Test Bank For Introduction To Medical-Surgical Nursing, 6th Edition

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Chapter 01: The Health CareSystemChapter 01: The Health Care SystemLinton: Introduction to Medical-Surgical Nursing, 6th EditionMULTIPLE CHOICE1. An 89-year-old man, who was recently discharged from a rehabilitation hospital because of aninability to concentrate and frequent memory lapses, cannot be left alone while his family works.What options should the discharge planning team suggest that will satisfy safety concerns and givethe greatest quality of life to the patient?a. Placement in a day care center from 8 AM to 5 PM dailyb. Placement in a long-term psychiatric facilityc. Placement in a high-security nursing homed. Admission to a general hospital for evaluationANS: ADay care centers provide supervision, safety, nutritious meals, and socialization while the caregivingfamily works.DIF: Cognitive Level: Application REF: p. 7 OBJ: 5TOP: Day Care Centers KEY: Nursing Process Step: PlanningMSC: NCLEX: Physiological Integrity: Reduction of Risk2. A 66-year-old hospitalized patient is anxious about how the physician will be paid now that he ison Medicare Parts A and B, instead of his previous privately funded insurance plan. Who should thenurse explain is the payor to the physician on this plan?a. Previous privately funded insurance planb. Medicare Part Ac. Medicare Part Bd. Patient or patient’s familyANS: CPart A pays skilled care facilities. Part B pays for physician’s services. The previously held insurance

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is no longer available because of the patient’s age. The family or patientis not responsible becausePart B is in effect.DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4TOP: Health Care Funding KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care3. What health care plan is the best referral for an unemployed 42-year-old patient with renal failurewho has lost his job-related private insurance?a. Medicareb. Medicaidc. Public health facilityd. Community-based outpatient clinicANS: BMedicaid is available to needy low-income persons younger than 65 years of age who have apermanent disability. Medicare is for persons 65 years and older. Public health services are involvedwith prevention more often than with chronic care.DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4TOP: Health Care Funding KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care4. A patient with terminal lung cancer with extensive metastasis is requesting a hospice transfer.What criteria are included as requirements for this transfer?a. The patient requests and agrees to the guidelines of hospice care without requiring a physician’sorder.b. The physician confirms that the patient has 6 months or less of life remaining and has provided awritten order for hospice care.c. Proof confirms that the family can no longer care for the patient at home.d. The patient’s specific diagnosis is included on a list of accepted diseases that qualifies the patientfor hospice care.ANS: BThe four criteria for transfer to hospice care are (1) diagnosis of any terminal illness, (2) prognosis ofless than 6 months of life, (3) informed consent of patient, and (4) written physician’s order.

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DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 5TOP: Hospice Care KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity: Basic Care and Comfort5. A patient admitted yesterday with a diagnosis-related group (DRG) diagnosis of abdominal pain ofan unknown cause is being discharged this afternoon because all diagnostic test results have beennegative. What does this scenario exemplify?a. Effective laboratory responseb. Medicare guidelines limiting hospital stayc. Cost containment related to a DRG diagnosisd. Patient who should not have been admitted in the first placeANS: CCost containment is a means by which the cost of hospitalization time is reduced when the need foracute hospital care is no longer necessary.DIF: Cognitive Level: Comprehension REF: p. 11-12 OBJ: 6TOP: Cost Containment per DRGs KEY: Nursing Process Step: N/AMSC: NCLEX: N/A6. A nurse is discussing discharge to a transitional subacute facility with a 72-year-old patientdiagnosed with diabetes and bilateral leg amputation. What should the nurse inform the patientregarding the stay in the new facility?a. It will be limited to 25 days.b. It will be limited to 50 days.c. It will be limited to 75 days.d. It is totally unlimited.ANS: DMedicare limitations are waived for patients who have undergone amputations.DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: 4TOP: Stay in a Skilled Care Facility KEY: Nursing Process Step: PlanningMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care7. A patient is applying for Medicaid. What does the receipt of benefits require?a. Following a supervised health maintenance planb. Enrolling in the Medicare-Preferred Drug Plan

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c. Qualifying for the food stamp programd. Having an annual income of less than $10,000ANS: BThe Medicare-Preferred Drug Plan is a condition of Medicaid eligibility. Nonenrollment may causethe loss of all health care benefits.DIF: Cognitive Level: Knowledge REF: p. 11 OBJ: 4TOP: Medicare-Preferred Drug Plan KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care8. Which is true concerning proprietary agencies?a. They are organized to be nonprofit operations.b. They are organized to make a profit on their operation.c. Any profit they make is immediately used to purchase better equipment and services.d. They must participate in Medicare.ANS: BThese agencies are usually owned by large corporations and established for the purpose of making aprofit. Although most such agencies do participate in Medicare, it is not required.DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 6TOP: Proprietary Agencies KEY: Nursing Process Step: N/AMSC: NCLEX: N/A9. Which patient should the nurse recognize as eligible for a referral to Medicaid?a. Military automobile mechanic with severe asthmab. Pregnant unmarried young woman employed at a discount retail store for 3 yearsc. College student on scholarship who works part-time at the college library and who needsmedication for arthritisd. Unemployed young mother on welfare who needs diabetic medication for one of her childrenANS: DMedicaid covers medication and health care services for welfare recipients for child health and long-term care.DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4TOP: Medicaid Services Eligibility KEY: Nursing Process Step: PlanningMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care

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10. Why was the Balanced Budget Act of 1997 the cause of closures of many proprietary homehealth care agencies?a. It specified that all care be given by registered nurses (RNs).b. It listed specific diagnoses that could qualify a patient for home health care.c. It limited the amount of money that could be spent on a patient.d. It increased the criteria for patient eligibility for home care.ANS: CThe Balanced Budget Act of 1997 placed a limit on the amount of money that could be spent on apatient’s home health care regardless of diagnosis or needs.DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 6TOP: Balanced Budget Act of 1997 KEY: Nursing Process Step: N/AMSC: NCLEX: N/A11. Who is considered the forerunner of modern public health nursing in the United States?a. Vincent DePaulb. William Rathbonec. Florence Nightingaled. Lillian WaldANS: DLillian Wald is recognized as the forerunner of modern public health nursing.DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 1TOP: Leaders and Founders of Public Health Nursing KEY: Nursing Process Step: N/AMSC: NCLEX: N/A12. What is true about voluntary health care agencies?a. They are supported by tax dollars.b. They are governed by boards made up of community members.c. They receive no fee for services.d. They use volunteers as health care providers.ANS: BVoluntary agencies are governed by boards made up of community members and are supported by avariety of sources. They are not supported by tax dollars.

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DIF: Cognitive Level: Comprehension REF: p. 5 OBJ: 5TOP: Voluntary Agencies KEY: Nursing Process Step: N/AMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care13. A client who is hospitalized for treatment after a stroke asks the nurse how long Medicare can beexpected to cover his treatment. What is the nurse’s most informative response?a. “Your Part B will cover your hospital care as long as is necessary.”b. “Your health care provider will determine how long your Medicare coverage will be in effect.”c. “You are allowed 50 days of inpatient care annually.”d. “You can receive skilled care for up to 100 days.”ANS: DPersons hospitalized for skilled nursing care receive 100 days of Medicare coverage.DIF: Cognitive Level: Application REF: p. 11 OBJ: 4TOP: Skilled Care Limitation KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care14. What statement exemplifies that health care benefits are supported by both federal and statefunding?a. Cost-containment prospective fundingb. Department of Health and Human Services (DHHS) Social Security benefits for denturesc. Centers for Disease Control and Prevention (CDC) surveillance of persons at risk for acquiredimmunodeficiency syndrome (AIDS)d. Medicaid provision for skilled care in the homeANS: DFederal and state cooperation are involved in home skilled care issues.DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4TOP: Coordinating Medicaid/Medicare BenefitsKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care15. A nurse is assessing a 65-year-old patient scheduled for outpatient cataract removal surgery in 10days. What should the nurse stress this patient will need?a. Adequate insuranceb. Adequate postoperative care at home

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c. Specialized glassesd. Preservation and protection of visionANS: BOutpatient surgical patients are at great risk for postoperative complications in the absence ofprofessional monitoring. This risk emphasizes the need for preoperative teaching and the provision ofpostoperative support in the home.DIF: Cognitive Level: Application REF: p. 4 OBJ: 6TOP: Postoperative Care for Outpatients KEY: Nursing Process Step: AssessmentMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care16. With what type of professionals are skilled nursing facilities mandated to staff facilities?a. Licensed health professionals around the clockb. RN in charge on each shiftc. RNs to supervise the patient care given by aidesd. Only RNs to provide complex careANS: AA skilled facility must have licensed health care professionals around the clock. Licensed practicalnurses (LPNs) may supervise nursing assistants (NAs), who are the major caregivers. LPNs canprovide wound care and ostomy care and monitor intravenous therapies.DIF: Cognitive Level: Knowledge REF: p. 9 OBJ: 5TOP: Skilled Nursing Facilities Staffing RequirementsKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care17. What is the purpose of a long-term care facility?a. Rehabilitation of patients to their former level of functioningb. Restoration of patients to their optimal level of independencec. To offer care to patients who do not need hospitalization but cannot care for themselvesd. Exclusive care for patients with dementiaANS: CLong-term care facilities care for patients who do not need to be hospitalized but who cannot care forthemselves. Although many patients with dementia are residents in a long-term care facility, thepurpose of such facilities is not to provide their care exclusively.

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DIF: Cognitive Level: Comprehension REF: p. 9 OBJ: 5TOP: Long-Term Care Facilities KEY: Nursing Process Step: N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care18. A resident in a long-term care facility has difficulty swallowing and frequently chokes on foodand liquids. The nurse identifies an increased risk of aspiration. To whom should the nurse initiate areferral for a swallowing evaluation?a. Physician who specializes in throat disordersb. Dietitianc. Nutritionistd. Speech therapistANS: DSpeech therapists are qualified to evaluate swallowing disorders.DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 5TOP: Swallowing Difficulties KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity: Coordinated Care19. What did the 2003 report from the Institute of Medicine (IOM), “Health Professions Education:A Bridge to Quality,” outline?a. Specific software technology to increase efficiency in health careb. Evaluation tool to evaluate the quality of health carec. Recommendations for curriculum changes in professional health care schoolsd. Five core competencies for health care professionalsANS: DThe 2003 IOM report “Health Professions Education: A Bridge to Quality” stressed the need forhealth professionals to be proficient in five areas: (1) providing patient-centered care, (2) working asa member of a team, (3) using evidence-based medicine, (4) focusing on quality improvement, and(5) using information technology.DIF: Cognitive Level: Knowledge REF: p. 12 OBJ: 8TOP: IOM Report KEY: Nursing Process Step: N/A MSC: NCLEX: N/AMULTIPLE RESPONSE

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20. What is the difference between a health maintenance organization (HMO) and a fee-for-serviceplan? (Select all that apply.)a. An HMO requires a set fee from each client.b. An HMO allows clients to select their own health care providers.c. An HMO permits admission to any inpatient facility.d. An HMO offers limited referral options.e. An HMO provides both inpatient and outpatient care.ANS: A, EHMOs require a set fee from each client to use health care providers specified or hired by eachHMO. Inpatient and outpatient care are provided in specified facilities. HMOs have a large group ofspecialists to whom it refers clients. Fee-for-service plans are more expensive, but they allow clientsto choose the health care provider and facility.DIF: Cognitive Level: Comprehension REF: p. 5 | p. 7 | p. 10OBJ: 4 TOP: Comparison of HMO to Fee-for-ServiceKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care21. What should a nurse assure the parents of a newborn with a congenital heart defect that will easeand support the home care for their child? (Select all that apply.)a. Availability of smaller and more compact equipmentb. Specialized DRGs for home care of childrenc. Medicaid-funded home care servicesd. Home care services funded by private insurancee. Grants and stipends from various drug manufacturersANS: A, B, C, DMedicaid funds home care for children, specialized DRGs, and home-sized equipment make homecare for children more easily accomplished.DIF: Cognitive Level: Comprehension REF: p. 11-12 OBJ: 4TOP: Home Health Care for Children KEY: Nursing Process Step: PlanningMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care22. A nurse outlines the benefits of using a home health aide to a homebound patient. With whatshould the home health aide assist this patient? (Select all that apply.)

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a. Bathingb. Doing laundryc. Shopping for groceriesd. Administering medicationse. AmbulatingANS: A, EHome health aides may assist with bathing, ambulation, skin care, and minor homemaking chores.They are not qualified to administer medications. Tasks of laundry, heavy house cleaning, andgrocery shopping are inappropriate for home health aides and are more appropriately assigned to ahomemaker serviceperson.DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 5TOP: Home Health Aid Utilization KEY: Nursing Process Step: PlanningMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care23. A patient inquires about eligibility for home health care. What should the nurse explain is thecriteria for skilled home health care? (Select all that apply.)a. Annual income less than $20,000b. Need for physical or speech therapyc. Nonavailability of transportationd. Must be homebounde. Need for wound dressing changesANS: B, D, EEligibility for skilled care from a home health care aide includes the need for nursing care for IVtherapies, respirators, wound dressing changes, and physical or speech therapy. No requirementrelative to low income or the lack of transportation exists, but the patient must be homebound.DIF: Cognitive Level: Comprehension REF: p. 5-6 OBJ: 5TOP: Home Health Care KEY: Nursing Process Step: PlanningMSC: NCLEX: Physiological Integrity: Basic Care and Comfort24. What is the mission of the Public Health Service (PHS)? (Select all that apply.)a. Ensure safety of foods and cosmetics.b. Provide access to health care services for low-income individuals.c. Conduct medical research.

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d. Support substance abuse prevention and treatment.e. Monitor and prevent disease outbreaks.f. Provide insurance coverage for low-income individuals.ANS: A, B, C, D, EThe PHS focus is on all levels of ensuring community health, both in providing treatment andsupporting prevention. The PHS also supports medical research.DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 3TOP: Public Health Service KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease25. What is true regarding the Medicare Prescription Drug Plan? (Select all that apply.)a. It is included in Medicare Part A.b. There is a $250 deductible.c. Approximately 25% of prescription drug expenses are covered.d. Only prescriptions written by a medical physician are covered.e. It reimburses 95% of out-of-pocket expenses over $3600.ANS: B, EMedicare Prescription Plan (Medicare Part D) requires a separate enrollment, pays 50% of drugexpenses after the $250 deductible is satisfied, honors all prescriptions written by licensed medicalpersonnel who have prescriptive power, and covers 95% of out-of-pocket expenses up to $3600.DIF: Cognitive Level: Comprehension REF: p. 10-11 OBJ: 4TOP: Medicare Prescription Plan KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care26. Why do physicians prefer to use e-prescription systems? (Select all that apply.)a. Drug requests are processed more efficiently.b. Drug duplications are prevented.c. Less expensive drugs are used.d. Contraindications for a drug are identified.e. Both the generic and trade names are labeled.ANS: A, B, DE-prescription systems that expedite the request also generate drug information related tocontraindications and side effects and can identify duplication of drugs.

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DIF: Cognitive Level: Knowledge REF: p. 12 OBJ: 8TOP: Topic: E-prescriptions KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity: Reduction of Risk27. What services are considered to be under the administration of the U.S. Department of Health andHuman Services (HHS)? (Select all that apply.)a. Public Health Service (PHS)b. Administration for Children and Familiesc. Administration on Agingd. American Medical Associatione. Centers for Medicare and MedicaidANS: A, B, C, EThe Public Health Service (PHS), Administration for Children and Families, Administration onAging, and Centers for Medicare and Medicaid all share the administration of the Department ofHealth and Human Services (HHS).DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 5TOP: DHHS KEY: Nursing Process Step: N/A MSC: NCLEX: N/ACOMPLETION28. The nurse clarifies that the insurance plan that pays the physician in advance each month for eachenrolled patient, whether or not the patient is treated by the physician, is a strategy known as _____.ANS:capitationCapitation is the system of payment that collects monthly “fees” from enrollees and pays thephysician whether the patient has been treated or not. It is rather like a salary that assures theattention of a physician in the event of an illness.DIF: Cognitive Level: Knowledge REF: p. 10 OBJ: 4TOP: Capitation KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment

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Chapter 02: Nursing in VariedPatient Care SettingsChapter 02: Nursing in Varied Patient Care SettingsLinton: Introduction to Medical-Surgical Nursing, 6th EditionMULTIPLE CHOICE1. While a home health nurse is making the entry to a service assessment on a home-bound patient,the spouse of the patient asks whether Medicare will cover the patient’s ventilator therapy and insulininjections. What is the best response by the nurse?a. “Yes, Medicare will cover both the ventilator therapy and the insulin injections.”b. “No, Medicare will not cover either of these ongoing therapies.”c. “Medicare will cover the ventilator therapy, but it does not cover the insulin injections.”d. “Medicare will cover the ongoing insulin therapy, but it does not cover a highly technical skillsuch as ventilator therapy.”ANS: CMedicare will cover skilled nursing tasks such as ventilator therapy, but common tasks that can betaught to the family or the patient are not covered.DIF: Cognitive Level: Application REF: p. 18 OBJ: 3TOP: Medicare Coverage for Home HealthKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care2. The wife of a patient asks the nurse whether her husband would be considered for placement in askilled nursing care facility when he is discharged from the general hospital. The patient isincontinent, has mild dementia but is able to ambulate with a walker, and must have help to eat anddress himself. What is the nurse’s most appropriate response?a. “Yes, your husband would qualify for a skilled care facility because of his inability to feed anddress himself.”b. “No, your husband’s disabilities would not qualify him for a skilled facility.”c. “Yes, your husband qualifies for placement in a skilled care facility because of his dementia.”d. “Yes, anyone who is willing to pay can be placed in a skilled nursing facility.”

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ANS: BPlacement in a skilled nursing facility must be authorized by a physician. A clear need forrehabilitation must be evident, or severe deficits in self-care that have a potential for improvementand require the services of a registered nurse, physical therapist, or speech therapist must exist.DIF: Cognitive Level: Analysis REF: p. 19 OBJ: 9TOP: Placement Qualifications for Skilled Nursing FacilityKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment3. A nurse has noted that a newly admitted resident to an extended care facility stays in her room,does not take active part in activities, and leaves the meal table after having eaten very little. Thenurse should analyze this relocation response asa. regression.b. social withdrawal.c. depersonalization.d. passive aggressive.ANS: BSocial withdrawal is a frequent response to relocation.DIF: Cognitive Level: Application REF: p. 27 OBJ: 10TOP: Relocation Response KEY: Nursing Process Step: AssessmentMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation4. A nurse clarifies to a new patient in a rehabilitation center what rehabilitation means. Whatstatement made by the patient indicates a correct understanding?a. “I will return to my previous level of functioning.”b. “I will be counseled into a new career.”c. “I will develop better coping skills to accept his disability.”d. “I will attain the greatest degree of independence possible.”ANS: DThe rehabilitation process works to promote independence at whatever level the patient is capable ofachieving.

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DIF: Cognitive Level: Comprehension REF: p. 21 OBJ: 4TOP: Rehabilitation Goals KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care5. A nurse assesses a patient who needs to be reminded to take premeasured oral medications, wash,go to meals, and undress and come to bed at night, but coming and going as he pleases is consideredsafe for him. What facility placement would be most appropriate for this patient?a. Skilled careb. Intermediate carec. Sheltered housingd. Domiciliary careANS: DDomiciliary care provides room, board, and supervision, and residents may come and go as theyplease. Sheltered housing does not provide 24-hour care.DIF: Cognitive Level: Comprehension REF: p. 25 OBJ: 3TOP: “Levels of Care, Criteria for Domiciliary Residence”KEY: Nursing Process Step: AssessmentMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care6. A nurse is making a list of the members of the rehabilitation team so the different types of servicesavailable to patients may be taught to a group of families. Which lists should be used?a. Physical therapist, nurse, family members, and personal physicianb. Occupational therapist, dietitian, nurse, and patientc. Rehabilitation physician, laboratory technician, patient, and familyd. Vocational rehabilitation specialist, patient, and psychiatristANS: AThe rehabilitation team usually consists of all of the choices except the laboratory technician,dietitian, and psychiatrist. (The mental health role is represented by the psychologist.)DIF: Cognitive Level: Comprehension REF: p. 23 OBJ: 8TOP: Rehabilitation Team Members KEY: Nursing Process Step: PlanningMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care7. A nurse explains the level of disability to a patient who was injured in a construction accident thatresulted in the loss of both his right arm and right leg. This loss has affected his quality of life and

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ability to return to previous employment. At what level should the client be classified as beingdisabled?a. Ib. IIc. IIId. IVANS: BThe patient is limited in the use of his right arm for feeding himself, dressing himself, and driving hiscar, which are three main activities of daily living. He may be able to work if workplacemodifications are made.DIF: Cognitive Level: Application REF: p. 21 OBJ: 5TOP: Levels of Disability KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care8. A nurse explains that in 1990, the Americans with Disabilities Act (ADA) was passed. For whichextended services for the disabled persons did this act provide?a. Covering the costs for the rehabilitation of disabled World War I servicemen by providing jobtrainingb. Extending protection to the disabled in the military sector, such as wheelchair ramps on militarybasesc. Extending protection to the disabled in private areas, such as accessibility to public restaurantbathrooms and telephonesd. Affording disabled persons full access to all health care servicesANS: CThe ADA of 1990 extended the previous legislative Acts of 1920, 1935, and 1973. The ADA nowcovers private sector individuals and public businesses in particular.DIF: Cognitive Level: Comprehension REF: p. 22-23 OBJ: 7TOP: Americans with Disabilities Act (ADA) of 1990KEY: Nursing Process Step: AssessmentMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care9. A frail patient in a long-term care facility asks the nurse if a bath is to be given this morning. Whatis the best reply by the nurse to encourage independence and give the patient the most flexibility?

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a. “Based on your room number, you get bathed on Monday, Wednesday, and Friday. Today isTuesday.”b. “If you want to eat breakfast in the dining room with the others, you may sponge yourself off inyour bathroom.”c. “When your daughter comes this evening, ask her if she can give you a bath.”d. “I will bring a basin of water for a sponge off for right now. After breakfast, we will talk about abath schedule.”ANS: DThe resident should be provided as much flexibility as possible and support for independence.DIF: Cognitive Level: Application REF: p. 28 OBJ: 11TOP: Maintenance of Autonomy in Extended Care FacilityKEY: Nursing Process Step: ImplementationMSC: NCLEX Physiological Integrity: Basic Care and Comfort10. A computer programmer who lost both legs is being retained by his employer, who has madearrangements for a ramp and a special desk to accommodate the patient’s wheelchair. What is thedisability level of the computer programmer?a. Ib. IIc. IIId. IVANS: BLevel II allows for workplace accommodation, which is the desk modification in this case.DIF: Cognitive Level: Analysis REF: p. 21 OBJ: 5TOP: Reasonable Accommodation KEY: Nursing Process Step: N/AMSC: NCLEX: N/A11. A partially paralyzed forklift operator is to be retrained by vocational rehabilitation services forless demanding office work. What law provides for this rehabilitation?a. Vocational Rehabilitation Act of 1920b. Social Security Act of 1935c. Rehabilitation Act of 1973d. Americans with Disabilities Act of 1990

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ANS: CThe Rehabilitation Act of 1973 provided a comprehensive approach and expanded resources forpublic vocational training.DIF: Cognitive Level: Comprehension REF: p. 22 OBJ: 7TOP: Rehabilitation Legislation KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care12. The home health care nurse performs all the following actions. Which is the only action that isreimbursable under Medicare payment rules?a. Observing a spouse cleaning and changing a dressingb. Taking a frail couple for a walk to provide exercisec. Watching a patient measure out all medicationsd. Teaching a patient to self-administer insulinANS: DMedicare reimburses skilled techniques that are clearly spelled out; these include teaching but notreturn demonstration–type actions by patient or family.DIF: Cognitive Level: Comprehension REF: p. 19 OBJ: 3TOP: Medicare Reimbursable Actions KEY: Nursing Process Step: AssessmentMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care13. A patient with multiple sclerosis must be fed, bathed, and dressed. How should the nurse assessthis patient?a. Disabledb. Disadvantagedc. Handicappedd. ImpairedANS: DFeeding oneself, dressing, and bathing are activities of daily living. The patient is impaired in thisscenario.DIF: Cognitive Level: Analysis REF: p. 21 OBJ: 4TOP: Principles of Rehabilitation | Defining Levels of Loss of Functioning IndependentlyKEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

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14. Which law initially provided for rehabilitation of disabled Americans?a. Vocational Rehabilitation Act of 1920b. Social Security Act of 1935c. Rehabilitation Act of 1973d. Americans with Disabilities Act of 1990ANS: AThe U.S. government has passed four pieces of legislation to identify and meet the needs of disabledindividuals with each one being more inclusive. The first one was passed in 1920.DIF: Cognitive Level: Knowledge REF: p. 22 OBJ: 7TOP: Rehabilitation Legislation KEY: Nursing Process Step: N/AMSC: NCLEX: N/A15. A client was admitted to a long-term residential care facility. On what should the admitting nursetell the family the concepts of long-term care are based?a. Amount of activities the resident can do for herselfb. Maintenance care with an emphasis on incontinencec. Successful adaptation to the regulations of the homed. Maintenance of as much function as possibleANS: DMaintenance of function and encouraging autonomy and independence are some of the basicconcepts of long-term care.DIF: Cognitive Level: Comprehension REF: p. 27 OBJ: 11TOP: Principles of Nursing Home Care KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care16. A 58-year-old patient with diabetes is recuperating from a broken hip and is concerned about howto pay for rehabilitation. The nurse should inform this patient that funds for rehabilitation areavailable from which resource?a. Vocational Rehabilitation Act of 1920b. Rehabilitation Act of 1973c. Disabled American Veterans Act of 1990d. Title V, Health of Crippled Americans 1935ANS: B

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The Rehabilitation Act of 1973 assists in paying for rehabilitation for those who are younger than 65years of age and who will benefit from vocational rehabilitation through teaching.DIF: Cognitive Level: Comprehension REF: p. 22 OBJ: 7TOP: Legislation for Funding Health CareKEY: Nursing Process Step: PlanningMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care17. What is an example of a description of community health nursing?a. Visiting patients in their homes after hospital discharge to assess their personal health statusb. Asking a nursing assistant (NA) to identify the health services most needed in the patient’spersonal lifec. Meeting with residents of low-income housing to identify their health care needsd. Developing a hospital-based home health care serviceANS: CWhereas community-based nursing looks at identified community needs and provides care at alllevels of wellness and illness, community health nursing seeks to provide services to groups tomodify or create systems of care.DIF: Cognitive Level: Comprehension REF: p. 16 OBJ: 2TOP: Defining Community-Based Nursing versus Community Health NursingKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Coordinated Care18. Home health nurses have some different nursing activities than those of community healthnurses. Which statement best describes the home health nurse’s activities?a. Conducting health education classes in a senior citizens’ common residence buildingb. Conducting blood pressure screening on a regular basis at a local mallc. Visiting and assessing the home care and further teaching needs of a patient who has been recentlydischarged from the hospitald. Acting as a nurse consultant to a chronic psychiatric section in a state institutionANS: CThe home health nurse works with individuals in the home; the other descriptors are communitynurse activities.

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DIF: Cognitive Level: Comprehension REF: p. 16-17 | p. 19OBJ: 1 TOP: Activities of the Home Health NurseKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care19. Based on guidelines from the Americans with Disability Act (ADA), which question is anappropriate choice for the director of nurses to ask a nurse with an artificial leg who is applying for astaff position in an extended care facility?a. “How long have you had your prosthesis?”b. “How many flights of stairs are you able to climb without assistance?”c. “Are you able to lift a load of 45 lb?”d. “Has your disability caused you to miss work?”ANS: CQueries to disabled job applicants can be made relative to specific job functions, but they cannot beasked relative to the severity of the disability or the degree of disability in general.DIF: Cognitive Level: Application REF: p. 22 OBJ: 7TOP: ADA KEY: Nursing Process Step: N/A MSC: NCLEX: N/AMULTIPLE RESPONSE20. What care skills are safe and appropriate for the licensed practical nurse (LPN) to teach familymembers in the home health care setting? (Select all that apply.)a. Insulin injectionb. Sterile dressing changesc. Venipuncturesd. Periodic Foley catheter insertionse. Instillation of eye dropsf. Changing dressings on small woundsANS: A, E, FInsulin injections, instillation of eye drops, and small wound dressing changes are safe to teach anonprofessional caregiver. Sterile dressings, venipunctures, and inserting Foley catheters areconsidered skilled, and the costs for these are reimbursed by Medicare.DIF: Cognitive Level: Comprehension REF: p. 19 OBJ: 3TOP: Skills Taught by Home Health Nurse

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KEY: Nursing Process Step: PlanningMSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control21. The nursing care plan in a long-term care facility calls for the documentation of regressivebehavior of a newly admitted 82-year-old resident who has had congestive heart failure andosteoarthritis. Of these behaviors observed by the nurse, which should be documented as regression?(Select all that apply.)a. Talks nonstop to staff and other residentsb. Wets and soils self several times a dayc. Wakes in the middle of the night and is unable to return to sleepd. Wears the same clothes day after daye. Cries frequently for no apparent reasonANS: B, D, EBehaviors that are infantile or immature in the absence of dementia are considered regressive.Frequent episodes of crying and inattention to personal hygiene are regressive in nature. Excessivetalking and wakefulness may be related to relocation anxiety, but they are not considered regressive.DIF: Cognitive Level: Analysis REF: p. 26-27 OBJ: 10TOP: Impact of Relocation KEY: Nursing Process Step: AssessmentMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation22. From what do most quality-of-care problems in home health care result? (Select all that apply.)a. Patient’s noncomplianceb. Family’s reluctance to participate in the carec. Inadequate documentationd. Limited fundinge. Defective communication among care team membersANS: C, EInadequate communication and incomplete documentation create most of the quality-of-careproblems.DIF: Cognitive Level: Comprehension REF: p. 20 OBJ: 2TOP: Communication in Home Health SettingKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

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23. An 80-year-old man is newly admitted to a long-term care facility and suddenly becomesincontinent of urine at night. What nursing interventions should be used to help restore self-toileting?(Select all that apply.)a. Waking the resident every 2 hours and escorting him to the bathroomb. Leaving a night-light onc. Discouraging the use of long-legged pajama bottomsd. Placing a urinal at the bedsidee. Keeping the room unclutteredANS: B, C, D, EProviding light in an uncluttered room, encouraging clothing that does not impede self-toileting, andmaking the urinal available increase independence and alleviate situations that make self-toiletingdifficult. Waking a resident not only disturbs his or her rest, but doing so also increases dependencyon the staff.DIF: Cognitive Level: Application REF: p. 27 OBJ: 1TOP: Independence in Long-Term Care CenterKEY: Nursing Process Step: PlanningMSC: NCLEX: Physiological Integrity: Physiological AdaptationCOMPLETION24. The nurse clarifies that an impairment that creates a measurable diminished capacity to work isa(n) _______.ANS:disabilityWhen there is a measurable impairment that changes the individual’s lifestyle, it is referred to as adisability.DIF: Cognitive Level: Knowledge REF: p. 21 OBJ: 5TOP: Rehabilitation Concepts KEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance: Coordinated CareOTHER25. A home health nurse, while in the home to change a decubitus dressing, notices that the woundhas a musky odor and is weepier than the previous visit, 2 days earlier. Place the following nursing

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interventions in order of priority from most to least. (Separate the letters with a comma and space: A,B, C, D.)A. Contact the case manager.B. Assess the patient’s entire skin and vital signs and be prepared to describe the wound findings.C. Cleanse the decubitus area well and redress the wound.D. Chart the appearance of the decubitus completely.D. Assess the patient’s mobility.ANS:B, C, E, D, AThe decubitus finding is important to communicate to the case manager but not until the nurse at thebedside has fully assessed the patient, signs and symptoms, vital signs, and other areas of change thatneed to be promptly communicated. Then the case manager will be able to give directions for furthercare.DIF: Cognitive Level: Application REF: p. 20 OBJ: 1TOP: Communication among Home Health StaffKEY: Nursing Process Step: AssessmentMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care26. What should the home health nurse do when teaching a family member the skill of injectinginsulin effectively? Prioritize these nursing interventions for this situation. (Separate the letters with acomma and space: A, B, C, D.)A. Offer instruction at an appropriate pace.B. Write down the steps of the procedure.C. Assess the level of knowledge of the family member.D. Inquire about the preferred learning style.E. Evaluate the family member’s performance.ANS:C, B, D, A, EEffective teaching depends on assessing the level of knowledge, breaking down the skill in steps,offering instruction in the preferred style, pacing the instruction appropriately, and evaluating theperformance.

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DIF: Cognitive Level: Application REF: p. 19 OBJ: 1TOP: Home Health Teaching KEY: Nursing Process Step: PlanningMSC: NCLEX: Physiological Integrity: Basic Care and ComfortChapter 03: Legal and EthicalConsiderationsChapter 03: Legal and Ethical ConsiderationsLinton: Introduction to Medical-Surgical Nursing, 6th EditionMULTIPLE CHOICE1. A good friend of a licensed practical/vocational nurse (LPN/LVN) confides that she is in a seriousromantic relationship with a man the LPN/LVN had as a patient when he was diagnosed with thehuman immunodeficiency virus (HIV). The policies of the Health Insurance Portability andAccountability Act (HIPAA) prevent the nurse from warning her friend. What is this situationconsidered?a. Moral dilemmab. Moral uncertaintyc. Moral distressd. Moral outrageANS: CMoral distress occurs when a nurse feels powerless because moral beliefs cannot be honored becauseof institutional or other barriers.DIF: Cognitive Level: Comprehension REF: p. 32 OBJ: 1TOP: Moral Distress KEY: Nursing Process Step: N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care2. A nurse reminds a resident in a long-term care facility that he has autonomy in many aspects of hisinstitutionalization. What is an example of autonomy?a. Selection of medication timesb. Availability of his own small electrical appliancesc. Smoking in the privacy of his own roomd. Application of advance directives

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ANS: DThe application of advance directives is an autonomous decision. Agency protocols relative tomedication times, access to private electrical devices, and smoking are rarely waived; these policiesare not in the control of the resident.DIF: Cognitive Level: Comprehension REF: p. 32 OBJ: 2TOP: Autonomy KEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity: Coping and Adaptation3. How might an LPN/LVN exhibit beneficence?a. Remove defective equipment from the patient’s room.b. Willingly work extra shifts during a staff shortage.c. Adhere to agency policy.d. Join the National Association for Practical Nurse Education and Service (NAPNES) and attendeducational seminars.ANS: ABeneficence means promoting good and reducing harm. Removing defective equipmentdemonstrates that the LPN/LVN is reducing possible harm to the patient. Working extra shifts,adhering to policy, and joining NAPNES are personal values, not beneficence.DIF: Cognitive Level: Comprehension REF: p. 32 OBJ: 2TOP: Beneficence KEY: Nursing Process Step: N/A MSC: NCLEX: N/A4. An LPN/LVN is educating a group of nursing students regarding values demonstrated in theirnursing practice. Where will the LPN/LVN indicate the base of these values is derived?a. Nursing school educationb. Family influencec. Peer relationshipsd. Agency policiesANS: BThe family shapes values that are demonstrated in later life. These values may be enhanced orchallenged by life experiences, but the base is forged in the family.DIF: Cognitive Level: Comprehension REF: p. 32 OBJ: 3TOP: Values KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

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5. One obstetric nurse remarks, “I don’t see how these young single women can keep on havingbabies without being married. Everyone knows a child needsa father.” What is this nurse exhibiting?a. Ethnocentrismb. Moral uncertaintyc. Values clarificationd. Professional concernANS: AEthnocentricity is the belief that one’s own culture and values are superior to those of another. Suchstatements are based on values clarification and, perhaps, on moral outrage.DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 5TOP: Ethnocentrism/Values Clarification KEY: Nursing Process Step: N/AMSC: NCLEX: N/A6. A nursing student asks the instructor to define the philosophic stand of utilitarianism. Whatexample should the instructor provide?a. An army officer sacrifices six paratroopers to save 100 prisoners of war.b. A priest burns down his church because it was defiled by Satanists.c. A mother jumps off a cliff with her baby to avoid being captured by Indians.d. A soldier murders captured enemies to prevent their divulging military secrets.ANS: AThe sacrifice of six to save 100 is an example of the greater good. The other options are based on thephilosophy of deontology.DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 6TOP: Utilitarianism KEY: Nursing Process Step: N/AMSC: NCLEX: N/A7. An LPN/LVN explains to a patient that the hospital has an institutional ethics committee. What isthe main function of this committee?a. Preside over policy implementation.b. Revoke the license of someone who violates the law.c. Solve personnel disputes.d. Ensure that hiring adheres to ethnic equality.ANS: A

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The main job of the institutional ethics committee is to preside over the implementation of agencypolicy.DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 8TOP: Institutional Ethics Committee KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care8. An LPN/LVN charts that “the patient is drunk and acting in a crazy manner.” The team leadercautions the LPN/LVN that this documentation is not appropriate. What charges of commission ofthe intentional tort is this an example of?a. Assaultb. Wrongful publicationc. Defamation of characterd. Invasion of privacyANS: CCharting or saying unsupported defamatory statements can lead to tort litigation.DIF: Cognitive Level: Comprehension REF: p. 38 OBJ: 2TOP: Torts KEY: Nursing Process Step: N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care9. When an LPN/LVN assists an older woman to stand after a fall in a shopping mall parking lot, thewoman twists and sprains her ankle. What protects the LPN/LVN from litigation or an unintentionaltort?a. Hospital malpractice insuranceb. Good faith agreementc. Good Samaritan lawd. Personal professional insuranceANS: CThe Good Samaritan law protects individuals who assist at an accident scene if they act in good faith.Professional insurance is not in effect because the actions were not performed while the LPN/LVNwas on duty.DIF: Cognitive Level: Comprehension REF: p. 39 OBJ: 2TOP: Torts KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

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10. An LPN/LVN trimmed the toenails of a patient with diabetes too short, which results in a toeamputation from infections. What is the LPN/LVN guilty of?a. Unintentional tortb. Intentional tortc. Negligenced. MalpracticeANS: DMalpractice occurs when an unintentional tort causes an injury to a patient.DIF: Cognitive Level: Comprehension REF: p. 39 OBJ: 2TOP: Malpractice KEY: Nursing Process Step: N/A MSC: NCLEX: N/A11. What must an LPN/LVN acquiring a signature on a surgical informed consent document ensure?a. The patient is not sedated.b. The physician is present.c. The family member is a witness.d. The signature is in ink.ANS: ABefore surgery, the consent form must be signed before any preoperative sedation is administered. Asedated person cannot give a valid consent.DIF: Cognitive Level: Application REF: p. 40 OBJ: 9TOP: Informed Consent KEY: Nursing Process Step: N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care12. A physician has written an order for Synthroid, 137 mg. The LPN/LVN is aware that the drug ismeasured in micrograms. What action should the nurse implement?a. Transcribe the order as if it were written in micrograms.b. Notify the nursing supervisor.c. Transcribe the order as written.d. Call the prescribing physician.ANS: DThe LPN/LVN may call the physician to clarify the order but may not alter the written order in anyway. The order for the correct dose will be written as a new order.

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DIF: Cognitive Level: Application REF: p. 40 OBJ: 12TOP: Doctor’s Orders KEY: Nursing Process Step: N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care13. A physician has written an order for morphine sulfate, 100 mg. The LPN/LVN inquires if hemeant to write 10 mg. The physician confirms that he meant 100 mg. What action should theLPN/LVN implement?a. Call a member of the hospital administration.b. Refuse to transcribe the order.c. Call the pharmacist.d. Notify the nursing supervisor.ANS: DIn the event of a physician’s refusal to clarify a questionable order, the LPN/LVN should notify thenursing supervisor to intervene.DIF: Cognitive Level: Application REF: p. 40 OBJ: 12TOP: Doctor’s Orders KEY: Nursing Process Step: N/AMSC: NCLEX: Safe, Effective Care Environment: Coordinated CareMULTIPLE RESPONSE14. On what are health care ethics based? (Select all that apply.)a. Autonomyb. Fidelityc. Professionalismd. Justicee. NonmaleficenceANS: A, B, D, EHealth care ethics are based on autonomy, fidelity, beneficence, justice, and nonmaleficenceDIF: Cognitive Level: Knowledge REF: p. 32 OBJ: 2TOP: Health Care Ethics KEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment: Coordinated Care15. How does values clarification support nursing practice? (Select all that apply.)a. Guides decision making

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