,Chapter 01: Caring for Medical-Surgical Patients
v v v v v
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 6th Edition
v v v v v v v
MULTIPLE CHOICE v
1. Which statement accurately describes the primary purpose of the state nurse practice act
v v v v v v v v v v v v
v (NPA)?
a. To test and license LPN/LVNs
v v v v
b. To define the scope of LPN/LVN practice
v v v v v v
c. To improve the quality of care provided by the LPN/LVN
v v v v v v v v v
d. To limit the LPN/LVN employment placement
v v v v v
ANS: B v
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
v v v v v v v v v v v v v v v v
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
v v v v v v v v v v v v v v v v v
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: v v v v
v3 TOP: NPA
v KEY: Nursing Process Step: Implementation
v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
v v v v v v v v v v v v v v v v
vocational nurse has not been taught during her educational program. How should the
v v v v v v v v v v v v v
vocational nurse respond?
v v v
a. Ask a more experienced nurse to demonstrate the procedure.
v v v v v v v v
b. Look up the procedure in the procedure manual.
v v v v v v v
c. Attempt to perform the procedure with supervision. v v v v v v
d. Inform the charge nurse of her lack of training in this procedure.
v v v v v v v v v v v
ANS: D v
The charge nurse should be informed of the lack of training to perform the procedure, and the
v v v v v v v v v v v v v v v v
vocational nurse should seek further training to gain proficiency. Although the other options
v v v v v v v v v v v v v
might be helpful, they are not safe.
v v v v v v v
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 v v v v v
TOP: Providing Safe Care
v v KEY: Nursing Process Step: N/A v v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v v
3. Which patient statement indicates a need for further discharge teaching that the vocational
v v v v v v v v v v v v
v nurse should address?
v v
a. ―I have no idea of how this drug will affect me.‖
v v v v v v v v v v
b. ―Do you know if my physician is coming back today?‖
v v v v v v v v v
c. ―Will my insurance pay for my stay?‖ v v v v v v
d. ―Am I going to have to go to a nursing home?‖ v v v v v v v v v v
ANS: A v
Lack of knowledge at discharge about medication effects and side effects is a concern that
v v v v v v v v v v v v v v
should be addressed by the vocational nurse. The other concerns in the options are the
v v v v v v v v v v v v v v v
responsibility of other departments to which the nurse might refer the patient.
v v v v v v v v v v v v
DIF: Cognitive Level: Application REF: p. 2 OBJ: v v v v
v1 TOP: Teaching KEY: Nursing Process Step: Implementation
v v v v v v
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
v v v v v v v v v v v v v v v
facility acts in which capacity?
v v v v v
a. Working under direct supervision of an RN on the unit v v v v v v v v v
b. Working with the RN in the building v v v v v v
c. Working under general supervision by the RN available on site or by phone
v v v v v v v v v v v v
d. Working as an independent vocational nurse v v v v v
ANS: C v
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
v v v v v v v v v v v v v v v v
the general supervision of an RN available on site or by phone.
v v v v v v v v v v v v
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 v v v v v
TOP: Charge Nurse/Manager
v v KEY: Nursing Process Step: N/A v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v v
5. The nurse is educating a patient that is a member of a health maintenance organization
v v v v v v v v v v v v v v
v (HMO). Which information should the nurse include?
v v v v v v
a. Seek the opinion of an alternate health care provider.
v v v v v v v v
b. Contact the insurance company for coverage details as services may be limited.
v v v v v v v v v v v
c. Provide detailed documentation of all care received for his condition.
v v v v v v v v v
d. Wait at least 6 months to see a specialist.
v v v v v v v v
ANS: B v
HMOs are a kind of managed care. This is accomplished by paying providers to care for
v v v v v v v v v v v v v v v
groups of patients for a set capitation fee and by limiting services. Patients are not required to
v v v v v v v v v v v v v v v v v
seek a second opinion, provide documentation of care, or wait a specific time period before
v v v v v v v v v v v v v v v
visiting a specialist.
v v v
DIF: Cognitive Level: Application REF: p. 9 OBJ: 9 v v v v v v v
TOP: Charge Nurse/Manager
v KEY: Nursing Process Step: Implementation
v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v v
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the
v v v v v v v v v v v v v v v v
hospital. Which statement accurately explains a deductible?
v v v v v v v
a. An amount of money put aside for the payment of future medical bills
v v v v v v v v v v v v
b. A one-time fee for service
v v v v
c. An amount of money deducted from the bill by the insurance company
v v v v v v v v v v v
d. An annual amount of money the patient must pay out-of-pocket for medical care
v v v v v v v v v v v v
ANS: D v
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
v v v v v v v v v v v v v v
company assuming the cost. This practice improves the profit of the insurance company.
v v v v v v v v v v v v v
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9 v v v v v v v
TOP: Health Care Financing
v KEY: Nursing Process Step: Implementation
v v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v v
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
v v v v v v v v v v v v v
a. Medicare Part A covers inpatient hospital costs. v v v v v v
b. Medicare Part A covers reimbursement to the physician. v v v v v v v
, c. Medicare Part A covers outpatient hospital services. v v v v v v
d. Medicare Part A covers ambulance transportation. v v v v v
ANS: A v
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
v v v v v v v v v v v
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
v v v v v v v v v v v v
services.
v
DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 v v v v v v
OBJ: 9 v TOP: Government-Sponsored Health v v
Insurance KEY: Nursing Process Step: Implementation
v v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
v v v v v v v v v
a. Hospitals focus only on the specific diagnosis. v v v v v v
b. Hospitals treat and discharge patients quickly. v v v v v
c. Reduced cost drugs are ordered for specific diagnoses.
v v v v v v v
d. Diagnostic group classification streamlines care. v v v v
ANS: B v
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
v v v v v v v v v v v v v v v
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
v v v v v v v v v v v v v v v v
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
v v v v v v v v v v v v v v v
contained, and the patient is discharged sooner.
v v v v v v v
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: v v v v
v9 TOP: Government-Sponsored Health Insurance
v v v v
KEY: Nursing Process Step: Implementation
v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
9. The nurse is assessing a group of patients. Which patient would most likely qualify for
v v v v v v v v v v v v v v
Medicaid?
v
a. A 35-year-old unemployed single mother with diabetes
v v v v v v
b. A 70-year-old Medicare recipient with retirement income who needs to be in a
v v v v v v v v v v v v
long-term care facility v v
c. An 80-year-old blind woman living in her own home who has inadequate private
v v v v v v v v v v v v
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
v v v v v v v v v v v v
ANS: A v
Medicaid is a joint effort of federal and state governments geared primarily for low-income
v v v v v v v v v v v v v
people with no insurance.
v v v v
DIF: Cognitive Level: Application REF: p. 8, Box 1-5 v v v v v v
OBJ: 9 v TOP: Government-Sponsored Health Insurance— v v v
Medicaid KEY: Nursing Process Step: Assessment
v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through
v v v v v v v v v v v v v v
which to improve the health of Americans in the second decade of the century?
v v v v v v v v v v v v v v
a. Research funding v
b. Health information distribution v v
v v v v v
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 6th Edition
v v v v v v v
MULTIPLE CHOICE v
1. Which statement accurately describes the primary purpose of the state nurse practice act
v v v v v v v v v v v v
v (NPA)?
a. To test and license LPN/LVNs
v v v v
b. To define the scope of LPN/LVN practice
v v v v v v
c. To improve the quality of care provided by the LPN/LVN
v v v v v v v v v
d. To limit the LPN/LVN employment placement
v v v v v
ANS: B v
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
v v v v v v v v v v v v v v v v
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
v v v v v v v v v v v v v v v v v
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: v v v v
v3 TOP: NPA
v KEY: Nursing Process Step: Implementation
v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
v v v v v v v v v v v v v v v v
vocational nurse has not been taught during her educational program. How should the
v v v v v v v v v v v v v
vocational nurse respond?
v v v
a. Ask a more experienced nurse to demonstrate the procedure.
v v v v v v v v
b. Look up the procedure in the procedure manual.
v v v v v v v
c. Attempt to perform the procedure with supervision. v v v v v v
d. Inform the charge nurse of her lack of training in this procedure.
v v v v v v v v v v v
ANS: D v
The charge nurse should be informed of the lack of training to perform the procedure, and the
v v v v v v v v v v v v v v v v
vocational nurse should seek further training to gain proficiency. Although the other options
v v v v v v v v v v v v v
might be helpful, they are not safe.
v v v v v v v
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1 v v v v v
TOP: Providing Safe Care
v v KEY: Nursing Process Step: N/A v v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v v
3. Which patient statement indicates a need for further discharge teaching that the vocational
v v v v v v v v v v v v
v nurse should address?
v v
a. ―I have no idea of how this drug will affect me.‖
v v v v v v v v v v
b. ―Do you know if my physician is coming back today?‖
v v v v v v v v v
c. ―Will my insurance pay for my stay?‖ v v v v v v
d. ―Am I going to have to go to a nursing home?‖ v v v v v v v v v v
ANS: A v
Lack of knowledge at discharge about medication effects and side effects is a concern that
v v v v v v v v v v v v v v
should be addressed by the vocational nurse. The other concerns in the options are the
v v v v v v v v v v v v v v v
responsibility of other departments to which the nurse might refer the patient.
v v v v v v v v v v v v
DIF: Cognitive Level: Application REF: p. 2 OBJ: v v v v
v1 TOP: Teaching KEY: Nursing Process Step: Implementation
v v v v v v
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care
v v v v v v v v v v v v v v v
facility acts in which capacity?
v v v v v
a. Working under direct supervision of an RN on the unit v v v v v v v v v
b. Working with the RN in the building v v v v v v
c. Working under general supervision by the RN available on site or by phone
v v v v v v v v v v v v
d. Working as an independent vocational nurse v v v v v
ANS: C v
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
v v v v v v v v v v v v v v v v
the general supervision of an RN available on site or by phone.
v v v v v v v v v v v v
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1 v v v v v
TOP: Charge Nurse/Manager
v v KEY: Nursing Process Step: N/A v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v v
5. The nurse is educating a patient that is a member of a health maintenance organization
v v v v v v v v v v v v v v
v (HMO). Which information should the nurse include?
v v v v v v
a. Seek the opinion of an alternate health care provider.
v v v v v v v v
b. Contact the insurance company for coverage details as services may be limited.
v v v v v v v v v v v
c. Provide detailed documentation of all care received for his condition.
v v v v v v v v v
d. Wait at least 6 months to see a specialist.
v v v v v v v v
ANS: B v
HMOs are a kind of managed care. This is accomplished by paying providers to care for
v v v v v v v v v v v v v v v
groups of patients for a set capitation fee and by limiting services. Patients are not required to
v v v v v v v v v v v v v v v v v
seek a second opinion, provide documentation of care, or wait a specific time period before
v v v v v v v v v v v v v v v
visiting a specialist.
v v v
DIF: Cognitive Level: Application REF: p. 9 OBJ: 9 v v v v v v v
TOP: Charge Nurse/Manager
v KEY: Nursing Process Step: Implementation
v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v v
6. The patient complains to the nurse that he is confused about his ―deductible‖ that he owes the
v v v v v v v v v v v v v v v v
hospital. Which statement accurately explains a deductible?
v v v v v v v
a. An amount of money put aside for the payment of future medical bills
v v v v v v v v v v v v
b. A one-time fee for service
v v v v
c. An amount of money deducted from the bill by the insurance company
v v v v v v v v v v v
d. An annual amount of money the patient must pay out-of-pocket for medical care
v v v v v v v v v v v v
ANS: D v
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
v v v v v v v v v v v v v v
company assuming the cost. This practice improves the profit of the insurance company.
v v v v v v v v v v v v v
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9 v v v v v v v
TOP: Health Care Financing
v KEY: Nursing Process Step: Implementation
v v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v v
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
v v v v v v v v v v v v v
a. Medicare Part A covers inpatient hospital costs. v v v v v v
b. Medicare Part A covers reimbursement to the physician. v v v v v v v
, c. Medicare Part A covers outpatient hospital services. v v v v v v
d. Medicare Part A covers ambulance transportation. v v v v v
ANS: A v
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
v v v v v v v v v v v
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
v v v v v v v v v v v v
services.
v
DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4 v v v v v v
OBJ: 9 v TOP: Government-Sponsored Health v v
Insurance KEY: Nursing Process Step: Implementation
v v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
v v v v v v v v v
a. Hospitals focus only on the specific diagnosis. v v v v v v
b. Hospitals treat and discharge patients quickly. v v v v v
c. Reduced cost drugs are ordered for specific diagnoses.
v v v v v v v
d. Diagnostic group classification streamlines care. v v v v
ANS: B v
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
v v v v v v v v v v v v v v v
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
v v v v v v v v v v v v v v v v
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
v v v v v v v v v v v v v v v
contained, and the patient is discharged sooner.
v v v v v v v
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: v v v v
v9 TOP: Government-Sponsored Health Insurance
v v v v
KEY: Nursing Process Step: Implementation
v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
9. The nurse is assessing a group of patients. Which patient would most likely qualify for
v v v v v v v v v v v v v v
Medicaid?
v
a. A 35-year-old unemployed single mother with diabetes
v v v v v v
b. A 70-year-old Medicare recipient with retirement income who needs to be in a
v v v v v v v v v v v v
long-term care facility v v
c. An 80-year-old blind woman living in her own home who has inadequate private
v v v v v v v v v v v v
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
v v v v v v v v v v v v
ANS: A v
Medicaid is a joint effort of federal and state governments geared primarily for low-income
v v v v v v v v v v v v v
people with no insurance.
v v v v
DIF: Cognitive Level: Application REF: p. 8, Box 1-5 v v v v v v
OBJ: 9 v TOP: Government-Sponsored Health Insurance— v v v
Medicaid KEY: Nursing Process Step: Assessment
v v v v v
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
v v v v v v v
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through
v v v v v v v v v v v v v v
which to improve the health of Americans in the second decade of the century?
v v v v v v v v v v v v v v
a. Research funding v
b. Health information distribution v v
