Dewitt's Medical -Surgical Nursing: Concepts & Dewitt's Medical -Surgical Nursing: Concepts &
Practice, 3rd Edition | 2023-2024 Test Bank Practice, 3rd Edition Test Bank
Chapter 01: Caring for Medical-Surgical Patients The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition information should the nurse include?
a. Seek the opinion of an alternate health care provider.
MULTIPLE CHOICE b. Obtain insurance approval for medical services prior to treatment.
c. Provide detailed documentation of all care received for his condition.
Which statement accurately describes the primary purpose of the state nurse practice act (NPA)? d. Wait at least 6 months to see a specialist.
a. To test and license LPN/LVNs. ANS: B
b. To define the scope of LPN/LVN practice. Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion,
c. To improve the quality of care provided by the LPN/LVN. provide documentation of care, or wait a specific time period before visiting a specialist.
d. To limit the LPN/LVN employment placement.
PTS: 1 DIF: Cognitive Level: Application REF: 9
ANS: B OBJ: 9 TOP: Charge Nurse/Manager
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the primary purpose of the NPA of KEY: Nursing Process Step: Implementation
each state defines the scope of nursing practice in that state. MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 ᜀ Ā ᜀ Ā ᜀ Ā ᜀ Ā ᜀ Ā ᜀ Ā ᜀ
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation he patient complains to the nurse that he is confused about his “deductible” that he owes the hospital. Which statement
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care accurately explains a deductible?
a. An amount of money put aside for the payment of future medical bills
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? b. A one-time fee for service
c. An amount of money deducted from the bill by the insurance company
a. Ask a more experienced nurse to demonstrate the procedure.
b. Look up the procedure in the procedure manual. d. An annual amount of money the patient must pay out-of-pocket for medical care
c. Attempt to perform the procedure with supervision. ANS: D
d. Inform the charge nurse of her lack of training in this procedure. 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.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should PTS: 1 DIF: Cognitive Level: Comprehension REF: 7
seek further training to gain proficiency. Although the other options might be helpful, they are not safe. OBJ: 9 TOP: Health Care Financing
KEY: Nursing Process Step: Implementation
PTS: 1 DIF: Cognitive Level: Application REF: 3 MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred
provider organization (PPO). Which information should the nurse include about HMOs?
Which patient statement indicates a need for further discharge teaching that the vocational nurse should address? a. HMOs require a set fee of each member monthly.
a. “I have no idea of how this drug will affect me.”
b. HMOs allow the member to select his health care provider.
b. “Do you know if my physician is coming back today?” c. HMOs permit admission to any facility the member prefers.
c. “Will my insurance pay for my stay?”
d. HMOs offer unlimited diagnostic tests and treatments.
d. “Am I going to have to go to a nursing home?”
ANS: A
ANS: A HMOs require a set fee from each member monthly (capitation). The patient will be treated by the HMO staff in HMO-
Lack of knowledge at discharge about medication effects and side effects is a concern that should be addressed by the vocational
approved facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
nurse. The other concerns in the options are the responsibility of other departments to which the nurse might refer the patient.
PTS: 1 DIF: Cognitive Level: Application REF: 9
PTS: 1 DIF: Cognitive Level: Application REF: 2 OBJ: 9 TOP: Managed Care
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in which A patient asks the nurse what Medicare Part A covers. Which response is correct?
capacity? a. Medicare Part A covers inpatient hospital costs.
a. Working under direct supervision of an RN on the unit b. Medicare Part A covers reimbursement to the physician.
b. Working with the RN in the building c. Medicare Part A covers outpatient hospital services.
c. Working under general supervision by the RN available on site or by phone
d. Medicare Part A covers ambulance transportation.
d. Working as an independent vocational nurse
ANS: A
ANS: C Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B pays
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with the general supervision of an the physician, ambulance transport, and outpatient services.
RN available on site or by phone.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 7, Box 1-4
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 OBJ: 9 TOP: Government-Sponsored Health Insurance
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
Which is the main cost-containment component of diagnosis-related groups (DRGs)?
,Dewitt's Medical-Surgical Nursing: Concepts & Practice, 3rd
Edition Test Bank
a. Hospitals focus only on the specific diagnosis. b. “I’m sure that the doctor was rushed and unaware of your needs.”
b. Hospitals treat and discharge patients quickly. c. “I’ll bet that made you feel very frustrated.”
c. Reduced cost drugs are ordered for specific diagnoses. d. “Take a deep breath and plan what you will say to him tomorrow.”
d. Diagnostic group classification streamlines care. ANS: C
ANS: B Empathy demonstrates that the nurse perceives the patient’s feelings but does not share the emotion. Belittling the
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless of patient’s feelings, showing sympathy, or defending the doctor makes the patient feel devalued.
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. PTS: 1 DIF: Cognitive Level: Analysis REF: 10
OBJ: 10 TOP: Nurse–Patient Relationship
PTS: 1 DIF: Cognitive Level: Comprehension REF: 8 KEY: Nursing Process Step: Implementation
OBJ: 9 TOP: Government-Sponsored Health Insurance MSC: NCLEX: Psychosocial Integrity
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care The nurse is explaining differences in a therapeutic relationship and a social relationship to a patient.
Which information about therapeutic relationships is most important for the nurse to include in the explanation?
The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid? a. Therapeutic relationships lack formal boundaries.
a. A 35-year-old unemployed single mother with diabetes b. Therapeutic relationships are goal directed.
b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-term care facility c. Therapeutic relationships meet the needs of each person in the relationship.
c. An 80-year-old blind woman living in her own home who has inadequate private insurance d. Therapeutic relationships extend past the hospitalization period.
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
ANS: B
ANS: A The therapeutic relationship is focused on the patient and is goal directed and designed to meet only the needs of the patient
Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no insurance. and does not extend past the period of hospitalization.
PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1-5 PTS: 1 DIF: Cognitive Level: Comprehension REF: 9
OBJ: 9 TOP: Government-Sponsored Health Insurance–Medicaid OBJ: 10 TOP: Therapeutic Relationship
KEY: Nursing Process Step: Assessment KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care MSC: NCLEX: Psychosocial Integrity
Which area is the major focus of Healthy People 2020 and the primary mechanism through which to improve the 15. The long- term care facility nurse is caring for a newly admitted 80-year-old patient who is depressed. Which approach is best for
health of Americans in the second decade of the century? the nurse to employ?
a. Research funding a. Encourage the resident to engage in an activity.
b. Health information distribution b. Remind the resident of reasons to be positive.
c. Healthy lifestyle encouragement c. Point out episodes of negative behavior.
d. Health improvement program designs d. Present a bright and cheerful behavior.
ANS: C ANS: A
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant Activity and social interaction are helpful to depressed patients. Presenting a cheery approach and pointing out negative
mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits, behavior and reasons to be positive are not therapeutic at this stage of the relationship.
and healthy weight.
PTS: 1 DIF: Cognitive Level: Analysis REF: 10
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6 OBJ: 10 TOP: Depressed Behavior
OBJ: 7 TOP: Healthy People 2020 KEY: Nursing Process Step: Implementation
KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
The nurse is caring for a patient who has been on antidepressants for 3 days. The patient tearfully says, “I still
12. Which term explains the type of care that addresses interventions for all dimensions of a patient’s life? feel terrible. I don’t think anything can help how I feel.” Which response is best?
a. Focused care a. “I will tell the charge nurse how you are feeling.”
b. General care b. “You just need to be patient and give your medicine some time to work.”
c. Directed care c. “Look how much you have improved since you were admitted to the facility.” d.
d. Holistic care “It must be frustrating to be going through this difficult time.”
ANS: D ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the patient. This response is an empathetic response that allows for further exploration of the patient’s feelings. The other responses
will block communication with this patient.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6
OBJ: 8 TOP: Holistic Care PTS: 1 DIF: Cognitive Level: Application REF: 9
KEY: Nursing Process Step: Planning OBJ: 10 TOP: Therapeutic Communication
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
A patient furiously says, “My doctor was so busy giving me instructions that he didn’t hear what I was trying to
ask him!” Which response is most empathetic? An overweight male patient rips off his hospital gown, throws it out the door, and shouts, “I’m not wearing this
a. “When people ignore me, I really get mad.” stupid gown! It is too small, too short, and exposes my backside to the world!” Which response is most appropriate?
a. Remind patient of the need to wear the gown for convenience in care.
, b. Confer with the patient for methods to acquire a larger gown.
c. Replace the torn gown with another. Which of the following are sources of clear guidelines for upholding clinical standards for safe and competent
care? (Select all that apply.)
d. Inform the charge nurse of the hostile behavior.
a. The state’s nurse practice act (NPA)
ANS: B b. The State Board of Nurse Examiners (BNE)
Allowing hostile patients to make reasonable requests defuses the anger and allows patients to vent their feelings. c. The National Association for Practical Nurse Education and Service (NAPNES)
d. Institutional policies
PTS: 1 DIF: Cognitive Level: Application REF: 9
OBJ: 10 TOP: Hostile Behavior e. The National Federation of Licensed Practical Nurses, Inc. (NFLPN)
KEY: Nursing Process Step: Implementation ANS: C, E
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation NAPNES and the NFLPN give clear guidelines for clinical standards that can be used as a basis for court decisions. The NPA
18. The nurse is caring for a patient who states, “You are the only nurse who understands about my pain. Can’t you give me an extra has broad guidelines, and institutional policies may not be complete. The BNE enforces the NPA.
dose of pain medication?” How should the nurse respond to the patient’s request? PTS: 1 DIF: Cognitive Level: Comprehension REF: 5
a. Explain that dosage schedules are by physician’s orders. OBJ: 3 TOP: Upholding Clinical Standards KEY: Nursing Process Step: N/A
b. Ignore the request. MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
c. Tell the patient that his behavior is manipulative.
Which statement(s) accurately describes the role of the LPN/LVN regardless of employment placement? (Select all that
d. Agree to give an extra dose of pain medication.
apply.)
ANS: A a. Uphold clinical standards
A matter-of-fact response to a manipulative request limits the effect of the manipulation, thereby helping the nurse to b. Educate patients
avoid becoming defensive or being swayed by flattery. c. Communicate effectively
d. Collaborate with the health care team
PTS: 1 DIF: Cognitive Level: Application REF: 9
OBJ: 10 TOP: Manipulative Behavior e. Initiate a care plan immediately after admission
KEY: Nursing Process Step: Implementation ANS: A,B,C,D
MSC: NCLEX: Psychosocial Integrity The LPN/LVN has the accountability to uphold clinical standards, educate patients, communicate effectively, and collaborate with
A female patient who has recently been diagnosed with an inoperable brain tumor asks the nurse, “Do you think the health care team. Depending on the type of facility, initiation of a care plan is often the role of the registered nurse.
God punishes us?” Which response demonstrates therapeutic communication? PTS: 1 DIF: Cognitive Level: Comprehension REF: 2
a. “What do you think?” OBJ: 3 TOP: Roles of LPN/LVNs
b. “God loves you.” KEY: Nursing Process Step: Implementation
c. “Would like to speak with the chaplain?” MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d. “God will not give you more than you can bear.”
The newly licensed LPN/LVN demonstrates an understanding of employment opportunities when applying to
ANS: A a position in which area(s)? (Select all that apply.)
Sitting with the patient and offering oneself to listen to the patient’s concerns and encouraging reflection is the best a. An outpatient clinic
approach rather than responding with a cliché or suggesting speaking with the chaplain. b. A home health care agency
c. An intravenous (IV) therapy team
PTS: 1 DIF: Cognitive Level: Application REF: 10
OBJ: 10 TOP: Spiritual Care d. A long-term care facility
KEY: Nursing Process Step: Implementation e. An ambulatory care unit
MSC: NCLEX: Psychosocial Integrity ANS: A,B,D,E
The nurse is communicating with a patient who voices concern about an upcoming high-risk procedure. With the exception of an IV therapy team, which requires postgraduate education and/or certification, the other options are
Which statement best demonstrates empathy? open to newly graduated vocational nurses.
a. “Would you like to talk about your feelings regarding the procedure?” PTS: 1 DIF: Cognitive Level: Application REF: 2
b. “My mother had the same procedure and did very well.” OBJ: 2 TOP: Employment Opportunities for LPN/LVNs
c. “I can’t imagine how you feel.” KEY: Nursing Process Step: N/A
d. “It must be difficult preparing for the procedure; how are you feeling?” MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
ANS: D What factor(s) should the LPN/LVN consider when delegating a task to unlicensed assistive personnel (UAP)?
This statement by the nurse displays empathy by trying to place oneself in the patient’s circumstance and validating the (Select all that apply.)
patient’s feelings. Simply asking patients if they would like to talk about their feelings does not show empathy and may elicit a a. A need for the UAP to voluntarily accept the task delegated
“yes” or “no” response. Telling the patient one’s mother had the procedure or stating “I can’t imagine how you feel” does not b. Continued accountability for the task by the LPN/LVN
show empathy toward the patient. c. Assurance that the task requires no further need for supervision of the UAP
PTS: 1 DIF: Cognitive Level: Application REF: 10 d. An understanding that the task is in the job description of the UAP
OBJ: 10 TOP: Nurse–Patient Relationship e. A transfer of authority to the UAP
KEY: Nursing Process Step: Implementation
ANS: A,B,D,E
MSC: NCLEX: Psychosocial Integrity
Delegation is a considered act involving the condition of the patient and the competency of the UAP. Delegation requires that
the UAP voluntarily accept the task, which is in the job description of the UAP. The vocational nurse has transferred authority
MULTIPLE RESPONSE for the completion of the task but is still accountable and should supervise.
, PTS: 1 DIF: Cognitive Level: Application REF: 3 PTS: 1 DIF: Cognitive Level: Comprehension REF: 16, Box 2-1
OBJ: 1 TOP: Delegation KEY: Nursing Process Step: N/A OBJ: 2 (theory) TOP: Factors Influencing Critical Thinking
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance
The LPN/LVN participates in an in-service about cost containment within the health care facility. Which Which fundamental belief underscores the basis of the nursing process?
action(s) demonstrate understanding of cost-containment principles? (Select all that apply.) a. Recognition that basic needs must be met by the individual without assistance.
a. Telling patients to limit their usage of supplies. b. Acknowledgment that patients and families appreciate an efficient health care system that functions without their input.
b. Asking the UAP to ensure correct charges for patient care items. c. A focus on disease control as the most important aspect of patient care.
c. Only using necessary items for patient care. d. Recognition that all people have worth and dignity.
d. Charging for extra patient care items that the patient may take home upon discharge.
e. Documenting supplies used for patients in their patient care record. ANS: D
The nursing process is based on the belief that all people have worth and dignity. Patient-centered care that is applied to all
ANS: B,C,E aspects of the patient’s health, and is not just disease oriented, is appreciated by the family and patient. Holistic care approach
The UAP must correctly charge patients utilizing the facility’s charging system, only necessary supplies should be used for can support the patient to meet basic needs.
patient care, and documenting supplies used assists in reimbursement. It is inappropriate and not the patient’s responsibility
to monitor their supply use, and excess charges would be incurred if items were given to the patient upon discharge. PTS: 1 DIF: Cognitive Level: Comprehension REF: 17
OBJ: 5 (theory) TOP: Basic Beliefs Pertinent to the Nursing Process
PTS: 1 DIF: Cognitive Level: Application REF: 6 KEY: Nursing Process Step: Implementation
OBJ: 8 TOP: Cost Containment MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care The nurse is assessing a new patient who complains of his chest feeling tight. The patient displays a temperature of 100°
F and an oxygen saturation of 89%, and expectorates frothy mucus. Which finding is an example of subjective data?
COMPLETION a. Temperature
b. Oxygen saturation
When an insurance company directly reimburses a licensed health care provider for services, the form of financing c. Frothy mucus
is called ______________. d. Chest tightness
ANS: ANS: D
fee for service Subjective data is information given by the patient that cannot be measured otherwise. The other data are considered objective
data. Objective data are pieces of information that can be measured by the examiner. The nurse should avoid making
Fee for service is the direct reimbursement by an insurance company to a health care provider. judgments or conclusions when obtaining data.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 7 PTS: 1 DIF: Cognitive Level: Application REF: 18
OBJ: 9 TOP: Health Care Financing KEY: Nursing Process Step: N/A OBJ: 8 (clinical) TOP: Assessment Data
KEY: Nursing Process Step: Planning
MSC: NCLEX: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
The nurse explains that the term _____________ refers to the severity of illness.
The nurse is caring for a newly admitted patient who is describing his recent symptoms to the nurse. This scenario is
ANS: an example of which type of source?
acuity a. Primary
b. Objective
Acuity is the term referring to the severity of illness or condition of a patient. c. Secondary
d. Complete
PTS: 1 DIF: Cognitive Level: Knowledge REF: 4
OBJ: 6 TOP: Acuity KEY: Nursing Process Step: Implementation ANS: A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care The patient is the primary source of information. Objective refers to a type of data obtained by the nurse that is measured or
can be verified through assessment techniques, secondary information is obtained from relatives or significant others, and
Chapter 02: Critical Thinking and the Nursing Process information is not necessarily complete when the patient is the source.
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition PTS: 1 DIF: Cognitive Level: Application REF: 19
OBJ: 8 (clinical) TOP: Sources of Information
MULTIPLE CHOICE KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
Which foundational behavior is necessary for effective critical thinking?
a. Unshakable beliefs and values The nurse is performing an intake interview on a new resident to the long-term care facility. The nurse detects the
odor of acetone from the patient’s breath. Which term accurately describes this assessment?
b. An open attitude
a. Inspection
c. An ability to disregard evidence inconsistent with set goals
b. Observation
d. An ability to recognize the perfect solution
c. Auscultation
ANS: B d. Olfaction
An open attitude not clouded by unshakable beliefs and values or preset goals allows the application of critical thinking.
Acceptance that there may not be a perfect solution leaves the field open to new ideas. ANS: D
Practice, 3rd Edition | 2023-2024 Test Bank Practice, 3rd Edition Test Bank
Chapter 01: Caring for Medical-Surgical Patients The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition information should the nurse include?
a. Seek the opinion of an alternate health care provider.
MULTIPLE CHOICE b. Obtain insurance approval for medical services prior to treatment.
c. Provide detailed documentation of all care received for his condition.
Which statement accurately describes the primary purpose of the state nurse practice act (NPA)? d. Wait at least 6 months to see a specialist.
a. To test and license LPN/LVNs. ANS: B
b. To define the scope of LPN/LVN practice. Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion,
c. To improve the quality of care provided by the LPN/LVN. provide documentation of care, or wait a specific time period before visiting a specialist.
d. To limit the LPN/LVN employment placement.
PTS: 1 DIF: Cognitive Level: Application REF: 9
ANS: B OBJ: 9 TOP: Charge Nurse/Manager
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the primary purpose of the NPA of KEY: Nursing Process Step: Implementation
each state defines the scope of nursing practice in that state. MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 ᜀ Ā ᜀ Ā ᜀ Ā ᜀ Ā ᜀ Ā ᜀ Ā ᜀ
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation he patient complains to the nurse that he is confused about his “deductible” that he owes the hospital. Which statement
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care accurately explains a deductible?
a. An amount of money put aside for the payment of future medical bills
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? b. A one-time fee for service
c. An amount of money deducted from the bill by the insurance company
a. Ask a more experienced nurse to demonstrate the procedure.
b. Look up the procedure in the procedure manual. d. An annual amount of money the patient must pay out-of-pocket for medical care
c. Attempt to perform the procedure with supervision. ANS: D
d. Inform the charge nurse of her lack of training in this procedure. 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.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should PTS: 1 DIF: Cognitive Level: Comprehension REF: 7
seek further training to gain proficiency. Although the other options might be helpful, they are not safe. OBJ: 9 TOP: Health Care Financing
KEY: Nursing Process Step: Implementation
PTS: 1 DIF: Cognitive Level: Application REF: 3 MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred
provider organization (PPO). Which information should the nurse include about HMOs?
Which patient statement indicates a need for further discharge teaching that the vocational nurse should address? a. HMOs require a set fee of each member monthly.
a. “I have no idea of how this drug will affect me.”
b. HMOs allow the member to select his health care provider.
b. “Do you know if my physician is coming back today?” c. HMOs permit admission to any facility the member prefers.
c. “Will my insurance pay for my stay?”
d. HMOs offer unlimited diagnostic tests and treatments.
d. “Am I going to have to go to a nursing home?”
ANS: A
ANS: A HMOs require a set fee from each member monthly (capitation). The patient will be treated by the HMO staff in HMO-
Lack of knowledge at discharge about medication effects and side effects is a concern that should be addressed by the vocational
approved facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
nurse. The other concerns in the options are the responsibility of other departments to which the nurse might refer the patient.
PTS: 1 DIF: Cognitive Level: Application REF: 9
PTS: 1 DIF: Cognitive Level: Application REF: 2 OBJ: 9 TOP: Managed Care
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in which A patient asks the nurse what Medicare Part A covers. Which response is correct?
capacity? a. Medicare Part A covers inpatient hospital costs.
a. Working under direct supervision of an RN on the unit b. Medicare Part A covers reimbursement to the physician.
b. Working with the RN in the building c. Medicare Part A covers outpatient hospital services.
c. Working under general supervision by the RN available on site or by phone
d. Medicare Part A covers ambulance transportation.
d. Working as an independent vocational nurse
ANS: A
ANS: C Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B pays
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with the general supervision of an the physician, ambulance transport, and outpatient services.
RN available on site or by phone.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 7, Box 1-4
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 OBJ: 9 TOP: Government-Sponsored Health Insurance
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
Which is the main cost-containment component of diagnosis-related groups (DRGs)?
,Dewitt's Medical-Surgical Nursing: Concepts & Practice, 3rd
Edition Test Bank
a. Hospitals focus only on the specific diagnosis. b. “I’m sure that the doctor was rushed and unaware of your needs.”
b. Hospitals treat and discharge patients quickly. c. “I’ll bet that made you feel very frustrated.”
c. Reduced cost drugs are ordered for specific diagnoses. d. “Take a deep breath and plan what you will say to him tomorrow.”
d. Diagnostic group classification streamlines care. ANS: C
ANS: B Empathy demonstrates that the nurse perceives the patient’s feelings but does not share the emotion. Belittling the
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless of patient’s feelings, showing sympathy, or defending the doctor makes the patient feel devalued.
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. PTS: 1 DIF: Cognitive Level: Analysis REF: 10
OBJ: 10 TOP: Nurse–Patient Relationship
PTS: 1 DIF: Cognitive Level: Comprehension REF: 8 KEY: Nursing Process Step: Implementation
OBJ: 9 TOP: Government-Sponsored Health Insurance MSC: NCLEX: Psychosocial Integrity
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care The nurse is explaining differences in a therapeutic relationship and a social relationship to a patient.
Which information about therapeutic relationships is most important for the nurse to include in the explanation?
The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid? a. Therapeutic relationships lack formal boundaries.
a. A 35-year-old unemployed single mother with diabetes b. Therapeutic relationships are goal directed.
b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-term care facility c. Therapeutic relationships meet the needs of each person in the relationship.
c. An 80-year-old blind woman living in her own home who has inadequate private insurance d. Therapeutic relationships extend past the hospitalization period.
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
ANS: B
ANS: A The therapeutic relationship is focused on the patient and is goal directed and designed to meet only the needs of the patient
Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no insurance. and does not extend past the period of hospitalization.
PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1-5 PTS: 1 DIF: Cognitive Level: Comprehension REF: 9
OBJ: 9 TOP: Government-Sponsored Health Insurance–Medicaid OBJ: 10 TOP: Therapeutic Relationship
KEY: Nursing Process Step: Assessment KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care MSC: NCLEX: Psychosocial Integrity
Which area is the major focus of Healthy People 2020 and the primary mechanism through which to improve the 15. The long- term care facility nurse is caring for a newly admitted 80-year-old patient who is depressed. Which approach is best for
health of Americans in the second decade of the century? the nurse to employ?
a. Research funding a. Encourage the resident to engage in an activity.
b. Health information distribution b. Remind the resident of reasons to be positive.
c. Healthy lifestyle encouragement c. Point out episodes of negative behavior.
d. Health improvement program designs d. Present a bright and cheerful behavior.
ANS: C ANS: A
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant Activity and social interaction are helpful to depressed patients. Presenting a cheery approach and pointing out negative
mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits, behavior and reasons to be positive are not therapeutic at this stage of the relationship.
and healthy weight.
PTS: 1 DIF: Cognitive Level: Analysis REF: 10
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6 OBJ: 10 TOP: Depressed Behavior
OBJ: 7 TOP: Healthy People 2020 KEY: Nursing Process Step: Implementation
KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
The nurse is caring for a patient who has been on antidepressants for 3 days. The patient tearfully says, “I still
12. Which term explains the type of care that addresses interventions for all dimensions of a patient’s life? feel terrible. I don’t think anything can help how I feel.” Which response is best?
a. Focused care a. “I will tell the charge nurse how you are feeling.”
b. General care b. “You just need to be patient and give your medicine some time to work.”
c. Directed care c. “Look how much you have improved since you were admitted to the facility.” d.
d. Holistic care “It must be frustrating to be going through this difficult time.”
ANS: D ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the patient. This response is an empathetic response that allows for further exploration of the patient’s feelings. The other responses
will block communication with this patient.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 6
OBJ: 8 TOP: Holistic Care PTS: 1 DIF: Cognitive Level: Application REF: 9
KEY: Nursing Process Step: Planning OBJ: 10 TOP: Therapeutic Communication
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
A patient furiously says, “My doctor was so busy giving me instructions that he didn’t hear what I was trying to
ask him!” Which response is most empathetic? An overweight male patient rips off his hospital gown, throws it out the door, and shouts, “I’m not wearing this
a. “When people ignore me, I really get mad.” stupid gown! It is too small, too short, and exposes my backside to the world!” Which response is most appropriate?
a. Remind patient of the need to wear the gown for convenience in care.
, b. Confer with the patient for methods to acquire a larger gown.
c. Replace the torn gown with another. Which of the following are sources of clear guidelines for upholding clinical standards for safe and competent
care? (Select all that apply.)
d. Inform the charge nurse of the hostile behavior.
a. The state’s nurse practice act (NPA)
ANS: B b. The State Board of Nurse Examiners (BNE)
Allowing hostile patients to make reasonable requests defuses the anger and allows patients to vent their feelings. c. The National Association for Practical Nurse Education and Service (NAPNES)
d. Institutional policies
PTS: 1 DIF: Cognitive Level: Application REF: 9
OBJ: 10 TOP: Hostile Behavior e. The National Federation of Licensed Practical Nurses, Inc. (NFLPN)
KEY: Nursing Process Step: Implementation ANS: C, E
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation NAPNES and the NFLPN give clear guidelines for clinical standards that can be used as a basis for court decisions. The NPA
18. The nurse is caring for a patient who states, “You are the only nurse who understands about my pain. Can’t you give me an extra has broad guidelines, and institutional policies may not be complete. The BNE enforces the NPA.
dose of pain medication?” How should the nurse respond to the patient’s request? PTS: 1 DIF: Cognitive Level: Comprehension REF: 5
a. Explain that dosage schedules are by physician’s orders. OBJ: 3 TOP: Upholding Clinical Standards KEY: Nursing Process Step: N/A
b. Ignore the request. MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
c. Tell the patient that his behavior is manipulative.
Which statement(s) accurately describes the role of the LPN/LVN regardless of employment placement? (Select all that
d. Agree to give an extra dose of pain medication.
apply.)
ANS: A a. Uphold clinical standards
A matter-of-fact response to a manipulative request limits the effect of the manipulation, thereby helping the nurse to b. Educate patients
avoid becoming defensive or being swayed by flattery. c. Communicate effectively
d. Collaborate with the health care team
PTS: 1 DIF: Cognitive Level: Application REF: 9
OBJ: 10 TOP: Manipulative Behavior e. Initiate a care plan immediately after admission
KEY: Nursing Process Step: Implementation ANS: A,B,C,D
MSC: NCLEX: Psychosocial Integrity The LPN/LVN has the accountability to uphold clinical standards, educate patients, communicate effectively, and collaborate with
A female patient who has recently been diagnosed with an inoperable brain tumor asks the nurse, “Do you think the health care team. Depending on the type of facility, initiation of a care plan is often the role of the registered nurse.
God punishes us?” Which response demonstrates therapeutic communication? PTS: 1 DIF: Cognitive Level: Comprehension REF: 2
a. “What do you think?” OBJ: 3 TOP: Roles of LPN/LVNs
b. “God loves you.” KEY: Nursing Process Step: Implementation
c. “Would like to speak with the chaplain?” MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d. “God will not give you more than you can bear.”
The newly licensed LPN/LVN demonstrates an understanding of employment opportunities when applying to
ANS: A a position in which area(s)? (Select all that apply.)
Sitting with the patient and offering oneself to listen to the patient’s concerns and encouraging reflection is the best a. An outpatient clinic
approach rather than responding with a cliché or suggesting speaking with the chaplain. b. A home health care agency
c. An intravenous (IV) therapy team
PTS: 1 DIF: Cognitive Level: Application REF: 10
OBJ: 10 TOP: Spiritual Care d. A long-term care facility
KEY: Nursing Process Step: Implementation e. An ambulatory care unit
MSC: NCLEX: Psychosocial Integrity ANS: A,B,D,E
The nurse is communicating with a patient who voices concern about an upcoming high-risk procedure. With the exception of an IV therapy team, which requires postgraduate education and/or certification, the other options are
Which statement best demonstrates empathy? open to newly graduated vocational nurses.
a. “Would you like to talk about your feelings regarding the procedure?” PTS: 1 DIF: Cognitive Level: Application REF: 2
b. “My mother had the same procedure and did very well.” OBJ: 2 TOP: Employment Opportunities for LPN/LVNs
c. “I can’t imagine how you feel.” KEY: Nursing Process Step: N/A
d. “It must be difficult preparing for the procedure; how are you feeling?” MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
ANS: D What factor(s) should the LPN/LVN consider when delegating a task to unlicensed assistive personnel (UAP)?
This statement by the nurse displays empathy by trying to place oneself in the patient’s circumstance and validating the (Select all that apply.)
patient’s feelings. Simply asking patients if they would like to talk about their feelings does not show empathy and may elicit a a. A need for the UAP to voluntarily accept the task delegated
“yes” or “no” response. Telling the patient one’s mother had the procedure or stating “I can’t imagine how you feel” does not b. Continued accountability for the task by the LPN/LVN
show empathy toward the patient. c. Assurance that the task requires no further need for supervision of the UAP
PTS: 1 DIF: Cognitive Level: Application REF: 10 d. An understanding that the task is in the job description of the UAP
OBJ: 10 TOP: Nurse–Patient Relationship e. A transfer of authority to the UAP
KEY: Nursing Process Step: Implementation
ANS: A,B,D,E
MSC: NCLEX: Psychosocial Integrity
Delegation is a considered act involving the condition of the patient and the competency of the UAP. Delegation requires that
the UAP voluntarily accept the task, which is in the job description of the UAP. The vocational nurse has transferred authority
MULTIPLE RESPONSE for the completion of the task but is still accountable and should supervise.
, PTS: 1 DIF: Cognitive Level: Application REF: 3 PTS: 1 DIF: Cognitive Level: Comprehension REF: 16, Box 2-1
OBJ: 1 TOP: Delegation KEY: Nursing Process Step: N/A OBJ: 2 (theory) TOP: Factors Influencing Critical Thinking
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care KEY: Nursing Process Step: N/A MSC: NCLEX: Health Promotion and Maintenance
The LPN/LVN participates in an in-service about cost containment within the health care facility. Which Which fundamental belief underscores the basis of the nursing process?
action(s) demonstrate understanding of cost-containment principles? (Select all that apply.) a. Recognition that basic needs must be met by the individual without assistance.
a. Telling patients to limit their usage of supplies. b. Acknowledgment that patients and families appreciate an efficient health care system that functions without their input.
b. Asking the UAP to ensure correct charges for patient care items. c. A focus on disease control as the most important aspect of patient care.
c. Only using necessary items for patient care. d. Recognition that all people have worth and dignity.
d. Charging for extra patient care items that the patient may take home upon discharge.
e. Documenting supplies used for patients in their patient care record. ANS: D
The nursing process is based on the belief that all people have worth and dignity. Patient-centered care that is applied to all
ANS: B,C,E aspects of the patient’s health, and is not just disease oriented, is appreciated by the family and patient. Holistic care approach
The UAP must correctly charge patients utilizing the facility’s charging system, only necessary supplies should be used for can support the patient to meet basic needs.
patient care, and documenting supplies used assists in reimbursement. It is inappropriate and not the patient’s responsibility
to monitor their supply use, and excess charges would be incurred if items were given to the patient upon discharge. PTS: 1 DIF: Cognitive Level: Comprehension REF: 17
OBJ: 5 (theory) TOP: Basic Beliefs Pertinent to the Nursing Process
PTS: 1 DIF: Cognitive Level: Application REF: 6 KEY: Nursing Process Step: Implementation
OBJ: 8 TOP: Cost Containment MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care The nurse is assessing a new patient who complains of his chest feeling tight. The patient displays a temperature of 100°
F and an oxygen saturation of 89%, and expectorates frothy mucus. Which finding is an example of subjective data?
COMPLETION a. Temperature
b. Oxygen saturation
When an insurance company directly reimburses a licensed health care provider for services, the form of financing c. Frothy mucus
is called ______________. d. Chest tightness
ANS: ANS: D
fee for service Subjective data is information given by the patient that cannot be measured otherwise. The other data are considered objective
data. Objective data are pieces of information that can be measured by the examiner. The nurse should avoid making
Fee for service is the direct reimbursement by an insurance company to a health care provider. judgments or conclusions when obtaining data.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 7 PTS: 1 DIF: Cognitive Level: Application REF: 18
OBJ: 9 TOP: Health Care Financing KEY: Nursing Process Step: N/A OBJ: 8 (clinical) TOP: Assessment Data
KEY: Nursing Process Step: Planning
MSC: NCLEX: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
The nurse explains that the term _____________ refers to the severity of illness.
The nurse is caring for a newly admitted patient who is describing his recent symptoms to the nurse. This scenario is
ANS: an example of which type of source?
acuity a. Primary
b. Objective
Acuity is the term referring to the severity of illness or condition of a patient. c. Secondary
d. Complete
PTS: 1 DIF: Cognitive Level: Knowledge REF: 4
OBJ: 6 TOP: Acuity KEY: Nursing Process Step: Implementation ANS: A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care The patient is the primary source of information. Objective refers to a type of data obtained by the nurse that is measured or
can be verified through assessment techniques, secondary information is obtained from relatives or significant others, and
Chapter 02: Critical Thinking and the Nursing Process information is not necessarily complete when the patient is the source.
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition PTS: 1 DIF: Cognitive Level: Application REF: 19
OBJ: 8 (clinical) TOP: Sources of Information
MULTIPLE CHOICE KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
Which foundational behavior is necessary for effective critical thinking?
a. Unshakable beliefs and values The nurse is performing an intake interview on a new resident to the long-term care facility. The nurse detects the
odor of acetone from the patient’s breath. Which term accurately describes this assessment?
b. An open attitude
a. Inspection
c. An ability to disregard evidence inconsistent with set goals
b. Observation
d. An ability to recognize the perfect solution
c. Auscultation
ANS: B d. Olfaction
An open attitude not clouded by unshakable beliefs and values or preset goals allows the application of critical thinking.
Acceptance that there may not be a perfect solution leaves the field open to new ideas. ANS: D
