Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
TEST BANK
Medical-Surgical Nursing
Concepts and Practice
Holly K. Stromberg
5th Edition
, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
Table of Contents
Unit I. Medical-Surgical Nursing Settings
1. Caring for Medical-Surgical Patients
2. Critical Thinking, Clinical Judgment, and the Nursing Process
Unit II. Medical-Surgical Patient Care Problems
3. Fluids, Electrolytes, Acid-Base Balance, and Intravenous Therapy
4. Care of Preoperative and Intraoperative Surgical Patients Surgery
5. Care of Postoperative Surgical Patients
6. Infection Prevention and Control
7. Care of Patients with Pain
8. Care of Patients with Cancer
9. Chronic Illness and Rehabilitation
Unit III. Immune System
10. The Immune and Lymphatic Systems
11. Care of Patients with Immune and Lymphatic Disorders
Unit IV. Respiratory System
12. The Respiratory System
13. Care of Patients with Disorders of the Upper Respiratory System
14. Care of Patients with Disorders of the Lower Respiratory System
Unit V. Hematologic System
15. The Hematologic System
16. Care of Patients with Hematologic Disorders
Unit VI. Cardiovascular System
17. The Cardiovascular System
18. Care of Patients with Hypertension and Peripheral Vascular Disease
19. Care of Patients with Cardiac Disorders
20. Care of Patients with Coronary Artery Disease and Cardiac Surgery
Unit VII. Neurologic System
21. The Neurologic System
22. Care of Patients with Head and Spinal Cord Injuries
23. Care of Patients with Brain Disorders
24. Care of Patients with Peripheral Nerve and Degenerative Neurologic Disorders
Unit VIII. Sensory System
25. The Sensory System: Eye
26. The Sensory System: Ear
Unit IX. Gastrointestinal System
27. The Gastrointestinal System
28. Care of Patients with Disorders of the Upper Gastrointestinal System
29. Care of Patients with Disorders of the Lower Gastrointestinal System
30. Care of Patients with Disorders of the Gallbladder, Liver, and Pancreas
, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
Unit X. Musculoskeletal System
31. The Musculoskeletal System
32. Care of Patients with Musculoskeletal and Connective Tissue Disorders
Unit XI. Urinary System
33. The Urinary System
34. Care of Patients with Disorders of the Urinary System
Unit XII. Endocrine System
35. The Endocrine System
36. Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders
37. Care of Patients with Diabetes and Hypoglycemia
Unit XIII. Reproductive System
38. The Reproductive System
39. Care of Women with Reproductive Disorders
40. Care of Men with Reproductive Disorders
41. Care of Patients with Sexually Transmitted Infections
Unit XIV. Integumentary System
42. The Integumentary System
43. Care of Patients with Integumentary Disorders and Burns
Unit XV. Emergency and Disaster Management
44. Care of Patients in Disasters or Bioterrorism Attacks
45. Care of Patients with Emergent Conditions, Trauma, and Shock
Unit XVI. Mental Health Nursing of the Adult
46. Care of Patients with Cognitive Function Disorders
47. Care of Patients with Anxiety, Mood, and Eating Disorders
48. Care of Patients with Substance-Related and Addictive Disorders
49. Care of Patients with Thought and Personality Disorders
, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
Chapter 01: Caring for Medical-Surgical Patients
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition
MULTIPLE CHOICE
1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
a. To test and license LPN/LVNs
b. To define the scope of LPN/LVN practice
c. To improve the quality of care provided by the LPN/LVN
d. To limit the LPN/LVN employment placement
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 of each state defines the scope of nursing practice in that state.
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 3
TOP: NPA KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
vocational nurse has not been taught during her educational program. How should the vocational nurse
respond?
a. Ask a more experienced nurse to demonstrate the procedure.
b. Look up the procedure in the procedure manual.
c. Attempt to perform the procedure with supervision.
d. Inform the charge nurse of her lack of training in this procedure.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the
vocational nurse should seek further training to gain proficiency. Although the other options might be
helpful, they are not safe.
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1
TOP: Providing Safe Care KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
3. Which patient statement indicates a need for further discharge teaching that the vocational nurse
should address?
a. "I have no idea of how this drug will affect me."
b. "Do you know if my physician is coming back today?"
c. "Will my insurance pay for my stay?"
d. "Am I going to have to go to a nursing home?"
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that should be
addressed by the vocational nurse. The other concerns in the options are the responsibility of other
departments to which the nurse might refer the patient.
DIF: Cognitive Level: Application REF: p. 2 OBJ: 1
TOP: Teaching KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility
acts in which capacity?
a. Working under direct supervision of an RN on the unit
b. Working with the RN in the building
c. Working under general supervision by the RN available on site or by phone
d. Working as an independent vocational nurse
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 RN available on site or by phone.
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1
TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
information should the nurse include?
a. Seek the opinion of an alternate health care provider.
b. Contact the insurance company for coverage details as services may be limited.
c. Provide detailed documentation of all care received for his condition.
d. Wait at least 6 months to see a specialist.
ANS: B
HMOs are a kind of managed care. This is accomplished by paying providers to care for groups of
patients for a set capitation fee and by limiting services. Patients are not required to seek a second
opinion, provide documentation of care, or wait a specific time period before visiting a specialist.
DIF: Cognitive Level: Application REF: p. 9 OBJ: 9
TOP: Charge Nurse/Manager KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
6. The patient complains to the nurse that he is confused about his "deductible" that he owes the hospital.
Which statement accurately explains a deductible?
a. An amount of money put aside for the payment of future medical bills
b. A one-time fee for service
c. An amount of money deducted from the bill by the insurance company
d. An annual amount of money the patient must pay out-of-pocket for medical care
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
company assuming the cost. This practice improves the profit of the insurance company.
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9
TOP: Health Care Financing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
a. Medicare Part A covers inpatient hospital costs.
b. Medicare Part A covers reimbursement to the physician.
c. Medicare Part A covers outpatient hospital services.
d. Medicare Part A covers ambulance transportation.
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care.
Medicare Part B pays the physician, ambulance transport, and outpatient services.
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, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4
OBJ: 9 TOP: Government-Sponsored Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
a. Hospitals focus only on the specific diagnosis.
b. Hospitals treat and discharge patients quickly.
c. Reduced cost drugs are ordered for specific diagnoses.
d. Diagnostic group classification streamlines care.
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient's diagnostic
category regardless of the length of time in the hospital. If hospitals can treat and discharge patients
before the allotted time, hospitals get to keep the excess payment; cost is contained, and the patient is
discharged sooner.
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: 9
TOP: Government-Sponsored Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
9. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
a. A 35-year-old unemployed single mother with diabetes
b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-term
care facility
c. An 80-year-old blind woman living in her own home who has inadequate private
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-income people
with no insurance.
DIF: Cognitive Level: Application REF: p. 8, Box 1-5
OBJ: 9 TOP: Government-Sponsored Health Insurance—Medicaid
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through which to
improve the health of Americans in the second decade of the century?
a. Research funding
b. Health information distribution
c. Healthy lifestyle encouragement
d. Health improvement program designs
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to
reduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective
immunizations, healthy eating habits, and healthy weight.
DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 7
TOP: Healthy People 2020 KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
11. Which term explains the type of care that addresses interventions for all dimensions of a patient's life?
a. Focused care
b. General care
c. Directed care
d. Holistic care
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the
patient.
DIF: Cognitive Level: Comprehension REF: p. 9 OBJ: 8
TOP: Holistic Care KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
12. A patient furiously says, "My doctor was so busy giving me instructions that he didn't hear what I was
trying to ask him!" Which response is most empathetic?
a. "When people ignore me, I really get mad."
b. "I'm sure that the doctor was rushed and unaware of your needs."
c. "That sounds really frustrating."
d. "Take a deep breath and plan what you will say to him tomorrow."
ANS: C
Empathy demonstrates that the nurse perceives the patient's feelings but does not share the emotion.
Belittling the patient's feelings, showing sympathy, or defending the doctor makes the patient feel
devalued.
DIF: Cognitive Level: Analysis REF: p. 10 OBJ: 10
TOP: Nurse-Patient Relationship KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
13. The nurse is explaining differences in a therapeutic relationship and a social relationship to a patient.
Which information about therapeutic relationships is most important for the nurse to include in the
explanation?
a. Therapeutic relationships lack formal boundaries.
b. Therapeutic relationships are goal directed.
c. Therapeutic relationships meet the needs of each person in the relationship.
d. Therapeutic relationships extend past the hospitalization period.
ANS: B
The therapeutic relationship is focused on the patient and is goal directed and designed to meet only
the needs of the patient and does not extend past the period of hospitalization.
DIF: Cognitive Level: Comprehension REF: p. 9 OBJ: 10
TOP: Therapeutic Relationship KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
14. The nurse is caring for a patient who has been on antidepressants for 3 days. The patient tearfully says,
"I still feel terrible. I don't think anything can help how I feel." Which response is best?
a. "I will tell the charge nurse how you are feeling."
b. "You just need to be patient and give your medicine some time to work."
c. "Look how much you have improved since you were admitted to the facility."
d. "It must be frustrating to be going through this difficult time."
ANS: D
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, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
This response is an empathetic response that allows for further exploration of the patient's feelings.
The other responses will block communication with this patient.
DIF: Cognitive Level: Application REF: p. 9 OBJ: 10
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
15. An overweight male patient rips off his hospital gown, throws it out the door, and shouts, "I'm not
wearing this stupid gown! It is too small, too short, and exposes my backside to the world!" Which
response is most appropriate?
a. Remind patient of the need to wear the gown for convenience in care.
b. Confer with the patient for methods to acquire a larger gown.
c. Replace the torn gown with another.
d. Inform the charge nurse of the hostile behavior.
ANS: B
Allowing hostile patients to make reasonable requests defuses the anger and allows patients to vent
their feelings.
DIF: Cognitive Level: Application REF: p. 10 OBJ: 10
TOP: Hostile Behavior KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
16. The nurse is caring for a patient who states, "You are the only nurse who understands about my pain.
Can't you give me an extra dose of pain medication?" How should the nurse respond to the patient's
request?
a. Explain that dosage schedules are by physician's orders.
b. Ignore the request.
c. Tell the patient that his behavior is manipulative.
d. Agree to give an extra dose of pain medication.
ANS: A
A matter-of-fact response to a manipulative request limits the effect of the manipulation, thereby
helping the nurse to avoid becoming defensive or being swayed by flattery.
DIF: Cognitive Level: Application REF: p. 10 OBJ: 10
TOP: Manipulative Behavior KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
17. A female patient who has recently been diagnosed with an inoperable brain tumor asks the nurse, "Do
you think God punishes us?" Which response demonstrates therapeutic communication?
a. "I don't know, tell me what you think."
b. "God loves you."
c. "Would like to speak with the chaplain?"
d. "God will not give you more than you can bear."
ANS: A
Sitting with the patient and offering oneself to listen to the patient's concerns and encouraging
reflection is the best approach rather than responding with a cliché or suggesting speaking with the
chaplain.
DIF: Cognitive Level: Application REF: p. 10 OBJ: 10
TOP: Spiritual Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
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, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
18. The nurse is communicating with a patient who voices concern about an upcoming high-risk
procedure. Which statement best demonstrates empathy?
a. "Would you like to talk about your feelings regarding the procedure?"
b. "My mother had the same procedure and did very well."
c. "I can't imagine how you feel."
d. "It must be difficult preparing for the procedure; how are you feeling?"
ANS: D
This statement by the nurse displays empathy by trying to place oneself in the patient's circumstance
and validating the patient's feelings. Simply asking patients if they would like to talk about their
feelings does not show empathy and may elicit a "yes" or "no" response. Telling the patient one's
mother had the procedure or stating "I can't imagine how you feel" does not show empathy toward the
patient.
DIF: Cognitive Level: Application REF: p. 10 OBJ: 10
TOP: Nurse-Patient Relationship KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
19. When an insurance company directly reimburses a licensed health care provider for services, the form
of financing is called:
a. fee for service.
b. deductible.
c. coinsurance.
d. copay.
ANS: A
Fee for service is the direct reimbursement by an insurance company to a health care provider.
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9
TOP: Health Care Financing KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
20. The nurse explains that which the term refers to the severity of illness?
a. DRG
b. Holistic care
c. Acuity
d. Managed care
ANS: C
Acuity is the term referring to the severity of illness or condition of a patient. DRG is diagnosis-related
group for insurance billing and payment processes. Holistic care is whole-person care. HMOs and
PPOs are types of managed care programs.
DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 6
TOP: Acuity KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
MULTIPLE RESPONSE
21. Which of the following are sources of clear guidelines for upholding clinical standards for safe and
competent care? (Select all that apply.)
a. The state's nurse practice act (NPA)
b. The State Board of Nurse Examiners (BNE)
c. The National Association for Practical Nurse Education and Service (NAPNES)
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, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
d. Institutional policies
e. The National Federation of Licensed Practical Nurses, Inc. (NFLPN)
ANS: C, E
NAPNES and the NFLPN give clear guidelines for clinical standards that can be used as a basis for
court decisions. The NPA has broad guidelines, and institutional policies may not be complete. The
BNE enforces the NPA.
DIF: Cognitive Level: Comprehension REF: p. 5 OBJ: 3
TOP: Upholding Clinical Standards KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
22. Which statement(s) accurately describes the role of the LPN/LVN regardless of employment
placement? (Select all that apply.)
a. Uphold clinical standards.
b. Educate patients.
c. Communicate effectively.
d. Collaborate with the health care team.
e. Initiate a care plan immediately after admission.
ANS: A, B, C, D
The LPN/LVN has the accountability to uphold clinical standards, educate patients, communicate
effectively, and collaborate with the health care team. Depending on the type of facility, initiation of a
care plan is often the role of the registered nurse.
DIF: Cognitive Level: Comprehension REF: p. 2 OBJ: 3
TOP: Roles of LPN/LVNs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
23. The newly licensed LPN/LVN demonstrates an understanding of employment opportunities when
applying to a position in which area(s)? (Select all that apply.)
a. An outpatient clinic
b. A home health care agency
c. An intravenous (IV) therapy team
d. A long-term care facility
e. An ambulatory care unit
ANS: A, B, D, E
With the exception of an IV therapy team, which requires postgraduate education and/or certification,
the other options are open to newly graduated vocational nurses.
DIF: Cognitive Level: Application REF: p. 3 OBJ: 2
TOP: Employment Opportunities for LPN/LVNs KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
24. What factor(s) should the LPN/LVN consider when delegating a task to unlicensed assistive personnel
(UAP)? (Select all that apply.)
a. A need for the UAP to voluntarily accept the task delegated
b. Continued accountability for the task by the LPN/LVN
c. Assurance that the task requires no further need for supervision of the UAP
d. An understanding that the task is in the job description of the UAP
e. A transfer of authority to the UAP
ANS: A, B, D,E
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TEST BANK
Medical-Surgical Nursing
Concepts and Practice
Holly K. Stromberg
5th Edition
, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
Table of Contents
Unit I. Medical-Surgical Nursing Settings
1. Caring for Medical-Surgical Patients
2. Critical Thinking, Clinical Judgment, and the Nursing Process
Unit II. Medical-Surgical Patient Care Problems
3. Fluids, Electrolytes, Acid-Base Balance, and Intravenous Therapy
4. Care of Preoperative and Intraoperative Surgical Patients Surgery
5. Care of Postoperative Surgical Patients
6. Infection Prevention and Control
7. Care of Patients with Pain
8. Care of Patients with Cancer
9. Chronic Illness and Rehabilitation
Unit III. Immune System
10. The Immune and Lymphatic Systems
11. Care of Patients with Immune and Lymphatic Disorders
Unit IV. Respiratory System
12. The Respiratory System
13. Care of Patients with Disorders of the Upper Respiratory System
14. Care of Patients with Disorders of the Lower Respiratory System
Unit V. Hematologic System
15. The Hematologic System
16. Care of Patients with Hematologic Disorders
Unit VI. Cardiovascular System
17. The Cardiovascular System
18. Care of Patients with Hypertension and Peripheral Vascular Disease
19. Care of Patients with Cardiac Disorders
20. Care of Patients with Coronary Artery Disease and Cardiac Surgery
Unit VII. Neurologic System
21. The Neurologic System
22. Care of Patients with Head and Spinal Cord Injuries
23. Care of Patients with Brain Disorders
24. Care of Patients with Peripheral Nerve and Degenerative Neurologic Disorders
Unit VIII. Sensory System
25. The Sensory System: Eye
26. The Sensory System: Ear
Unit IX. Gastrointestinal System
27. The Gastrointestinal System
28. Care of Patients with Disorders of the Upper Gastrointestinal System
29. Care of Patients with Disorders of the Lower Gastrointestinal System
30. Care of Patients with Disorders of the Gallbladder, Liver, and Pancreas
, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
Unit X. Musculoskeletal System
31. The Musculoskeletal System
32. Care of Patients with Musculoskeletal and Connective Tissue Disorders
Unit XI. Urinary System
33. The Urinary System
34. Care of Patients with Disorders of the Urinary System
Unit XII. Endocrine System
35. The Endocrine System
36. Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders
37. Care of Patients with Diabetes and Hypoglycemia
Unit XIII. Reproductive System
38. The Reproductive System
39. Care of Women with Reproductive Disorders
40. Care of Men with Reproductive Disorders
41. Care of Patients with Sexually Transmitted Infections
Unit XIV. Integumentary System
42. The Integumentary System
43. Care of Patients with Integumentary Disorders and Burns
Unit XV. Emergency and Disaster Management
44. Care of Patients in Disasters or Bioterrorism Attacks
45. Care of Patients with Emergent Conditions, Trauma, and Shock
Unit XVI. Mental Health Nursing of the Adult
46. Care of Patients with Cognitive Function Disorders
47. Care of Patients with Anxiety, Mood, and Eating Disorders
48. Care of Patients with Substance-Related and Addictive Disorders
49. Care of Patients with Thought and Personality Disorders
, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
Chapter 01: Caring for Medical-Surgical Patients
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition
MULTIPLE CHOICE
1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)?
a. To test and license LPN/LVNs
b. To define the scope of LPN/LVN practice
c. To improve the quality of care provided by the LPN/LVN
d. To limit the LPN/LVN employment placement
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 of each state defines the scope of nursing practice in that state.
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 3
TOP: NPA KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a skill that the
vocational nurse has not been taught during her educational program. How should the vocational nurse
respond?
a. Ask a more experienced nurse to demonstrate the procedure.
b. Look up the procedure in the procedure manual.
c. Attempt to perform the procedure with supervision.
d. Inform the charge nurse of her lack of training in this procedure.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and the
vocational nurse should seek further training to gain proficiency. Although the other options might be
helpful, they are not safe.
DIF: Cognitive Level: Application REF: p. 3 OBJ: 1
TOP: Providing Safe Care KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
3. Which patient statement indicates a need for further discharge teaching that the vocational nurse
should address?
a. "I have no idea of how this drug will affect me."
b. "Do you know if my physician is coming back today?"
c. "Will my insurance pay for my stay?"
d. "Am I going to have to go to a nursing home?"
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that should be
addressed by the vocational nurse. The other concerns in the options are the responsibility of other
departments to which the nurse might refer the patient.
DIF: Cognitive Level: Application REF: p. 2 OBJ: 1
TOP: Teaching KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
4. According to most state NPAs, the vocational nurse acting as charge nurse in a long-term care facility
acts in which capacity?
a. Working under direct supervision of an RN on the unit
b. Working with the RN in the building
c. Working under general supervision by the RN available on site or by phone
d. Working as an independent vocational nurse
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 RN available on site or by phone.
DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 1
TOP: Charge Nurse/Manager KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
5. The nurse is educating a patient that is a member of a health maintenance organization (HMO). Which
information should the nurse include?
a. Seek the opinion of an alternate health care provider.
b. Contact the insurance company for coverage details as services may be limited.
c. Provide detailed documentation of all care received for his condition.
d. Wait at least 6 months to see a specialist.
ANS: B
HMOs are a kind of managed care. This is accomplished by paying providers to care for groups of
patients for a set capitation fee and by limiting services. Patients are not required to seek a second
opinion, provide documentation of care, or wait a specific time period before visiting a specialist.
DIF: Cognitive Level: Application REF: p. 9 OBJ: 9
TOP: Charge Nurse/Manager KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
6. The patient complains to the nurse that he is confused about his "deductible" that he owes the hospital.
Which statement accurately explains a deductible?
a. An amount of money put aside for the payment of future medical bills
b. A one-time fee for service
c. An amount of money deducted from the bill by the insurance company
d. An annual amount of money the patient must pay out-of-pocket for medical care
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the insurance
company assuming the cost. This practice improves the profit of the insurance company.
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9
TOP: Health Care Financing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
7. A patient asks the nurse what Medicare Part A covers. Which response is correct?
a. Medicare Part A covers inpatient hospital costs.
b. Medicare Part A covers reimbursement to the physician.
c. Medicare Part A covers outpatient hospital services.
d. Medicare Part A covers ambulance transportation.
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and intensive care.
Medicare Part B pays the physician, ambulance transport, and outpatient services.
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, Test Bank - Medical Surgical Nursing Concepts and Practice 5th Edition (Stromberg, 2024)
DIF: Cognitive Level: Comprehension REF: p. 8, Box 1-4
OBJ: 9 TOP: Government-Sponsored Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
8. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
a. Hospitals focus only on the specific diagnosis.
b. Hospitals treat and discharge patients quickly.
c. Reduced cost drugs are ordered for specific diagnoses.
d. Diagnostic group classification streamlines care.
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient's diagnostic
category regardless of the length of time in the hospital. If hospitals can treat and discharge patients
before the allotted time, hospitals get to keep the excess payment; cost is contained, and the patient is
discharged sooner.
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: 9
TOP: Government-Sponsored Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
9. The nurse is assessing a group of patients. Which patient would most likely qualify for Medicaid?
a. A 35-year-old unemployed single mother with diabetes
b. A 70-year-old Medicare recipient with retirement income who needs to be in a long-term
care facility
c. An 80-year-old blind woman living in her own home who has inadequate private
insurance
d. A 67-year-old stroke victim with Medicare Part A and an income from investments
ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-income people
with no insurance.
DIF: Cognitive Level: Application REF: p. 8, Box 1-5
OBJ: 9 TOP: Government-Sponsored Health Insurance—Medicaid
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
10. Which area is the major focus of Healthy People 2020 and the primary mechanism through which to
improve the health of Americans in the second decade of the century?
a. Research funding
b. Health information distribution
c. Healthy lifestyle encouragement
d. Health improvement program designs
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and information to
reduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and to increase effective
immunizations, healthy eating habits, and healthy weight.
DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 7
TOP: Healthy People 2020 KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
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11. Which term explains the type of care that addresses interventions for all dimensions of a patient's life?
a. Focused care
b. General care
c. Directed care
d. Holistic care
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of the
patient.
DIF: Cognitive Level: Comprehension REF: p. 9 OBJ: 8
TOP: Holistic Care KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
12. A patient furiously says, "My doctor was so busy giving me instructions that he didn't hear what I was
trying to ask him!" Which response is most empathetic?
a. "When people ignore me, I really get mad."
b. "I'm sure that the doctor was rushed and unaware of your needs."
c. "That sounds really frustrating."
d. "Take a deep breath and plan what you will say to him tomorrow."
ANS: C
Empathy demonstrates that the nurse perceives the patient's feelings but does not share the emotion.
Belittling the patient's feelings, showing sympathy, or defending the doctor makes the patient feel
devalued.
DIF: Cognitive Level: Analysis REF: p. 10 OBJ: 10
TOP: Nurse-Patient Relationship KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
13. The nurse is explaining differences in a therapeutic relationship and a social relationship to a patient.
Which information about therapeutic relationships is most important for the nurse to include in the
explanation?
a. Therapeutic relationships lack formal boundaries.
b. Therapeutic relationships are goal directed.
c. Therapeutic relationships meet the needs of each person in the relationship.
d. Therapeutic relationships extend past the hospitalization period.
ANS: B
The therapeutic relationship is focused on the patient and is goal directed and designed to meet only
the needs of the patient and does not extend past the period of hospitalization.
DIF: Cognitive Level: Comprehension REF: p. 9 OBJ: 10
TOP: Therapeutic Relationship KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
14. The nurse is caring for a patient who has been on antidepressants for 3 days. The patient tearfully says,
"I still feel terrible. I don't think anything can help how I feel." Which response is best?
a. "I will tell the charge nurse how you are feeling."
b. "You just need to be patient and give your medicine some time to work."
c. "Look how much you have improved since you were admitted to the facility."
d. "It must be frustrating to be going through this difficult time."
ANS: D
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This response is an empathetic response that allows for further exploration of the patient's feelings.
The other responses will block communication with this patient.
DIF: Cognitive Level: Application REF: p. 9 OBJ: 10
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
15. An overweight male patient rips off his hospital gown, throws it out the door, and shouts, "I'm not
wearing this stupid gown! It is too small, too short, and exposes my backside to the world!" Which
response is most appropriate?
a. Remind patient of the need to wear the gown for convenience in care.
b. Confer with the patient for methods to acquire a larger gown.
c. Replace the torn gown with another.
d. Inform the charge nurse of the hostile behavior.
ANS: B
Allowing hostile patients to make reasonable requests defuses the anger and allows patients to vent
their feelings.
DIF: Cognitive Level: Application REF: p. 10 OBJ: 10
TOP: Hostile Behavior KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
16. The nurse is caring for a patient who states, "You are the only nurse who understands about my pain.
Can't you give me an extra dose of pain medication?" How should the nurse respond to the patient's
request?
a. Explain that dosage schedules are by physician's orders.
b. Ignore the request.
c. Tell the patient that his behavior is manipulative.
d. Agree to give an extra dose of pain medication.
ANS: A
A matter-of-fact response to a manipulative request limits the effect of the manipulation, thereby
helping the nurse to avoid becoming defensive or being swayed by flattery.
DIF: Cognitive Level: Application REF: p. 10 OBJ: 10
TOP: Manipulative Behavior KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
17. A female patient who has recently been diagnosed with an inoperable brain tumor asks the nurse, "Do
you think God punishes us?" Which response demonstrates therapeutic communication?
a. "I don't know, tell me what you think."
b. "God loves you."
c. "Would like to speak with the chaplain?"
d. "God will not give you more than you can bear."
ANS: A
Sitting with the patient and offering oneself to listen to the patient's concerns and encouraging
reflection is the best approach rather than responding with a cliché or suggesting speaking with the
chaplain.
DIF: Cognitive Level: Application REF: p. 10 OBJ: 10
TOP: Spiritual Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
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18. The nurse is communicating with a patient who voices concern about an upcoming high-risk
procedure. Which statement best demonstrates empathy?
a. "Would you like to talk about your feelings regarding the procedure?"
b. "My mother had the same procedure and did very well."
c. "I can't imagine how you feel."
d. "It must be difficult preparing for the procedure; how are you feeling?"
ANS: D
This statement by the nurse displays empathy by trying to place oneself in the patient's circumstance
and validating the patient's feelings. Simply asking patients if they would like to talk about their
feelings does not show empathy and may elicit a "yes" or "no" response. Telling the patient one's
mother had the procedure or stating "I can't imagine how you feel" does not show empathy toward the
patient.
DIF: Cognitive Level: Application REF: p. 10 OBJ: 10
TOP: Nurse-Patient Relationship KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
19. When an insurance company directly reimburses a licensed health care provider for services, the form
of financing is called:
a. fee for service.
b. deductible.
c. coinsurance.
d. copay.
ANS: A
Fee for service is the direct reimbursement by an insurance company to a health care provider.
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 9
TOP: Health Care Financing KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
20. The nurse explains that which the term refers to the severity of illness?
a. DRG
b. Holistic care
c. Acuity
d. Managed care
ANS: C
Acuity is the term referring to the severity of illness or condition of a patient. DRG is diagnosis-related
group for insurance billing and payment processes. Holistic care is whole-person care. HMOs and
PPOs are types of managed care programs.
DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 6
TOP: Acuity KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
MULTIPLE RESPONSE
21. Which of the following are sources of clear guidelines for upholding clinical standards for safe and
competent care? (Select all that apply.)
a. The state's nurse practice act (NPA)
b. The State Board of Nurse Examiners (BNE)
c. The National Association for Practical Nurse Education and Service (NAPNES)
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d. Institutional policies
e. The National Federation of Licensed Practical Nurses, Inc. (NFLPN)
ANS: C, E
NAPNES and the NFLPN give clear guidelines for clinical standards that can be used as a basis for
court decisions. The NPA has broad guidelines, and institutional policies may not be complete. The
BNE enforces the NPA.
DIF: Cognitive Level: Comprehension REF: p. 5 OBJ: 3
TOP: Upholding Clinical Standards KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
22. Which statement(s) accurately describes the role of the LPN/LVN regardless of employment
placement? (Select all that apply.)
a. Uphold clinical standards.
b. Educate patients.
c. Communicate effectively.
d. Collaborate with the health care team.
e. Initiate a care plan immediately after admission.
ANS: A, B, C, D
The LPN/LVN has the accountability to uphold clinical standards, educate patients, communicate
effectively, and collaborate with the health care team. Depending on the type of facility, initiation of a
care plan is often the role of the registered nurse.
DIF: Cognitive Level: Comprehension REF: p. 2 OBJ: 3
TOP: Roles of LPN/LVNs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
23. The newly licensed LPN/LVN demonstrates an understanding of employment opportunities when
applying to a position in which area(s)? (Select all that apply.)
a. An outpatient clinic
b. A home health care agency
c. An intravenous (IV) therapy team
d. A long-term care facility
e. An ambulatory care unit
ANS: A, B, D, E
With the exception of an IV therapy team, which requires postgraduate education and/or certification,
the other options are open to newly graduated vocational nurses.
DIF: Cognitive Level: Application REF: p. 3 OBJ: 2
TOP: Employment Opportunities for LPN/LVNs KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
24. What factor(s) should the LPN/LVN consider when delegating a task to unlicensed assistive personnel
(UAP)? (Select all that apply.)
a. A need for the UAP to voluntarily accept the task delegated
b. Continued accountability for the task by the LPN/LVN
c. Assurance that the task requires no further need for supervision of the UAP
d. An understanding that the task is in the job description of the UAP
e. A transfer of authority to the UAP
ANS: A, B, D,E
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