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