Nursing Concepts and Practices, Exams of Nursing

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MEDICAL SURGICAL NURSING

CHAPTER 1 EVALUATED 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 These characteristics are more likely to be found in which behavior: 1 Withdrawn 2 Manipulative 3 Dependent 4 Hostile - CORRECT ANSWER-ANS 1 Rationale: Patients displaying withdrawn behavior frequently are lonely and fearful, and set up barriers for contact, such as avoiding eye contact.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 - CORRECT ANSWER-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 - CORRECT ANSWER-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 - CORRECT ANSWER-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: 1 Providing perineal care each morning and evening 2 Collecting a urine specimen for laboratory testing 3 Irrigating the catheter to ensure patency 4 Instilling antibiotics for a urinary infection - CORRECT ANSWER-ANS 1 Rationale: Perineal care requires the use of medical asepsis (clean technique). Nursing assistants learn principles of medical asepsis. Collecting a urine specimen, irrigating, or instilling antibiotics for a patient with an indwelling urinary catheter requires sterile technique, and nursing assistants do not learn principles of sterile technique. In caring for patients with pressure ulcers, which task would be most appropriate to delegate to the nursing assistant: 1 Providing assistance in making dietary choices, including fruits 2 Participating in determining the appropriate type of wound care 3 Repositioning the patient every 2 hours 4 Describing conditions of the wound and any drainage - CORRECT ANSWER-ans 3 Rationale: Repositioning of patients is included in the nursing assistant program and changing position every 2 hours helps to avoid pressure on body parts that would contribute to the development of another pressure ulcer. Licensed nurses learn the nutrients needed to assist in healing skin breakdown, can decide wound care system to be used for a pressure ulcer situation, and can evaluate the effectiveness of chosen wound care system. The nurse finds a confused patient with a history of falls attepting to get out of bed. To maintain the patient's self-esteem and safety, the nurse's intervention should be to: 1 Apply physical restraints to keep the patient in bed 2 Administer sedatives per doctor's order 3 Installing a bed alarm to notify staff 4 Discover what the patient is searching for - CORRECT ANSWER-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 - CORRECT ANSWER-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 - CORRECT ANSWER-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 - CORRECT ANSWER-ANS 2, Rationale: 2 and 3 are examples of therapeutic communication. Response #2 states the nurse's observation and indicates the nurse is listening. The question #3 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." - CORRECT ANSWER-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 network describes a PPO (preferred provider organization). Few health care plans provide full coverage for all costs. The nurse working as a case manager for a health insurance company would expect to perform which duties? 1 Assist in determining costs for specific types of care. 2 Coordinate the health care of enrolled patients. 3 Determine who is eligible for coverage. 4 Provide direct patient care. - CORRECT ANSWER-ANS 2 A nursing case manager for a health insurance company arranges for the implementation of services for patients. The new nurse understands the job description of the unlicensed assistive personnel (UAP) by making which statement? (Select all that apply.) 1 "The UAP may assist the nurse with direct patient care." 2 "The UAP is able to do whatever the nurse delegates to them." 3 "The UAP may perform care without direct supervision." 4 "The UAP is trained and certified to perform certain nursing tasks." - CORRECT ANSWER-ANS 1, The UAP may assist the nurse or perform certain nursing tasks independently that they have been trained and certified to perform, with supervision by the licensed nurse. Unlicensed personnel may only be delegated tasks that they can legally be expected to do and that the nurse can be reasonably sure they are able to perform. The nurse remains responsible for the care provided by the UAP. The LPN/LVN may be limited from assuming primary care responsibility for which patient? 1 A patient who is in labor. 2 A patient who is 2 days postoperative for an appendectomy. 3 A patient who has a central line venous access device. 4 A patient who has bipolar disorder. - CORRECT ANSWER-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?" - CORRECT ANSWER-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 - CORRECT ANSWER-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 - CORRECT ANSWER-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 - CORRECT ANSWER-ANS 4 The LPN/LVN is responsible for care during all aspects of health and illness. It is not limited to long-term care or hospital nursing. Initiation of care plans is not the responsibility of the LPN/LVN. In what way is the role of the registered nurse (RN) different from that of the LPN/LVN? 1 The RN focuses on giving direct care. 2 The RN focuses on coordinating care. 3 The LPN/LVN focuses on basic supervisory functions. 4 The LPN/LVN focuses on in-depth assessments. - CORRECT ANSWER-ANS 2 The LPN/LVN does not focus on coordination of patient care; this is the primary role of the registered nurse. The LPN/LVN focuses on giving direct patient care. The LPN/LVN is discussing health care with colleagues. For which reason(s) is the health care system undergoing many changes at this time? (Select all that apply.) 1 The population of young people is growing very rapidly. 2 There are more people living in poverty than there are self-supporting people. 3 There is a shortage of health care personnel. 4 Elderly people tend to have extensive health care needs. - CORRECT ANSWER-ANS 3, Shortage of health care personnel and the growing population of the elderly requiring extensive health care are influencing the current level of change in the health care system. A patient tells the LPN/LVN that he is thinking of joining a health maintenance organization (HMO). To discuss this option with the patient, the LPN/LVN should know that the purpose of an HMO is to: 1 encourage as many diagnostic tests as possible. 2 provide services at the specialist level to as many patients as possible. 3 keep patients as healthy as possible. 4 limit the amount of health education information available to patients. - CORRECT ANSWER-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. - CORRECT ANSWER-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. - CORRECT ANSWER-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 - CORRECT ANSWER-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?" - CORRECT ANSWER-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.