,Chapter 01: Caring for Medical-Surgical Patients
d d d d d
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
d d d d d d d
MULTIPLE CHOICE d
1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
d d d d d d d d d d d d d
a. To test and license LPN/LVNs. d d d d
b. To define the scope of LPN/LVN practice.
d d d d d d
c. To improve the quality of care provided by the
d d d d d d d d
LPN/LVN. d
d. To limit the LPN/LVN employment placement.
d d d d d
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
d d d d d d d d d d d d d d d d d d d d d
of each state defines the scope of nursing practice in that state.
d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 d d
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the vocational nurse
d d d d d d d d d d d d d d d d d d
has
d d notbeen taught during her educational program. How should the vocational nurse respond?
d d d d d d d d d d d d
a. Ask a more experienced nurse to demonstrate the procedure.
d d d d d d d d
b. Look up the procedure in the procedure manual.
d d d d d d d
c. Attempt to perform the procedure with supervision.
d d d d d d
d. Inform the charge nurse of her lack of training in this
d d d d d d d d d d
dprocedure.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should seek
d d d d d d d d d d d d d d d d d d d d
further training to gain proficiency. Although the other options might be helpful, they are not safe.
d d d d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Application REF: 3 d d d
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A d d d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
3. Which patient statement indicates a need for further discharge teaching that the vocational nurse should address?
d d d d d d d d d d d d d d d
a. “I have no idea of how this drug will affect me.”
d d d d d d d d d d
b. “Do you know if my physician is coming back
d d d d d d d d
today?” d
c. “Will my insurance pay for my stay?” d d d d d d
d. “Am I going to have to go to a nursing home?”
d d d d d d d d d d
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that should be addressed by the
d d d d d d d d d d d d d d d d d d d
vocationalnurse. The other concerns in the options are the responsibility of other departments to which the nurse might
d d d d d d d d d d d d d d d d d d d
refer the patient.
d d d
PTS: 1 DIF: Cognitive Level: Application REF: 2 d d d d d
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation d d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in
d d d d d d d d d d d d d d d d d d
which capacity?
d d
a. Working under direct supervision of an RN on the unit d d d d d d d d d
b. Working with the RN in the building d d d d d d
c. Working under general supervision by the RN available on site or by d d d d d d d d d d d
phone d
d. Working as an independent vocational nurse d d d d d
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
d d d d d d d d d d d d d d d d d d d d d
RN available on site or by phone.
d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 d d
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
,5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
d d d d d d d d d d d d d d d d
informationshould the nurse include?
d d d d d
a. Seek the opinion of an alternate health care provider.
d d d d d d d d
b. Obtain insurance approval for medical services prior to treatment.
d d d d d d d d
c. Provide detailed documentation of all care received for his
d d d d d d d d
condition.
d
d. Wait at least 6 months to see a specialist.
d d d d d d d d
ANS: B
Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion, provide
d d d d d d d d d d d d d d d d
documentation of care, or wait a specific time period before visiting a specialist.
d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Application REF: 9 d d d
OBJ: 9 TOP: Charge Nurse/Manager d
KEY: Nursing Process Step: Implementation
d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
6. The patient complains to the nurse that he is confused about his “deductible” that he owes the hospital.
d d d d d d d d d d d d d d d d d
Whichstatement accurately explains a deductible?
d d d d d d
a. An amount of money put aside for the payment of future medical bills
d d d d d d d d d d d d
b. A one-time fee for service
d d d d
c. An amount of money deducted from the bill by the insurance company
d d d d d d d d d d d
d. An annual amount of money the patient must pay out-of-pocket for medical
d d d d d d d d d d d
care d
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company assuming the cost.
d d d d d d d d d d d d d d d d d d
This practice improves the profit of the insurance company.
d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: d d 7
OBJ: 9 TOP: Health Care Financing d d
KEY: Nursing Process Step: Implementation
d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
7. The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred
d d d d d d d d d d d d d
providerorganization (PPO). Which information should the nurse include about HMOs?
d d d d d d d d d d d
a. HMOs require a set fee of each member monthly.
d d d d d d d d
b. HMOs allow the member to select his health care
d d d d d d d d
provider.
d
c. HMOs permit admission to any facility the member
d d d d d d d
prefers.
d
d. HMOs offer unlimited diagnostic tests and treatments.
d d d d d d
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated by the HMO staff in HMO-
d d d d d d d d d d d d d d d d d d d d
approved facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Application REF: 9 d d d
OBJ: 9 TOP: Managed Care d
KEY: Nursing Process Step: Implementation
d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
8. A patient d d asks the nurse what Medicare Part A covers. Which response is correct?
d d d d d d d d d d d
a. Medicare Part d d A covers inpatient hospital costs.
d d d d
b. Medicare Part d d A covers reimbursement to the
d d d d
physician.
d
c. Medicare Part d d A covers outpatient hospital services.
d d d d
d. Medicare Part d d A covers ambulance transportation.
d d d
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B
d d d d d d d d d d d d d d d d
pays the physician, ambulance transport, and outpatient services.
d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: d d 7, Box 1-4
d d
OBJ: 9 TOP: Government-Sponsored Health Insurance d d
KEY: Nursing Process Step: Implementation
d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
9. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
d d d d d d d d d
, a. Hospitals focus only on the specific diagnosis. d d d d d d
b. Hospitals treat and discharge patients quickly. d d d d d
c. Reduced cost drugs are ordered for specific d d d d d d
diagnoses.
d
d. Diagnostic group classification streamlines care. d d d d
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless of
d d d d d d d d d d d d d d d d d d d
the length of time in the hospital. If hospitals can treat and discharge patients before the allotted time, hospitals get to keep
d d d d d d d d d d d d d d d d d d d d d d
the excess payment; cost is contained, and the patient is discharged sooner.
d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: d d 8
OBJ: 9 TOP: Government-Sponsored Health Insurance d d
KEY: d d d d d d Nursing Process Step: Implementation d d d
MSC: d d d d NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d d
10. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
d d d d d d d d d d d d d d d
a. A 35-year-old unemployed single mother with diabetes
d d d d d d
b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-term care
d d d d d d d d d d d d d d
facility d
c. An 80-year-old blind woman living in her own home who has inadequate private insurance
d d d d d d d d d d d d d
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
d d d d d d d d d d d d
ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no insurance.
d d d d d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1- d d d d d d d
5OBJ:
d 9 TOP: Government-Sponsored Health Insurance–Medicaid d d
KEY:
d Nursing Process Step: Assessment d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
11. Which area is the major focus of Healthy People 2020 and the primary mechanism through which to improve the
d d d d d d d d d d d d d d d d d d
healthof Americans in the second decade of the century?
d d d d d d d d d d
a. Research funding d
b. Health information distribution d d
c. Healthy lifestyle encouragement d d
d. Health improvement program designs d d d
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant mortality,
d d d d d d d d d d d d d d d d
cancer, cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits, and healthy
d d d d d d d d d d d d d d d
weight.
d
PTS: 1 DIF: Cognitive Level: Comprehension REF: d d 6
OBJ: 7 TOP: Healthy People 2020 d d
KEY: Nursing Process Step: Implementation d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
12. Which term explains the type of care that addresses interventions for all dimensions of a patient’s life?
d d d d d d d d d d d d d d d d
a. Focused care d
b. General care d
c. Directed care d
d. Holistic care d
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the patient.
d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension d d REF: 6
OBJ: 8 TOP: Holistic Care d
KEY: Nursing Process Step: Planning d d d
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
d d d d d
13. A patient furiously says, “My doctor was so busy giving me instructions that he didn’t hear what I was trying
d d d d d d d d d d d d d d d d d d d
to askhim!” Which response is most empathetic?
d d d d d d d d
a. “When people ignore me, I really get mad.” d d d d d d d
d d d d d
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
d d d d d d d
MULTIPLE CHOICE d
1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
d d d d d d d d d d d d d
a. To test and license LPN/LVNs. d d d d
b. To define the scope of LPN/LVN practice.
d d d d d d
c. To improve the quality of care provided by the
d d d d d d d d
LPN/LVN. d
d. To limit the LPN/LVN employment placement.
d d d d d
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
d d d d d d d d d d d d d d d d d d d d d
of each state defines the scope of nursing practice in that state.
d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 d d
OBJ: 3 TOP: NPA KEY: Nursing Process Step: Implementation d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the vocational nurse
d d d d d d d d d d d d d d d d d d
has
d d notbeen taught during her educational program. How should the vocational nurse respond?
d d d d d d d d d d d d
a. Ask a more experienced nurse to demonstrate the procedure.
d d d d d d d d
b. Look up the procedure in the procedure manual.
d d d d d d d
c. Attempt to perform the procedure with supervision.
d d d d d d
d. Inform the charge nurse of her lack of training in this
d d d d d d d d d d
dprocedure.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the vocational nurse should seek
d d d d d d d d d d d d d d d d d d d d
further training to gain proficiency. Although the other options might be helpful, they are not safe.
d d d d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Application REF: 3 d d d
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process Step: N/A d d d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
3. Which patient statement indicates a need for further discharge teaching that the vocational nurse should address?
d d d d d d d d d d d d d d d
a. “I have no idea of how this drug will affect me.”
d d d d d d d d d d
b. “Do you know if my physician is coming back
d d d d d d d d
today?” d
c. “Will my insurance pay for my stay?” d d d d d d
d. “Am I going to have to go to a nursing home?”
d d d d d d d d d d
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that should be addressed by the
d d d d d d d d d d d d d d d d d d d
vocationalnurse. The other concerns in the options are the responsibility of other departments to which the nurse might
d d d d d d d d d d d d d d d d d d d
refer the patient.
d d d
PTS: 1 DIF: Cognitive Level: Application REF: 2 d d d d d
OBJ: 1 TOP: Teaching KEY: Nursing Process Step: Implementation d d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility acts in
d d d d d d d d d d d d d d d d d d
which capacity?
d d
a. Working under direct supervision of an RN on the unit d d d d d d d d d
b. Working with the RN in the building d d d d d d
c. Working under general supervision by the RN available on site or by d d d d d d d d d d d
phone d
d. Working as an independent vocational nurse d d d d d
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
d d d d d d d d d d d d d d d d d d d d d
RN available on site or by phone.
d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: 2 d d
OBJ: 1 TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
,5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
d d d d d d d d d d d d d d d d
informationshould the nurse include?
d d d d d
a. Seek the opinion of an alternate health care provider.
d d d d d d d d
b. Obtain insurance approval for medical services prior to treatment.
d d d d d d d d
c. Provide detailed documentation of all care received for his
d d d d d d d d
condition.
d
d. Wait at least 6 months to see a specialist.
d d d d d d d d
ANS: B
Most HMOs require preprocedure authorization for treatment. Patients are not required to seek a second opinion, provide
d d d d d d d d d d d d d d d d
documentation of care, or wait a specific time period before visiting a specialist.
d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Application REF: 9 d d d
OBJ: 9 TOP: Charge Nurse/Manager d
KEY: Nursing Process Step: Implementation
d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
6. The patient complains to the nurse that he is confused about his “deductible” that he owes the hospital.
d d d d d d d d d d d d d d d d d
Whichstatement accurately explains a deductible?
d d d d d d
a. An amount of money put aside for the payment of future medical bills
d d d d d d d d d d d d
b. A one-time fee for service
d d d d
c. An amount of money deducted from the bill by the insurance company
d d d d d d d d d d d
d. An annual amount of money the patient must pay out-of-pocket for medical
d d d d d d d d d d d
care d
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance company assuming the cost.
d d d d d d d d d d d d d d d d d d
This practice improves the profit of the insurance company.
d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: d d 7
OBJ: 9 TOP: Health Care Financing d d
KEY: Nursing Process Step: Implementation
d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
7. The nurse compares the characteristics of a health maintenance organization (HMO) and a preferred
d d d d d d d d d d d d d
providerorganization (PPO). Which information should the nurse include about HMOs?
d d d d d d d d d d d
a. HMOs require a set fee of each member monthly.
d d d d d d d d
b. HMOs allow the member to select his health care
d d d d d d d d
provider.
d
c. HMOs permit admission to any facility the member
d d d d d d d
prefers.
d
d. HMOs offer unlimited diagnostic tests and treatments.
d d d d d d
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated by the HMO staff in HMO-
d d d d d d d d d d d d d d d d d d d d
approved facilities. Excessive use of diagnostic tests and treatments is discouraged by the HMO.
d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Application REF: 9 d d d
OBJ: 9 TOP: Managed Care d
KEY: Nursing Process Step: Implementation
d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
8. A patient d d asks the nurse what Medicare Part A covers. Which response is correct?
d d d d d d d d d d d
a. Medicare Part d d A covers inpatient hospital costs.
d d d d
b. Medicare Part d d A covers reimbursement to the
d d d d
physician.
d
c. Medicare Part d d A covers outpatient hospital services.
d d d d
d. Medicare Part d d A covers ambulance transportation.
d d d
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care. Medicare Part B
d d d d d d d d d d d d d d d d
pays the physician, ambulance transport, and outpatient services.
d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: d d 7, Box 1-4
d d
OBJ: 9 TOP: Government-Sponsored Health Insurance d d
KEY: Nursing Process Step: Implementation
d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
9. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
d d d d d d d d d
, a. Hospitals focus only on the specific diagnosis. d d d d d d
b. Hospitals treat and discharge patients quickly. d d d d d
c. Reduced cost drugs are ordered for specific d d d d d d
diagnoses.
d
d. Diagnostic group classification streamlines care. d d d d
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s diagnostic category regardless of
d d d d d d d d d d d d d d d d d d d
the length of time in the hospital. If hospitals can treat and discharge patients before the allotted time, hospitals get to keep
d d d d d d d d d d d d d d d d d d d d d d
the excess payment; cost is contained, and the patient is discharged sooner.
d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension REF: d d 8
OBJ: 9 TOP: Government-Sponsored Health Insurance d d
KEY: d d d d d d Nursing Process Step: Implementation d d d
MSC: d d d d NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d d
10. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
d d d d d d d d d d d d d d d
a. A 35-year-old unemployed single mother with diabetes
d d d d d d
b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-term care
d d d d d d d d d d d d d d
facility d
c. An 80-year-old blind woman living in her own home who has inadequate private insurance
d d d d d d d d d d d d d
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
d d d d d d d d d d d d
ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-income people with no insurance.
d d d d d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Application REF: 8, Box 1- d d d d d d d
5OBJ:
d 9 TOP: Government-Sponsored Health Insurance–Medicaid d d
KEY:
d Nursing Process Step: Assessment d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
11. Which area is the major focus of Healthy People 2020 and the primary mechanism through which to improve the
d d d d d d d d d d d d d d d d d d
healthof Americans in the second decade of the century?
d d d d d d d d d d
a. Research funding d
b. Health information distribution d d
c. Healthy lifestyle encouragement d d
d. Health improvement program designs d d d
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to reduce infant mortality,
d d d d d d d d d d d d d d d d
cancer, cardiovascular disease, and HIV/AIDS, and to increase effective immunizations, healthy eating habits, and healthy
d d d d d d d d d d d d d d d
weight.
d
PTS: 1 DIF: Cognitive Level: Comprehension REF: d d 6
OBJ: 7 TOP: Healthy People 2020 d d
KEY: Nursing Process Step: Implementation d d d
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
d d d d d d
12. Which term explains the type of care that addresses interventions for all dimensions of a patient’s life?
d d d d d d d d d d d d d d d d
a. Focused care d
b. General care d
c. Directed care d
d. Holistic care d
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the patient.
d d d d d d d d d d d d d
PTS: 1 DIF: Cognitive Level: Comprehension d d REF: 6
OBJ: 8 TOP: Holistic Care d
KEY: Nursing Process Step: Planning d d d
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
d d d d d
13. A patient furiously says, “My doctor was so busy giving me instructions that he didn’t hear what I was trying
d d d d d d d d d d d d d d d d d d d
to askhim!” Which response is most empathetic?
d d d d d d d d
a. “When people ignore me, I really get mad.” d d d d d d d
