Chapter 02: Medical-Surgical
Practice Settings
Linton: Medical-Surgical
Nursing, 7th Edition
MULTIPLE CHOICE
1. While a home health nurse is
making the entry to a service assessment on a homebound patient, the spouse of the
patient asks whether Medicare will cover the patient’s ventilator therapy and
insulin injections. What is the best response by the nurse?
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a.
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“Yes, Medicare will cover
both the ventilator therapy and the insulin injections.”
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b.
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“No, Medicare will not cover
either of these ongoing therapies.”
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c.
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“Medicare will cover the
ventilator therapy, but it does not cover the insulin injections.”
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d.
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“Medicare will cover the
ongoing insulin therapy, but it does not cover a highly technical skill such
as ventilator therapy.”
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ANS: C
Medicare will cover skilled
nursing tasks such as ventilator therapy, but common tasks that can be taught
to the family or the patient are not covered.
DIF: Cognitive Level:
Application REF: pp. 12-13 OBJ: 3 | 4
TOP: Medicare Coverage for
Home Health
KEY: Nursing Process Step:
Implementation
MSC: NCLEX: Safe, Effective
Care Environment: Coordinated Care
2. The wife of a patient asks the
nurse whether her husband would be considered for placement in a skilled
nursing care facility when he is discharged from the general hospital. The
patient is incontinent, has mild dementia but is able to ambulate with a
walker, and must have help to eat and dress himself. What is the nurse’s most
appropriate response?
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a.
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“Yes, your husband would
qualify for a skilled care facility because of his inability to feed and
dress himself.”
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b.
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“No, your husband’s
disabilities would not qualify him for a skilled facility.”
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c.
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“Yes, your husband qualifies
for placement in a skilled care facility because of his dementia.”
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d.
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“Yes, anyone who is willing
to pay can be placed in a skilled nursing facility.”
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ANS: B
Placement in a skilled nursing
facility must be authorized by a physician. A clear need for rehabilitation
must be evident, or severe deficits in self-care that have a potential for
improvement and require the services of a registered nurse, a physical
therapist, or a speech therapist must exist.
DIF: Cognitive Level:
Analysis REF: p. 13 OBJ: 6
TOP: Placement
Qualifications for Skilled Nursing Facility
KEY: Nursing Process Step:
Implementation
MSC: NCLEX: Safe, Effective
Care Environment
3. 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. The nurse should analyze this relocation response as
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a.
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regression.
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b.
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social withdrawal.
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c.
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depersonalization.
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d.
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passive aggressive.
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ANS: B
Social withdrawal is a
frequent response to relocation.
DIF: Cognitive Level:
Application REF: p. 21 OBJ: 10
TOP: Relocation Response KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial
Integrity: Coping and Adaptation
4. A nurse clarifies to a new
patient in a rehabilitation center what rehabilitation means. What statement
made by the patient indicates a correct understanding?
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a.
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“I will return to my
previous level of functioning.”
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b.
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“I will be counseled into a
new career.”
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c.
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“I will develop better
coping skills to accept his disability.”
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d.
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“I will attain the greatest
degree of independence possible.”
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ANS: D
The rehabilitation process
works to promote independence at whatever level the patient is capable of
achieving.
DIF: Cognitive Level:
Comprehension REF: p. 15 OBJ: 7
TOP: Rehabilitation Goals KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion
and Maintenance: Coordinated Care
5. 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
considered safe for him. What facility placement would be most appropriate for
this patient?
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a.
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Skilled care
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b.
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Intermediate care
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c.
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Sheltered housing
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d.
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Domiciliary care
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ANS: D
Domiciliary care provides
room, board, and supervision, and residents may come and go as they please.
Sheltered housing does not provide 24-hour care.
DIF: Cognitive Level:
Comprehension REF: p. 19 OBJ: 3 | 9
TOP: “Levels of Care,
Criteria for Domiciliary Residence”
KEY: Nursing Process Step:
Assessment
MSC: NCLEX: Safe, Effective
Care Environment: Coordinated Care
6. A nurse is making a list of
the members of the rehabilitation team, so the different types of services
available to patients may be taught to a group of families. Which lists should
be used?
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a.
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Physical therapist, nurse,
family members, and personal physician
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b.
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Occupational therapist,
dietitian, nurse, and patient
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c.
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Rehabilitation physician,
laboratory technician, patient, and family
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d.
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Vocational rehabilitation
specialist, patient, and psychiatrist
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ANS: A
The 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. 17 OBJ: 7
TOP: Rehabilitation Team
Members KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective
Care Environment: Coordinated Care
7. A nurse explains the level of
disability to a patient who was injured in a construction accident that
resulted in the loss of both his right arm and right leg. This loss has
affected his quality of life and ability to return to previous employment. At
what level should the client be classified as being disabled?
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a.
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I
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b.
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II
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c.
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III
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d.
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IV
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ANS: B
The patient is limited in the
use of his right arm for feeding himself, dressing himself, and driving his
car, which are three main activities of daily living. He may be able to work if
workplace modifications are made.
DIF: Cognitive Level:
Application REF: p. 15 OBJ: 8
TOP: Levels of Disability KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective
Care Environment: Coordinated Care
8. A nurse explains that in 1990,
the Americans with Disabilities Act (ADA) was passed. For which extended
services for the disabled persons did this act provide?
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a.
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Covering the costs for the
rehabilitation of disabled World War I servicemen by providing job training
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b.
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Extending protection to the
disabled in the military sector, such as wheelchair ramps on military bases
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c.
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Extending protection to the
disabled in private areas, such as accessibility to public restaurant
bathrooms and telephones
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d.
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Affording disabled persons
full access to all health care services
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ANS: C
The ADA of 1990 extended the
previous legislative Acts of 1920, 1935, and 1973. The ADA now covers private
sector individuals and public businesses in particular.
DIF: Cognitive Level:
Comprehension REF: p. 16 OBJ: 8
TOP: Americans with
Disabilities Act (ADA) of 1990
KEY: Nursing Process Step:
Assessment
MSC: NCLEX: Safe, Effective
Care Environment: Coordinated Care
9. A frail patient in a long-term
care facility asks the nurse if a bath is to be given this morning. What is the
best reply by the nurse to encourage independence and give the patient the most
flexibility?
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a.
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“Based on your room number,
you get bathed on Monday, Wednesday, and Friday. Today is Tuesday.”
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b.
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“If you want to eat
breakfast in the dining room with the others, you may sponge yourself off in
your bathroom.”
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c.
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“When your daughter comes
this evening, ask her if she can give you a bath.”
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d.
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“I will bring a basin of
water for a sponge off for right now. After breakfast, we will talk about a
bath schedule.”
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ANS: D
The resident should be
provided as much flexibility as possible and support for independence.
DIF: Cognitive Level:
Application REF: p. 22 OBJ: 11
TOP: Maintenance of
Autonomy in Extended Care Facility
KEY: Nursing Process Step:
Implementation
MSC: NCLEX Physiological
Integrity: Basic Care and Comfort
10. A computer programmer who lost both legs is being retained by his
employer, who has made arrangements for a ramp and a special desk to
accommodate the patient’s wheelchair. What is the disability level of the
computer programmer?
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a.
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I
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b.
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II
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c.
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III
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d.
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IV
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ANS: B
Level II allows for workplace
accommodation, which is the desk modification in this case.
DIF: Cognitive Level:
Analysis REF: p. 15 OBJ: N/A
TOP: Reasonable
Accommodation KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
11. A partially paralyzed forklift operator is to be retrained by
vocational rehabilitation services for less demanding office work. What law
provides for this rehabilitation?
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a.
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Vocational Rehabilitation
Act of 1920
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b.
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Social Security Act of 1935
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c.
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Rehabilitation Act of 1973
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d.
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Americans with Disabilities
Act of 1990
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ANS: C
The Rehabilitation Act of 1973
provided a comprehensive approach and expanded resources for public vocational
training.
DIF: Cognitive Level:
Comprehension REF: p. 16 OBJ: 7
TOP: Rehabilitation
Legislation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective
Care Environment: Coordinated Care
12. The home health care nurse performs all the following actions.
Which is the only action that is reimbursable under Medicare payment rules?
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a.
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Observing a spouse cleaning
and changing a dressing
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b.
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Taking a frail couple for a
walk to provide exercise
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c.
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Watching a patient measure
out all medications
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d.
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Teaching a patient to
self-administer insulin
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ANS: D
Medicare reimburses skilled
techniques that are clearly spelled out; these include teaching but not return
demonstration–type actions by patient or family.
DIF: Cognitive Level:
Comprehension REF: pp. 12-13 OBJ: 4
TOP: Medicare Reimbursable
Actions KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective
Care Environment: Coordinated Care
13. A patient with multiple sclerosis must be fed, bathed, and
dressed. How should the nurse assess this patient?
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a.
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Disabled
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b.
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Disadvantaged
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c.
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Handicapped
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d.
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Impaired
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ANS: D
Feeding oneself, dressing, and
bathing are activities of daily living. The patient is impaired in this
scenario.
DIF: Cognitive Level:
Analysis REF: p. 15 OBJ: 7
TOP: Principles of
Rehabilitation | Defining Levels of Loss of Functioning Independently
KEY: Nursing Process Step:
Implementation
MSC: NCLEX: Physiological
Integrity
14. Which law initially provided for rehabilitation of disabled
Americans?
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a.
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Vocational Rehabilitation
Act of 1920
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b.
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Social Security Act of 1935
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c.
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Rehabilitation Act of 1973
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d.
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Americans with Disabilities
Act of 1990
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ANS: A
The U.S. government has passed
four pieces of legislation to identify and meet the needs of disabled
individuals with each one being more inclusive. The first one was passed in
1920.
DIF: Cognitive Level:
Knowledge REF: p. 16 OBJ: 8
TOP: Rehabilitation
Legislation KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
15. A client was admitted to a long-term residential care facility. On
what should the admitting nurse tell the family the concepts of long-term care
are based?
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a.
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Amount of activities the
resident can do for herself
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b.
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Maintenance care with an
emphasis on incontinence
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c.
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Successful adaptation to the
regulations of the home
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d.
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Maintenance of as much
function as possible
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ANS: D
Maintenance of function and
encouraging autonomy and independence are some of the basic concepts of
long-term care.
DIF: Cognitive Level:
Comprehension REF: p. 18 OBJ: 11
TOP: Principles of Nursing
Home Care KEY: Nursing Process Step: Implementation
