Chapter 01: Caring for Medical-Surgical Patients
b b b b b
deWit: Medical-Surgical Nursing: Concepts & Practice, 5th Edition
b b b b b b b
MULTIPLE CHOICE b
Which statement accurately describes the primary purpose of the state nurse practice
b b b b b b b b b b b
act (NPA)?
b b
a. To test and license LPN/LVNs. b b b b
b. To define the scope of LPN/LVN b b b b b
practice.
c. To improve the quality of care b b b b b
provided by the LPN/LVN. b b b
d. To limit the LPN/LVN employment b b b b
placement.
ANS: B b
While improving quality of care provided by the LPN/LVN may be a result of the
b b b b b b b b b b b b b b
NPA, the primary purpose of the NPA of each state defines the scope of nursing
b b b b b b b b b b b b b b b
practice in that state.
b b b b
PTS: 1
Cognitive Level: Comprehension DIF: b b
REF: 2 b
OBJ:3 TOP: NPA KEY: Nursing Process Step: b b b b
Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill
b b b b b b b b b b b b b b
that the vocational nurse has notbeen taught during her educational program. How
b b b b b b b b b b b b
bshould the vocational nurse respond?
b b b b
a. Ask a more experienced nurse to b b b b b
demonstrate the procedure. b b
b. Look up the procedure in the procedure b b b b b b
manual.
c. Attempt to perform the procedure with b b b b b
supervision.
d. Inform the charge nurse of her lack of b b b b b b b
training in this procedure. b b b
ANS: D b
The charge nurse should be informed of the lack of training to perform the procedure,
b b b b b b b b b b b b b b
and the vocational nurse should seek further training to gain proficiency. Although the
b b b b b b b b b b b b b
bother options might be helpful, they are not safe.
b b b b b b b b
PTS: 1 DIF: Cognitive Level: b 3
, Application REF: b
OBJ:1 TOP: Providing Safe Care Nursing Process b b b
KEY: Step: N/A b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
Which patient statement indicates a need for further discharge teaching that the
b b b b b b b b b b b
vocational nurse should address?
b b b b
a. “I have no idea of how this drug
b b b b b b b
will affect me.” b b
b. “Do you know if my physician is b b b b b b
coming back today?” b b
c. “Will my insurance pay for my b b b b b
stay?”
d. “Am I going to have to go to a b b b b b b b b
nursing home?” b
ANS: A b
Lack of knowledge at discharge about medication effects and side effects is a concern
b b b b b b b b b b b b b
that should be addressed by the vocationalnurse. The other concerns in the options are
b b b b b b b b b b b b b b
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
PTS: 1
Cognitive Level: Application REF: DIF: b b
2
OBJ:1 TOP: Teaching KEY: Nursing Process b b
Step: Implementation b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
According to most state NPAs, the vocational nurse acting as charge nurse in a long-
b b b b b b b b b b b b b b
term care facility acts in which capacity?
b b b b b b b
a. Working under direct supervision of an RN on b b b b b b b
the unit b
b. Working with the RN in the building b b b b b b
c. Working under general supervision by the RN b b b b b b
available on site or by phone 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
b b b b b b b b b b b b b b
acts with the general supervision of an RNavailable on site or by phone.
b b b b b b b b b b b b b
PTS: 1
Cognitive Level: REF: 2 DIF: b
Comprehension
OBJ:1 TOP: Charge Nurse/Manager Nursi Process b
KEY: ng Step: N/A b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
,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 informationshould the nurse include?
b b b b b b
a. Seek the opinion of an alternate health care b b b b b b b
provider.
b. Obtain insurance approval for medical b b b b
services prior to treatment. b b b
c. Provide detailed documentation of all care b b b b b
received for his condition. b b b
d. Wait at least 6 months to see a specialist. b b b b b b b b
ANS: B b
Most HMOs require preprocedure authorization for treatment. Patients are not
b b b b b b b b b
required to seek a second opinion, providedocumentation of care, or wait a specific
b b b b b b b b b b b b b
time period before visiting a specialist.
b b b b b b
PTS: 1
Cognitive Level: 9 DIF: b
Application REF: b
OBJ:9 TOP: Charge Nurse/Manager 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
The patient complains to the nurse that he is confused about his “deductible” that he
b b b b b b b b b b b b b b
owes the hospital. Whichstatement accurately explains a deductible?
b b b b b b b b
a. An amount of money put aside for the payment of
b b b b b b b b b
future medical bills b b
b. A one-time fee for service b b b b
c. An amount of money deducted from the bill by
b b b b b b b b
the insurance company b b
d. An annual amount of money the patient must pay
b b b b b b b b
out-of-pocket for medical care b b b
ANS: D b
The deductible is the annual amount the insured must pay out-of-pocket prior to the
b b b b b b b b b b b b b
insurance company assuming the cost. This practice improves the profit of the
b b b b b b b b b b b b
binsurance company. b
PTS: 1
Cognitive Level: REF: 7 DIF: b
Comprehension
OBJ:9 TOP: Health Care Financing 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
The nurse compares the characteristics of a health maintenance organization (HMO)
b b b b b b b b b b
and a preferred providerorganization (PPO). Which information should the nurse
b b b b b b b b b b
include about HMOs?
b b b
, a. HMOs require a set fee of each b b b b b b
member monthly. b
b. HMOs allow the member to select b b b b b
his health care provider. b b b
c. HMOs permit admission to any b b b b
facility the member prefers. b b b
d. HMOs offer unlimited diagnostic b b b
tests and treatments. b b
ANS: A b
HMOs require a set fee from each member monthly (capitation). The patient will be
b b b b b b b b b b b b b
treated by the HMO staff in HMO-approvedfacilities. Excessive use of diagnostic
b b b b b b b b b b b
btests and treatments is discouraged by the HMO.
b b b b b b b
PTS: 1
Cognitive Level: 9 DIF: b
Application REF: b
OBJ:9 TOP: Managed Care 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
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 b b b b
hospital costs. b
b. Medicare Part A covers b b b
reimbursement to the physician. b b b
c. Medicare Part A covers outpatient b b b b
hospital services. b
d. Medicare Part A covers ambulance b b b b
transportation.
ANS: A b
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work,
b b b b b b b b b b
and intensive care. Medicare Part B pays thephysician, ambulance transport, and
b b b b b b b b b b b
outpatient services.
b b
PTS: 1
Cognitive Level: REF 7, Box DIF: b b
Comprehension : 1-4
OBJ:9 TOP: Government-Sponsored
Health Insurance 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
Which is the main cost-containment component of diagnosis-related groups (DRGs)?
b b b b b b b b b
b b b b b
deWit: Medical-Surgical Nursing: Concepts & Practice, 5th Edition
b b b b b b b
MULTIPLE CHOICE b
Which statement accurately describes the primary purpose of the state nurse practice
b b b b b b b b b b b
act (NPA)?
b b
a. To test and license LPN/LVNs. b b b b
b. To define the scope of LPN/LVN b b b b b
practice.
c. To improve the quality of care b b b b b
provided by the LPN/LVN. b b b
d. To limit the LPN/LVN employment b b b b
placement.
ANS: B b
While improving quality of care provided by the LPN/LVN may be a result of the
b b b b b b b b b b b b b b
NPA, the primary purpose of the NPA of each state defines the scope of nursing
b b b b b b b b b b b b b b b
practice in that state.
b b b b
PTS: 1
Cognitive Level: Comprehension DIF: b b
REF: 2 b
OBJ:3 TOP: NPA KEY: Nursing Process Step: b b b b
Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill
b b b b b b b b b b b b b b
that the vocational nurse has notbeen taught during her educational program. How
b b b b b b b b b b b b
bshould the vocational nurse respond?
b b b b
a. Ask a more experienced nurse to b b b b b
demonstrate the procedure. b b
b. Look up the procedure in the procedure b b b b b b
manual.
c. Attempt to perform the procedure with b b b b b
supervision.
d. Inform the charge nurse of her lack of b b b b b b b
training in this procedure. b b b
ANS: D b
The charge nurse should be informed of the lack of training to perform the procedure,
b b b b b b b b b b b b b b
and the vocational nurse should seek further training to gain proficiency. Although the
b b b b b b b b b b b b b
bother options might be helpful, they are not safe.
b b b b b b b b
PTS: 1 DIF: Cognitive Level: b 3
, Application REF: b
OBJ:1 TOP: Providing Safe Care Nursing Process b b b
KEY: Step: N/A b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
Which patient statement indicates a need for further discharge teaching that the
b b b b b b b b b b b
vocational nurse should address?
b b b b
a. “I have no idea of how this drug
b b b b b b b
will affect me.” b b
b. “Do you know if my physician is b b b b b b
coming back today?” b b
c. “Will my insurance pay for my b b b b b
stay?”
d. “Am I going to have to go to a b b b b b b b b
nursing home?” b
ANS: A b
Lack of knowledge at discharge about medication effects and side effects is a concern
b b b b b b b b b b b b b
that should be addressed by the vocationalnurse. The other concerns in the options are
b b b b b b b b b b b b b b
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
PTS: 1
Cognitive Level: Application REF: DIF: b b
2
OBJ:1 TOP: Teaching KEY: Nursing Process b b
Step: Implementation b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
According to most state NPAs, the vocational nurse acting as charge nurse in a long-
b b b b b b b b b b b b b b
term care facility acts in which capacity?
b b b b b b b
a. Working under direct supervision of an RN on b b b b b b b
the unit b
b. Working with the RN in the building b b b b b b
c. Working under general supervision by the RN b b b b b b
available on site or by phone 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
b b b b b b b b b b b b b b
acts with the general supervision of an RNavailable on site or by phone.
b b b b b b b b b b b b b
PTS: 1
Cognitive Level: REF: 2 DIF: b
Comprehension
OBJ:1 TOP: Charge Nurse/Manager Nursi Process b
KEY: ng Step: N/A b
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
b b b b b b b
,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 informationshould the nurse include?
b b b b b b
a. Seek the opinion of an alternate health care b b b b b b b
provider.
b. Obtain insurance approval for medical b b b b
services prior to treatment. b b b
c. Provide detailed documentation of all care b b b b b
received for his condition. b b b
d. Wait at least 6 months to see a specialist. b b b b b b b b
ANS: B b
Most HMOs require preprocedure authorization for treatment. Patients are not
b b b b b b b b b
required to seek a second opinion, providedocumentation of care, or wait a specific
b b b b b b b b b b b b b
time period before visiting a specialist.
b b b b b b
PTS: 1
Cognitive Level: 9 DIF: b
Application REF: b
OBJ:9 TOP: Charge Nurse/Manager 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
The patient complains to the nurse that he is confused about his “deductible” that he
b b b b b b b b b b b b b b
owes the hospital. Whichstatement accurately explains a deductible?
b b b b b b b b
a. An amount of money put aside for the payment of
b b b b b b b b b
future medical bills b b
b. A one-time fee for service b b b b
c. An amount of money deducted from the bill by
b b b b b b b b
the insurance company b b
d. An annual amount of money the patient must pay
b b b b b b b b
out-of-pocket for medical care b b b
ANS: D b
The deductible is the annual amount the insured must pay out-of-pocket prior to the
b b b b b b b b b b b b b
insurance company assuming the cost. This practice improves the profit of the
b b b b b b b b b b b b
binsurance company. b
PTS: 1
Cognitive Level: REF: 7 DIF: b
Comprehension
OBJ:9 TOP: Health Care Financing 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
The nurse compares the characteristics of a health maintenance organization (HMO)
b b b b b b b b b b
and a preferred providerorganization (PPO). Which information should the nurse
b b b b b b b b b b
include about HMOs?
b b b
, a. HMOs require a set fee of each b b b b b b
member monthly. b
b. HMOs allow the member to select b b b b b
his health care provider. b b b
c. HMOs permit admission to any b b b b
facility the member prefers. b b b
d. HMOs offer unlimited diagnostic b b b
tests and treatments. b b
ANS: A b
HMOs require a set fee from each member monthly (capitation). The patient will be
b b b b b b b b b b b b b
treated by the HMO staff in HMO-approvedfacilities. Excessive use of diagnostic
b b b b b b b b b b b
btests and treatments is discouraged by the HMO.
b b b b b b b
PTS: 1
Cognitive Level: 9 DIF: b
Application REF: b
OBJ:9 TOP: Managed Care 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
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 b b b b
hospital costs. b
b. Medicare Part A covers b b b
reimbursement to the physician. b b b
c. Medicare Part A covers outpatient b b b b
hospital services. b
d. Medicare Part A covers ambulance b b b b
transportation.
ANS: A b
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work,
b b b b b b b b b b
and intensive care. Medicare Part B pays thephysician, ambulance transport, and
b b b b b b b b b b b
outpatient services.
b b
PTS: 1
Cognitive Level: REF 7, Box DIF: b b
Comprehension : 1-4
OBJ:9 TOP: Government-Sponsored
Health Insurance 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
Which is the main cost-containment component of diagnosis-related groups (DRGs)?
b b b b b b b b b
