Step: N/A b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
3. Which patient statement indicates a need for further discharge teaching that the vocational nurse should address?
b b b b b b b b b b b b b 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
Lack of knowledge at discharge about medication effects and side effects is a concern that should be addressed by the vocational
b b b b b b b b b b b b b b b b b b b b
nurse. The other concerns in the options are the responsibility of other departments to which the nurse might refer the patient.
b b b b b b b b b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: 2 b b b b
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in which b b b b b b b b b b b b b b b b b b b
capacity?
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
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with the general supervision of an RN
b b b b b b b b b b b b b b b b b b b b b b
available on site or by phone.
b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension b b REF: 2
OBJ: 1 TOP: Charge Nurse/Manager KEY: b Nursing Process Step: N/A b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
,5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which information
b b b b b b b b b b b b b b b b b
should the nurse include?
b b b b
a. Seek the opinion of an alternate health care provider.
b b b b b b b b
b. Obtain insurance approval for medical services prior to treatment.
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
Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion, provide
b b b b b b b b b b b b b b b b
documentation of care, or wait a specific time period before visiting a specialist.
b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: b b b b 9
OBJ: 9 TOP: Charge Nurse/Manager b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
6. The patient complains to the nurse that he is confused about his “deductible” that he owes the hospital. Which
b b b b b b b b b b b b b b b b b b
statement accurately explains a deductible?
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
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company assuming the cost. This
b b b b b b b b b b b b b b b b b b b
practice improves the profit of the insurance company.
b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension b b REF: 7
OBJ: 9 TOP: Health Care Financing b b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
7. The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred provider
b b b b b b b b b b b b b b
organization (PPO). Which information should the nurse include about HMOs?
b b b b b b b b b b
a. HMOs require a set fee of each member monthly.
b b b b b b b b
b. HMOs allow the member to select his health care provider.
b b b b b b b b b
c. HMOs permit admission to any facility the member prefers.
b b b b b b b b
d. HMOs offer unlimited diagnostic tests and treatments.
b b b b b b
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated by the HMO staff in HMO-approved
b b b b b b b b b b b b b b b b b b b b
facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: b b b b 9
OBJ: 9 TOP: Managed Care b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
8. 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
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B pays the
b b b b b b b b b b b b b b b b b b
physician, ambulance transport, and outpatient services.
b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension REF: b b 7, Box 1-4
b b
OBJ: 9 TOP: Government-Sponsored Health Insurance b b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
9. 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
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless of the
b b b b b b b b b b b b b b b b b b b b
length of time in the hospital. If hospitals can treat and discharge patients before the allotted time, hospitals get to keep the excess
b b b b b b b b b b b b b b b b b b b b b b b
payment; cost is contained, and the patient is discharged sooner.
b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension REF: b b 8
OBJ: 9 TOP: Government-Sponsored Health Insurance b b
KEY: b b b Nursing Process Step: Implementation b b b
MSC: b b NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
10. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
b b b b b b b b b b b b b b 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 long-term care facility
b b b b b b b b b b b b b b b
c. An 80-year-old blind woman living in her own home who has inadequate private insurance
b b b b b b b b b b b b b
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
Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no insurance.
b b b b b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1-5 b b b b b
OBJ:
b 9 TOP: Government-Sponsored Health Insurance–Medicaid b b
KEY:
b Nursing Process Step: Assessment b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
11. Which area is the major focus of Healthy People 2020 and the primary mechanism through which to improve the health of
b b b b b b b b b b b b b b b b b b b b
Americans in the second decade of the century?
b b b b b b b b
a. Research funding b
b. Health information distribution b b
c. Healthy lifestyle encouragement b b
d. Health improvement program designs b b b
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant mortality, cancer,
b b b b b b b b b b b b b b b b b
cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits, and healthy weight.
b b b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension b b REF: 6
OBJ: 7 TOP: Healthy People 2020 b b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
12. Which term explains the type of care that addresses interventions for all dimensions of a patient’s life?
b b b b b b b b b b b b b b b b
a. Focused care b
b. General care b
c. Directed care b
d. Holistic care b
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the patient.
b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension b b REF: 6
OBJ: 8 TOP: Holistic Care b
KEY: Nursing Process Step: Planning b b b
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation b b b b b
13. A patient furiously says, “My doctor was so busy giving me instructions that he didn’t hear what I was trying to ask
b b b b b b b b b b b b b b b b b b b b b
him!” Which response is most empathetic?
b b b b b b
a. “When people ignore me, I really get mad.” b b b b b b b
b. “I’m sure that the doctor was rushed and unaware of your needs.”
b b b b b b b b b b b
b b b b b
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
b b b b b b b
MULTIPLE CHOICE b
1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
b b b b b b b b b b b b 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
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
b b b b b b b b b b b b b b b b b b b b b b b
state defines the scope of nursing practice in that state.
b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 b b
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the vocational nurse has not
b b b b b b b b b b b b b b b b b b b b
been taught during her educational program. How should the vocational nurse respond?
b b b b b b b b b 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
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should seek further
b b b b b b b b b b b b b b b b b b b b b
training to gain proficiency. Although the other options might be helpful, they are not safe.
b b b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: b b b b 3
OBJ: 1 TOP: Providing Safe Care KEY: b b Nursing Process Step: N/A b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
3. Which patient statement indicates a need for further discharge teaching that the vocational nurse should address?
b b b b b b b b b b b b b 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
Lack of knowledge at discharge about medication effects and side effects is a concern that should be addressed by the vocational
b b b b b b b b b b b b b b b b b b b b
nurse. The other concerns in the options are the responsibility of other departments to which the nurse might refer the patient.
b b b b b b b b b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: 2 b b b b
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation b b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in which b b b b b b b b b b b b b b b b b b b
capacity?
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
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with the general supervision of an RN
b b b b b b b b b b b b b b b b b b b b b b
available on site or by phone.
b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension b b REF: 2
OBJ: 1 TOP: Charge Nurse/Manager KEY: b Nursing Process Step: N/A b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
,5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which information
b b b b b b b b b b b b b b b b b
should the nurse include?
b b b b
a. Seek the opinion of an alternate health care provider.
b b b b b b b b
b. Obtain insurance approval for medical services prior to treatment.
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
Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion, provide
b b b b b b b b b b b b b b b b
documentation of care, or wait a specific time period before visiting a specialist.
b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: b b b b 9
OBJ: 9 TOP: Charge Nurse/Manager b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
6. The patient complains to the nurse that he is confused about his “deductible” that he owes the hospital. Which
b b b b b b b b b b b b b b b b b b
statement accurately explains a deductible?
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
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company assuming the cost. This
b b b b b b b b b b b b b b b b b b b
practice improves the profit of the insurance company.
b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension b b REF: 7
OBJ: 9 TOP: Health Care Financing b b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
7. The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred provider
b b b b b b b b b b b b b b
organization (PPO). Which information should the nurse include about HMOs?
b b b b b b b b b b
a. HMOs require a set fee of each member monthly.
b b b b b b b b
b. HMOs allow the member to select his health care provider.
b b b b b b b b b
c. HMOs permit admission to any facility the member prefers.
b b b b b b b b
d. HMOs offer unlimited diagnostic tests and treatments.
b b b b b b
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated by the HMO staff in HMO-approved
b b b b b b b b b b b b b b b b b b b b
facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: b b b b 9
OBJ: 9 TOP: Managed Care b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
8. 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
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B pays the
b b b b b b b b b b b b b b b b b b
physician, ambulance transport, and outpatient services.
b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension REF: b b 7, Box 1-4
b b
OBJ: 9 TOP: Government-Sponsored Health Insurance b b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
9. 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
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless of the
b b b b b b b b b b b b b b b b b b b b
length of time in the hospital. If hospitals can treat and discharge patients before the allotted time, hospitals get to keep the excess
b b b b b b b b b b b b b b b b b b b b b b b
payment; cost is contained, and the patient is discharged sooner.
b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension REF: b b 8
OBJ: 9 TOP: Government-Sponsored Health Insurance b b
KEY: b b b Nursing Process Step: Implementation b b b
MSC: b b NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
10. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
b b b b b b b b b b b b b b 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 long-term care facility
b b b b b b b b b b b b b b b
c. An 80-year-old blind woman living in her own home who has inadequate private insurance
b b b b b b b b b b b b b
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
Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no insurance.
b b b b b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1-5 b b b b b
OBJ:
b 9 TOP: Government-Sponsored Health Insurance–Medicaid b b
KEY:
b Nursing Process Step: Assessment b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
11. Which area is the major focus of Healthy People 2020 and the primary mechanism through which to improve the health of
b b b b b b b b b b b b b b b b b b b b
Americans in the second decade of the century?
b b b b b b b b
a. Research funding b
b. Health information distribution b b
c. Healthy lifestyle encouragement b b
d. Health improvement program designs b b b
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant mortality, cancer,
b b b b b b b b b b b b b b b b b
cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits, and healthy weight.
b b b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension b b REF: 6
OBJ: 7 TOP: Healthy People 2020 b b
KEY: Nursing Process Step: Implementation b b b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care b b b b b b
12. Which term explains the type of care that addresses interventions for all dimensions of a patient’s life?
b b b b b b b b b b b b b b b b
a. Focused care b
b. General care b
c. Directed care b
d. Holistic care b
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the patient.
b b b b b b b b b b b b b
PTS: 1 DIF: Cognitive Level: Comprehension b b REF: 6
OBJ: 8 TOP: Holistic Care b
KEY: Nursing Process Step: Planning b b b
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation b b b b b
13. A patient furiously says, “My doctor was so busy giving me instructions that he didn’t hear what I was trying to ask
b b b b b b b b b b b b b b b b b b b b b
him!” Which response is most empathetic?
b b b b b b
a. “When people ignore me, I really get mad.” b b b b b b b
b. “I’m sure that the doctor was rushed and unaware of your needs.”
b b b b b b b b b b b
