Medical Surgical
k k
NursingConcepts
k k
and Practice 3th E
k k k
dition.
,Chapterk01:kCaring kforkMedical-Surgical kPatients
deWit:kMedical-Surgical kNursing:kConceptsk&kPractice,k3rdkEdition
MULTIPLEkCHOICE
1. Which k statementk accurately k describes k thek primary k purposek of k thek statek nursek practicek actk (NPA)?
a. To k testk and k licensek LPN/LVNs.
b. To k definek thek scopek of k LPN/LVNk practice.
c. To k improvek thek quality k of k carek provided k by k thek LPN/LVN.
d. To k limitk thek LPN/LVNk employmentk placement.
ANS: B
Whilek improvingk quality k of k carek provided k by k thek LPN/LVNk m ay k bek ak resultk of k thek NPA,k thek primary k purposek ofk thek NPAk of k each
k statek defines k thek scopek of k nursingk practicek in k thatk state.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 2
OBJ: 3 TOP: NPA KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
2. Thek chargek nursek asks k thek newk vocationalk nursek to k startk an k intravenous k infusion, k ak skillk thatk thek vocationalk nursek has k n
otk been k taughtk duringk her k educationalk program. k Howk should k thek vocationalk nursek respond?
a. Ask k ak morek experienced k nursek to k demonstratek thek procedure.
b. Look k up k thek procedurek in k thek procedurek manual.
c. Attemptk to k perform k thek procedurek with k supervision.
d. Inform k thek chargek nursek of k her k lack k of k trainingk in k this k procedure.
ANS: D
Thek chargek nursek should k bek informed k of k thek lack k of k trainingk to k perform k thek procedure, k and k thek vocationalk nursek should k seek k fur
ther k trainingk to k gain k proficiency. k Although k thek other k options k migh tk bek helpful, k they k arek notk safe.
PTS: 1 DIF: Cognitivek Level:k Application k k REF: 3
OBJ: 1 TOP: ProvidingkSafekCare KEY: NursingkProcess kStep:kN/A
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
3. Which k patientk statementk indicates k ak need k for k further k dischargek teachin gk thatk thek vocationalk nursek should k address?
a. “I k havek no k ideak of k howk this k drugk willk affectk me.”
b. “Do k you k knowk if k my k physician k is k comingk back k today?”
c. “Willk my k insurancek pay k for k my k stay?”
d. “Am k I k goingk to k havek to k go k to k ak nursingk home?”
ANS: A
Lack k of k knowledgek atk dischargek aboutk medication k effects k and k sidek effects k is k ak concern k thatk should k bek addressed k by k thek vocationa
lk nurse. k Thek other k concerns k in k thek options k arek thek responsibility k of k other k departments k to k which k thek nursek mightk refer k thek patient.
PTS: 1 DIF: Cognitivek Level:k Application k k REF: 2
OBJ: 1 TOP: Teachingk KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
4. Accordingk to k mostk statek NPAs,k thek vocationalk nursek actingk as k chargek nursek in k ak long-
term k carek facility k acts k in k which k capacity?
a. Workingk under k directk supervision k of k an k RNk on k thek unit
b. Workingk with k thek RNk in k thek building
c. Workingk under k generalk supervision k by k thek RNk availablek on k sitek or k by k phone
d. Workingk as k an k independentk vocationalk nurse
ANS: C
Thek vocationalk nursek in k thek capacity k of k thek chargek nursek in k ak long-
term k carek facility k acts k with k thek generalk supervision k of k an k RNk availablek on k sitek or k by k phone.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 2
OBJ: 1 TOP: Chargek Nurse/Manager KEY: Nursing Process kStep:kN/A
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
,5. Thek nursek is k educatingk ak patientk thatk is k ak member k of k ak health k maintenancek organization k (HMO). k Which k informatio
n k should k thek nursek include?
a. Seek k thek opinion k of k an k alternatek health k carek provider.
b. Obtain k insurancek approvalk for k medicalk services k prior k to k treatment.
c. Providek detailed k documentation k of k allk carek received k for k his k condition.
d. Waitk atk leastk 6 k months k to k seek ak specialist.
ANS: B
Mostk HMOs k requirek preprocedurek authorization k for k treatment.k Patien ts k arek notk required k to k seek k ak second k opinion, k providek docum
entation k of k care,k or k waitk ak specifick timek period k beforek visitingk ak specialist.
PTS: 1 DIF: Cognitivek Level:k Application k k REF: 9
OBJ: 9 TOP: Chargek Nurse/Manager
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
6. Thek patientk complains k to k thek nursek thatk hek is k confused k aboutk his k “deductible”k thatk hek owes k thek hospital. k Whic
h k statementk accurately k explains k ak deductible?
a. An k amountk of k money k putk asidek for k thek paymentk of k futurek medicalk bills
b. Ak one-timek feek for k service
c. An k amountk of k money k deducted k from k thek billk by k thek insurancek company
d. An k annualk amountk of k money k thek patientk mustk pay k out-of-pocketk for k medicalk care
ANS: D
Thek deductiblek is k thek annualk amountk thek insured k mustk pay k out-of-
pocketk prior k to k thek insurancek company k assumingk thek cost.k This k practicek improves k thek profitk of k thek insurancek company.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 7
OBJ: 9 TOP: Health k Carek Financing
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
7. Thek nursek compares k thek characteristics k of k ak health k maintenancek organization k (HMO) k and k ak preferred k provide
r k organization k (PPO).k Which k information k should k thek nursek includek aboutk HMOs?
a. HMOs k requirek ak setk feek of k each k member k monthly.
b. HMOs k allowk thek member k to k selectk his k health k carek provider.
c. HMOs k permitk admission k to k any k facility k thek member k prefers.
d. HMOs k offer k unlimited k diagnostick tests k and k treatments.
ANS: A
HMOs k requirek ak setk feek from k each k member k monthly k (capitation). k Thek patientk willk bek treated k by k thek HMOk staff k in k HM O-
approved k facilities. k Excessivek usek of k diagnostick tests k and k treatments k is k discouraged k by k thek HMO.
PTS: 1 DIF: Cognitivek Level:k Application k k REF: 9
OBJ: 9 TOP: Managed k Care
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
8. Ak patientk asks k thek nursek whatk Medicarek Partk Ak covers. k Which k responsek is k correct?
a. Medicarek Partk Ak covers k inpatientk hospitalk costs.
b. Medicarek Partk Ak covers k reimbursementk to k thek physician.
c. Medicarek Partk Ak covers k outpatientk hospitalk services.
d. Medicarek Partk Ak covers k ambulancek transportation.
ANS: A
Medicarek Partk Ak covers k inpatientk hospitalk expenses, k drugs,k x-
rays,k laboratory k work, k and k intensivek care.k Medicarek Partk Bk pays k thek physician, k ambulancek transport, k and k outpatientk services.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 7,k Box k 1-4
OBJ: 9 TOP: Government-Sponsored kHealth k Insurance
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
9. Which k is k thek main k cost-containmentk componentk of k diagnosis-related k groups k (DRGs)?
, a. Hospitals k focus k only k on k thek specifick diagnosis.
b. Hospitals k treatk and k dischargek patients k quickly.
c. Reduced k costk drugs k arek ordered k for k specifick diagnoses.
d. Diagnostick group k classification k streamlines k care.
ANS: B
DRGs k arek ak prospectivek paymentk plan k in k wh ich k hospitals k receivek ak flatk feek for k each k patient’s k diagnostick category k regardless k of k th
ek length k of k timek in k thek hospital. k If k hospitals k can k treatk and k dischargek patients k beforek thek allotted k tim e,k hospitals k getk to k keep k thek ex
cess k payment;k costk is k contained, k and k thek patientk is k discharged k sooner.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 8
OBJ: 9 TOP: Government-Sponsored kHealth k Insurance
KEY:k k k Nursingk Process k Step:k Implementation
MSC:k k NCLEX:k Safe, k Effectivek Carek Environment:k Coordinated k Care
10 . Thek nursek is k assessingk ak group k of k patients. k Which k patientk would k mostk likely k qualify k for k Medicaid?
a. Ak 35-year-old k unemployed k singlek mother k with k diabetes
b. Ak 70-year-old k Medicarek recipientk with k retirementk incom ek who k needs k to k bek in k ak long-term k carek facility
c. An k 80-year-old k blind k woman k livingk in k her k own k homek who k has k inadequatek privatek insurance
d. Ak 67-year-old k strokek victim k with k Medicarek Partk Ak and k an k incomek from k investments
ANS: A
Medicaid k is k ak jointk effortk of k federalk and k statek governments k geared k primarily k for k low-incomek peoplek with k no k insurance.
PTS: 1 DIF: Cognitivek Level:k Application k REF: 8,kBox k1-
5 k OBJ: 9 TOP: Government-Sponsored k Health k Insurance–
Medicaid k KEY: Nursingk Process k Step:k Assessment
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
11 . Which k areak is k thek major k focus k ofk HealthykPeoplek2020 kand k thek primary k mechanism k through k which k to k improvek thek healt
h k of k Americans k in k thek second k decadek of k thek century?
a. Research k funding
b. Health k information k distribution
c. Healthy k lifestylek encouragement
d. Health k improvementk program k designs
ANS: C
HealthykPeoplek2020 kfocuses k on k expandingk ongoingk programs k to k includek supportk and k information k to k reducek infantk mortality, k ca
ncer,k cardiovascular k disease, k and k HIV/AIDS, k and k to k increasek effectivek immunizations, k healthy k eatin gk habits, k and k healthy k weight
.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 6
OBJ: 7 TOP: Healthy kPeoplek2020
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
12 . Which k term k explains k thek typek of k carek thatk addresses k interventions k for k allk dimensions k of k ak patient’s k life?
a. Focused k care
b. Generalk care
c. Directed k care
d. Holistick care
ANS: D
Holistick carek addresses k thek physiologic, k psychological, k social,k cultural, k and k spiritualk needs k of k thek patient.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 6
OBJ: 8 TOP: HolistickCare
KEY: NursingkProcess kStep:kPlanning
MSC: NCLEX:kPsychosocialkIntegrity:kCopingkand kAdaptation
13 . Ak patientk furiously k says,k “My k doctor k was k so k busy k givingk mek instructions k thatk hek didn’tk hear k whatk I k was k tryingk to k as
k k him!”k Which k responsek is k mostk empathetic?
a. “When k peoplek ignorek me,k I k really k getk mad.”
k k
NursingConcepts
k k
and Practice 3th E
k k k
dition.
,Chapterk01:kCaring kforkMedical-Surgical kPatients
deWit:kMedical-Surgical kNursing:kConceptsk&kPractice,k3rdkEdition
MULTIPLEkCHOICE
1. Which k statementk accurately k describes k thek primary k purposek of k thek statek nursek practicek actk (NPA)?
a. To k testk and k licensek LPN/LVNs.
b. To k definek thek scopek of k LPN/LVNk practice.
c. To k improvek thek quality k of k carek provided k by k thek LPN/LVN.
d. To k limitk thek LPN/LVNk employmentk placement.
ANS: B
Whilek improvingk quality k of k carek provided k by k thek LPN/LVNk m ay k bek ak resultk of k thek NPA,k thek primary k purposek ofk thek NPAk of k each
k statek defines k thek scopek of k nursingk practicek in k thatk state.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 2
OBJ: 3 TOP: NPA KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
2. Thek chargek nursek asks k thek newk vocationalk nursek to k startk an k intravenous k infusion, k ak skillk thatk thek vocationalk nursek has k n
otk been k taughtk duringk her k educationalk program. k Howk should k thek vocationalk nursek respond?
a. Ask k ak morek experienced k nursek to k demonstratek thek procedure.
b. Look k up k thek procedurek in k thek procedurek manual.
c. Attemptk to k perform k thek procedurek with k supervision.
d. Inform k thek chargek nursek of k her k lack k of k trainingk in k this k procedure.
ANS: D
Thek chargek nursek should k bek informed k of k thek lack k of k trainingk to k perform k thek procedure, k and k thek vocationalk nursek should k seek k fur
ther k trainingk to k gain k proficiency. k Although k thek other k options k migh tk bek helpful, k they k arek notk safe.
PTS: 1 DIF: Cognitivek Level:k Application k k REF: 3
OBJ: 1 TOP: ProvidingkSafekCare KEY: NursingkProcess kStep:kN/A
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
3. Which k patientk statementk indicates k ak need k for k further k dischargek teachin gk thatk thek vocationalk nursek should k address?
a. “I k havek no k ideak of k howk this k drugk willk affectk me.”
b. “Do k you k knowk if k my k physician k is k comingk back k today?”
c. “Willk my k insurancek pay k for k my k stay?”
d. “Am k I k goingk to k havek to k go k to k ak nursingk home?”
ANS: A
Lack k of k knowledgek atk dischargek aboutk medication k effects k and k sidek effects k is k ak concern k thatk should k bek addressed k by k thek vocationa
lk nurse. k Thek other k concerns k in k thek options k arek thek responsibility k of k other k departments k to k which k thek nursek mightk refer k thek patient.
PTS: 1 DIF: Cognitivek Level:k Application k k REF: 2
OBJ: 1 TOP: Teachingk KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
4. Accordingk to k mostk statek NPAs,k thek vocationalk nursek actingk as k chargek nursek in k ak long-
term k carek facility k acts k in k which k capacity?
a. Workingk under k directk supervision k of k an k RNk on k thek unit
b. Workingk with k thek RNk in k thek building
c. Workingk under k generalk supervision k by k thek RNk availablek on k sitek or k by k phone
d. Workingk as k an k independentk vocationalk nurse
ANS: C
Thek vocationalk nursek in k thek capacity k of k thek chargek nursek in k ak long-
term k carek facility k acts k with k thek generalk supervision k of k an k RNk availablek on k sitek or k by k phone.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 2
OBJ: 1 TOP: Chargek Nurse/Manager KEY: Nursing Process kStep:kN/A
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
,5. Thek nursek is k educatingk ak patientk thatk is k ak member k of k ak health k maintenancek organization k (HMO). k Which k informatio
n k should k thek nursek include?
a. Seek k thek opinion k of k an k alternatek health k carek provider.
b. Obtain k insurancek approvalk for k medicalk services k prior k to k treatment.
c. Providek detailed k documentation k of k allk carek received k for k his k condition.
d. Waitk atk leastk 6 k months k to k seek ak specialist.
ANS: B
Mostk HMOs k requirek preprocedurek authorization k for k treatment.k Patien ts k arek notk required k to k seek k ak second k opinion, k providek docum
entation k of k care,k or k waitk ak specifick timek period k beforek visitingk ak specialist.
PTS: 1 DIF: Cognitivek Level:k Application k k REF: 9
OBJ: 9 TOP: Chargek Nurse/Manager
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
6. Thek patientk complains k to k thek nursek thatk hek is k confused k aboutk his k “deductible”k thatk hek owes k thek hospital. k Whic
h k statementk accurately k explains k ak deductible?
a. An k amountk of k money k putk asidek for k thek paymentk of k futurek medicalk bills
b. Ak one-timek feek for k service
c. An k amountk of k money k deducted k from k thek billk by k thek insurancek company
d. An k annualk amountk of k money k thek patientk mustk pay k out-of-pocketk for k medicalk care
ANS: D
Thek deductiblek is k thek annualk amountk thek insured k mustk pay k out-of-
pocketk prior k to k thek insurancek company k assumingk thek cost.k This k practicek improves k thek profitk of k thek insurancek company.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 7
OBJ: 9 TOP: Health k Carek Financing
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
7. Thek nursek compares k thek characteristics k of k ak health k maintenancek organization k (HMO) k and k ak preferred k provide
r k organization k (PPO).k Which k information k should k thek nursek includek aboutk HMOs?
a. HMOs k requirek ak setk feek of k each k member k monthly.
b. HMOs k allowk thek member k to k selectk his k health k carek provider.
c. HMOs k permitk admission k to k any k facility k thek member k prefers.
d. HMOs k offer k unlimited k diagnostick tests k and k treatments.
ANS: A
HMOs k requirek ak setk feek from k each k member k monthly k (capitation). k Thek patientk willk bek treated k by k thek HMOk staff k in k HM O-
approved k facilities. k Excessivek usek of k diagnostick tests k and k treatments k is k discouraged k by k thek HMO.
PTS: 1 DIF: Cognitivek Level:k Application k k REF: 9
OBJ: 9 TOP: Managed k Care
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
8. Ak patientk asks k thek nursek whatk Medicarek Partk Ak covers. k Which k responsek is k correct?
a. Medicarek Partk Ak covers k inpatientk hospitalk costs.
b. Medicarek Partk Ak covers k reimbursementk to k thek physician.
c. Medicarek Partk Ak covers k outpatientk hospitalk services.
d. Medicarek Partk Ak covers k ambulancek transportation.
ANS: A
Medicarek Partk Ak covers k inpatientk hospitalk expenses, k drugs,k x-
rays,k laboratory k work, k and k intensivek care.k Medicarek Partk Bk pays k thek physician, k ambulancek transport, k and k outpatientk services.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 7,k Box k 1-4
OBJ: 9 TOP: Government-Sponsored kHealth k Insurance
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
9. Which k is k thek main k cost-containmentk componentk of k diagnosis-related k groups k (DRGs)?
, a. Hospitals k focus k only k on k thek specifick diagnosis.
b. Hospitals k treatk and k dischargek patients k quickly.
c. Reduced k costk drugs k arek ordered k for k specifick diagnoses.
d. Diagnostick group k classification k streamlines k care.
ANS: B
DRGs k arek ak prospectivek paymentk plan k in k wh ich k hospitals k receivek ak flatk feek for k each k patient’s k diagnostick category k regardless k of k th
ek length k of k timek in k thek hospital. k If k hospitals k can k treatk and k dischargek patients k beforek thek allotted k tim e,k hospitals k getk to k keep k thek ex
cess k payment;k costk is k contained, k and k thek patientk is k discharged k sooner.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 8
OBJ: 9 TOP: Government-Sponsored kHealth k Insurance
KEY:k k k Nursingk Process k Step:k Implementation
MSC:k k NCLEX:k Safe, k Effectivek Carek Environment:k Coordinated k Care
10 . Thek nursek is k assessingk ak group k of k patients. k Which k patientk would k mostk likely k qualify k for k Medicaid?
a. Ak 35-year-old k unemployed k singlek mother k with k diabetes
b. Ak 70-year-old k Medicarek recipientk with k retirementk incom ek who k needs k to k bek in k ak long-term k carek facility
c. An k 80-year-old k blind k woman k livingk in k her k own k homek who k has k inadequatek privatek insurance
d. Ak 67-year-old k strokek victim k with k Medicarek Partk Ak and k an k incomek from k investments
ANS: A
Medicaid k is k ak jointk effortk of k federalk and k statek governments k geared k primarily k for k low-incomek peoplek with k no k insurance.
PTS: 1 DIF: Cognitivek Level:k Application k REF: 8,kBox k1-
5 k OBJ: 9 TOP: Government-Sponsored k Health k Insurance–
Medicaid k KEY: Nursingk Process k Step:k Assessment
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
11 . Which k areak is k thek major k focus k ofk HealthykPeoplek2020 kand k thek primary k mechanism k through k which k to k improvek thek healt
h k of k Americans k in k thek second k decadek of k thek century?
a. Research k funding
b. Health k information k distribution
c. Healthy k lifestylek encouragement
d. Health k improvementk program k designs
ANS: C
HealthykPeoplek2020 kfocuses k on k expandingk ongoingk programs k to k includek supportk and k information k to k reducek infantk mortality, k ca
ncer,k cardiovascular k disease, k and k HIV/AIDS, k and k to k increasek effectivek immunizations, k healthy k eatin gk habits, k and k healthy k weight
.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 6
OBJ: 7 TOP: Healthy kPeoplek2020
KEY: NursingkProcess kStep:kImplementation
MSC: NCLEX:kSafe,kEffectivekCarekEnvironment:kCoordinated kCare
12 . Which k term k explains k thek typek of k carek thatk addresses k interventions k for k allk dimensions k of k ak patient’s k life?
a. Focused k care
b. Generalk care
c. Directed k care
d. Holistick care
ANS: D
Holistick carek addresses k thek physiologic, k psychological, k social,k cultural, k and k spiritualk needs k of k thek patient.
PTS: 1 DIF: CognitivekLevel:kComprehension REF: 6
OBJ: 8 TOP: HolistickCare
KEY: NursingkProcess kStep:kPlanning
MSC: NCLEX:kPsychosocialkIntegrity:kCopingkand kAdaptation
13 . Ak patientk furiously k says,k “My k doctor k was k so k busy k givingk mek instructions k thatk hek didn’tk hear k whatk I k was k tryingk to k as
k k him!”k Which k responsek is k mostk empathetic?
a. “When k peoplek ignorek me,k I k really k getk mad.”
