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Medical Surgical Nursing Chapter 1
Exams
On initial assessment the patient is found to be quiet interested in asking questions about the nurse, evades personal questions, and is often silent while making no eye contact. These characteristics are more likely to be found in which behavior: 1 Withdrawn 2 Manipulative 3 Dependent 4 Hostile - ✔ANS 1 Rationale: Patients displaying withdrawn behavior frequently are lonely and fearful, and set up barriers for contact, such as avoiding eye contact. Getting personal needs met is characteristic of the patient with manipulative behavior. Patients with dependent behavior may make unreasonable demands on the nurse's time. Patients with hostile behavior may threaten to report the nurse and may even physically strike out. Which statement made by a patient strongly indicates dependent behavior: 1 I can do this by myself, I do not need help 2 I will try to do this and will ask for help if needed 3 Would you help me if I am not able to do it myself 4 I'm tired and I'd rather you help me dress - ✔ANS 4 Rationale: "Would you help me dress?" indicates a reliance on the caregiver to do things for him. To do or try to do things for self indicates independent behavior.
A patient must decide between HMO or PPO health care plans that her employee offers. Which statement best describes coverage of the HMO: 1 All health care bills are covered except yearly mammograms, annual physical exams, and routine colonoscopies 2 Patients can only see physicians hired by the HMO whenever a visit or treatment is required, no exceptions 3 I will have to pay a fixed monthly fee and a copayment for each doctor's visit is required, no exceptions 4 I will have to pay charges as I leave the doctor's office and send the bill to the HMO for reimbursement - ✔ANS 3 Rationale: When joining an HMO, patients pay a fixed fee that covers all needed care. HMOs encourage prevention of disease by practicing preventive medicine. This in turn saves the HMO money. For an extra fee, patients can see a physician outside the HMO group of physicians. HMOs charge a yearly fee that is paid monthly or quarterly. This fee covers all medical expenses for that year. Which condition is not paid for by Medicare if it develops after hospitalization: 1 Hypokalemia 2 Heart attack 3 Hip Fracture 4 Meningitis - ✔ANS 3 Rationale: In an effort to save millions of tax dollars every year, starting in 2009, Medicare does not cover the costs of "preventable" conditions, mistakes, and infections resulting from a hospital stay. The cost of treatment of a fractured hip that occurred while hospitalized would be the responsibility of the hospital. The other conditions listed would not be covered by Medicare. If the nurse is caring for a patient with an indwelling urinary catheter, which task can be delegated to the nursing assistant:
3 Installing a bed alarm to notify staff 4 Discover what the patient is searching for - ✔Ans 4 Rationale: Alarm systems alert staff of patient's continual attempts to get out of bed. Administering sedatives requires a physician's order, and applying physical restraints requires an order within 24 hours after a restraint is applied. Applying restraints and administering sedatives are medically ordered interventions. Because of the patient's confusion, getting to the reason for the patient's attempts to get out of bed is important. She could be interrupting a previous ritual, like calling her husband after supper each time he is away to let her know she is ok. After providing discharge instructions to a patient following knee replacement, which statement by the patient indicates a need for further teaching 1 I will wash my hands before changing my dressing 2 I will be on strict bed rest to allow my knee to heal 3 I will take analgesics before the pain gets worse 4 I will be able to eat and drink as usual - ✔Ans 2 Rationale: Washing the hands is appropriate medical asepsis before changing a dressing. Patient teaching includes the need to take pain medication when pain is first experienced and not to wait until the pain escalates. There are no dietary restrictions associated with knee replacement, unless a medical condition requires a special diet. What should the nurse do before delegating a specific task: (Select All That Apply) 1 Know the scope of practice 2 Be aware of the staff person's competency and experience 3 Seek approval from the facility administrator 4 Determine stability of the patient's condition 5 Provide adequate explanation and oversight of the task -
✔ANS 1,
Rationale: The task must be within the LPN/LVN scope of practice before it can be delegated; the staff member's degree of competency and experience must be considered. Approval of a superior is not appropriate. The stability of the patient's condition does not enter into delegation although it is important when assigning tasks. Providing adequate explanation and oversight of the task is not appropriate when delegating, because the UAP should already know how to complete a task delegated to him/her. The patient states, I'm worried about this procedure. Which statement(s) would be therapeutic: (Select All That Apply) 1 You poor thing. I had a similar surgery 2 You seem upset regarding your procedure 3 Can you tell me what you mean by that 4 You will be fine. Your doctor is the best 5 I will hold your hand during the entire procedure - ✔ANS 2, Rationale: 2 and 3 are examples of therapeutic communication. Response # states the nurse's observation and indicates the nurse is listening. The question # gives an example of clarifying the patient's response. Which statement by the patient indicates that the patient understands his HMO (health maintenance organization) insurance plan? 1 "My health plan contracts with medical groups to provide services." 2 "I must receive pre-approval for any physician's office visit." 3 "My plan reduces costs by establishing a network of preferred providers." 4 "All health care costs in my HMO are fully covered." - ✔ANS 1 This is the definition of an HMO. Patients may be allowed to arrange for certain services independently (annual gynecology examinations, e.g.). Preferred provider
3 A patient who has a central line venous access device. 4 A patient who has bipolar disorder. - ✔ans 3 The LPN/LVN may be part of an IV team if postgraduate training/certification has occurred but cannot assume primary care of a patient with a central line venous access device. An LPN/LVN can be assigned responsibility for care of a patient in labor, a stable postoperative patient, and a patient with bipolar disorder. The nurse observes a patient's wife sitting alone after visiting hours, crying. When the nurse approaches her, she states, "I'm so worried about him." Which is the best response by the nurse? 1 "Are you worried about him being in the hospital?" 3 "Tell me what is worrying you." 4 "Would you like to talk with the social worker?" 5 "Would you like to talk with the doctor?" - ✔ANS 2 The most therapeutic response is an open-ended one that allows the wife the opportunity to discuss her concerns. The other options are direct, closed-ended questions suggesting only a "Yes" or "No" answer and do not encourage the wife to express her concerns. Home health care has been a growing area of health care provision. It differs from hospital and nursing home care in which way? 1 Placing more focus on the patient's support system and environment 2 The amount of medication a patient can receive 3 The types of skilled and unskilled services that can be provided 4 Physician involvement in patient care - ✔ANS 1
This is carefully assessed by the nurse to ensure a patient can be safely maintained in the home setting. The amount of medication a patient receives, skilled versus unskilled care, and the physician involvement are concepts in both home health and institutional settings. In a long-term care facility an elderly resident refuses to take his medication. The nurse is aware that the resident has which right(s) regarding medications? (Select all that apply.) 1 Residents can refuse treatments, including medication. 2 The Patient Self-Determination Act guarantees the right to refuse all treatments. 3 Legal systems can force patients to take medication for contagious diseases. 4 Health care providers cannot force patients to take medications for contagious - ✔ANS 1 Health care and legal systems can enforce treatment for contagious disease. If the medication is not for the treatment of infectious disease, however, the patient can refuse it. In general, patients can refuse any or all treatments, except in highly specific cases such as contagious disease. B is incorrect. The Patient Self- Determination Act generally guarantees the right to refuse all treatments, except in certain cases such as contagious disease. Health care systems, along with legal systems, can force patients to take medications for contagious disease. However, if such a situation arises, the LPN/LVN's most appropriate action would be to notify the immediate supervisor. Which action best describes the role of the licensed practical/vocational nurse (LPN/LVN)? 1 To initiate plans for care for assigned patients 2 To care for individuals in the long-term care setting 3 To care for individuals during hospitalization during acute illnesses 4 To care for individuals during illness, to prevent disease, and to care for the dying patient - ✔ANS 4
3 keep patients as healthy as possible. 4 limit the amount of health education information available to patients. - ✔ANS 3 The HMO is focused on keeping patients as healthy as possible. Health education materials are one way of accomplishing this goal. Only necessary tests and referrals to specialists should be ordered. A 70-year-old patient who was treated for a respiratory problem is to be discharged from the hospital. The patient says the physician told her that she must leave "because of DRGs." To discuss this statement with the patient, the LPN/LVN must understand that DRGs (diagnostic-related groups) are a way of paying the hospital money: 1 in advance for care provided for a particular diagnosis. 2 for each day of service provided. 3 based on whether a patient is cured. 4 in a lump sum for the care of a patient with a particular diagnosis. - ✔ANS 4 Under the DRG system, the fee the government will pay for hospitalization depends on the DRG category (illness). Hospitals receive a flat fee for each patient's DRG category, regardless of length of stay in the hospital; thus hospitals have an incentive to treat patients and discharge them as quickly as possible. In the hospital in which a newly licensed LPN/ LVN is employed, a collaborative care plan is used. What does the term collaborative care plan indicate? 1 Collaborative care plans are primarily for RNs to use. 2 Collaborative care plans include tasks to be performed by all members of the health care team. 3 Collaborative care plans involve various nursing personnel. 4 Collaborative care plans are diagnosis-specific and cannot be individualized to meet individual patient needs. -
✔ANS 2
Collaborative care involves working with all members of the health care team, such as nurses, dieticians, physical therapists; thus a collaborative care plan would involve care given by all health care team members. A patient who has chronic pain is thinking about having acupuncture. Before discussing this treatment option with the patient, the LPN/LVN is aware that acupuncture is considered __________ therapy. 1 biomedical 2 CAM 3 unapproved 4 questionable - ✔ANS 2 CAM refers to complementary and alternative medicine and focuses on assisting the body's own healing powers and restoring body balance. A patient is considering using alternative treatments for health problems. Which question is most important for the patient to consider? 1 "What are the risks and benefits of the therapy?" 2 "What will my family think about my using this type of therapy?" 3 "Will my physician approve of this course of action?" 4 "Will my friends think this is a wise decision?" - ✔ANS 1 The most important consideration is determining the risks and benefits of the therapy. Family friends and some physicians may not approve of alternative therapy.
