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