Linton: Introduction to Medical-Surgical Nursing, 5th Edition

Chapter 01: The Health Care System

Test Bank

MULTIPLE CHOICE

	1.	An 89-year-old man, who was recently discharged from a rehabilitation hospital because of an inability to concentrate and frequent memory lapses, cannot be left alone while his family works. What options can the discharge planning team suggest that will satisfy safety concerns and give the greatest quality of life to the patient?
a.	Placement in a day care center from 8 AM to 5 PM daily	
b.	Placement in a long-term psychiatric facility	
c.	Placement in a high-security nursing home	
d.	Admission to a general hospital for evaluation	

ANS:	A
Day care centers provide supervision, safety, nutritious meals, and socialization while the care-giving family works.

DIF:	Cognitive Level: Application	REF:	p. 10	OBJ:	4
TOP:	Day Care Centers		KEY:	Nursing Process Step: Planning
MSC:	NCLEX: Physiological Integrity: Reduction of risk

	2.	A 66-year-old hospitalized patient is anxious about how the physician will be paid now that he is on Medicare-Parts A and B, instead of his previous privately funded insurance plan. The nurse explains that the physician will be paid by:
a.	Previous privately funded insurance plan	
b.	Medicare Part A	
c.	Medicare Part B	
d.	Patient or patient’s family	

ANS:	C
Part A pays skilled care facilities. Part B pays for physician’s services. The previously held insurance is no longer available because of the patient’s age. The family or patient is not responsible, because Part B is in effect.

DIF:	Cognitive Level: Comprehension	REF:	p. 4	OBJ:	3
TOP:	Health Care Funding		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Safe Effective Care Environment: Coordinated care	

	3.	A nurse could best refer an unemployed 42-year-old patient with renal failure who has lost his job-related private insurance to which health care plan for his medical care?
a.	Medicare	
b.	Medicaid	
c.	Public health facility	
d.	Community-based outpatient clinic	

ANS:	B
Medicaid is available to needy low-income persons under 65 years of age who have a permanent disability. Medicare is for persons 65 years and older. Public health services are involved with prevention more often than with chronic care.

DIF:	Cognitive Level: Comprehension	REF:	p. 4	OBJ:	3
TOP:	Health Care Funding		KEY:	Nursing Process Step: Implementation
MSC:	"NCLEX: Safe, Effective Care Environment: Coordinated care"	

	4.	A 50-year-old woman with terminal lung cancer with extensive metastasis is requesting a hospice transfer. The requirements for this transfer include which criteria?
a.	Patient requests and agrees to the guidelines of hospice care without requiring a physician’s order.	
b.	Physician confirms that the patient has 6 months or less of life remaining and has provided a written order for hospice care.	
c.	Proof confirms that the family can no longer care for the patient at home.	
d.	Patient’s specific diagnosis is included on a list of accepted diseases that qualifies the patient for hospice care.	

ANS:	B
The four criteria for transfer to hospice care are (1) diagnosis of any terminal illness, (2) prognosis of less than 6 months of life, (3) informed consent of patient, and (4) written physician’s order.

DIF:	Cognitive Level: Comprehension	REF:	p. 10	OBJ:	4
TOP:	Hospice Care			KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Physiological Integrity: Basic care and comfort

	5.	A 42-year-old patient admitted yesterday with a diagnosis-related group (DRG) diagnosis of abdominal pain of an unknown cause is being discharged this afternoon because all diagnostic tests have been negative. This scenario is an example of:
a.	Effective laboratory response	
b.	Medicare guidelines limiting hospital stay	
c.	Cost containment related to a DRG diagnosis	
d.	Patient who should not have been admitted in the first place	

ANS:	C
Cost containment is a means by which the cost of hospitalization time is reduced when the need for acute hospital care is no longer necessary.

DIF:	Cognitive Level: Comprehension	REF:	p. 5	OBJ:	5
TOP:	Cost Containment per DRGs	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	6.	In discussing the discharge to a transitional subacute facility with a 72-year-old patient with diabetes who has had both legs amputated, the nurse informs the patient that his stay in the new facility will be limited to:
a.	25 days	
b.	50 days	
c.	75 days	
d.	Is totally unlimited	

ANS:	D
Medicare limitations are waived for patients who have undergone amputations.

DIF:	Cognitive Level: Application	REF:	p. 11	OBJ:	4
TOP:	Stay in a Skilled Care Facility	KEY:	Nursing Process Step: Planning
MSC:	"NCLEX: Safe, Effective Care Environment: Coordinated care"	

	7.	The nurse clarifies to the patient who is applying for Medicaid that the receipt of benefits requires:
a.	Following a supervised health maintenance plan	
b.	Enrolling in the Medicare-Preferred Drug Plan	
c.	Qualifying for the food stamp program	
d.	Having an annual income of less than $10,000	

ANS:	B
The Medicare-Preferred Drug Plan is a condition of Medicaid eligibility. Nonenrollment may cause the loss of all health care benefits.

DIF:	Cognitive Level: Application	REF:	p. 2	OBJ:	3
TOP:	Medicare-Preferred Drug Plan	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	8.	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:	B
These agencies are usually owned by large corporations and established for the purpose of making a profit. Although most such agencies do participate in Medicare, it is not required.

DIF:	Cognitive Level: Comprehension	REF:	p. 8	OBJ:	4
TOP:	Proprietary Agencies		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	9.	Which patient would the nurse recognize as eligible for a referral to Medicaid?
a.	Military automobile mechanic with severe asthma	
b.	Pregnant unmarried young woman employed at a discount retail store for 3 years	
c.	College student on scholarship who works part-time at the college library and who needs medication for arthritis	
d.	Unemployed young mother on welfare who needs diabetic medication for one of her children	

ANS:	D
Medicaid covers medication and health care services for welfare recipients for child health and long-term care.

DIF:	Cognitive Level: Application	REF:	p. 5	OBJ:	3
TOP:	Medicaid Services Eligibility	KEY:	Nursing Process Step: Planning
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	10.	The Balanced Budget Act of 1997 was the cause of closures of many proprietary home health care agencies because the Act:
a.	Specified that all care be given by registered nurses (RNs).	
b.	Listed specific diagnoses that could qualify a patient for home health care.	
c.	Limited the amount of money that could be spent on a patient.	
d.	Increased the criteria for patient eligibility for home care.	

ANS:	C
The Balanced Budget Act of 1997 placed a limit on the amount of money that could be spent on a patient’s home health care, regardless of diagnosis or needs.

DIF:	Cognitive Level: Comprehension	REF:	p. 8	OBJ:	5
TOP:	Balanced Budget Act of 1997	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	11.	The person who is considered the forerunner of modern public health nursing in the United States is:
a.	Vincent DePaul	
b.	William Rathbone	
c.	Florence Nightingale	
d.	Lillian Wald	

ANS:	D
Lillian Wald is recognized as the forerunner of modern public health nursing.

DIF:	Cognitive Level: Knowledge	REF:	p. 7	OBJ:	1
TOP:	Leaders and Founders of Public Health Nursing	KEY:	Nursing Process Step: N/A
MSC:	NCLEX: N/A		

	12.	A voluntary health care agency is one that:
a.	Is supported by tax dollars.	
b.	Is governed by boards made up of community members.	
c.	Receives no fee for its services.	
d.	Uses volunteers as health care providers.	

ANS:	B
Voluntary agencies are governed by boards made up of community members and are supported by a variety of sources. They are not supported by tax dollars.

DIF:	Cognitive Level: Comprehension	REF:	p. 8	OBJ:	3
TOP:	Voluntary agencies		KEY:	Nursing Process Step: N/A
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	13.	A 76-year-old man, who is hospitalized for treatment after a stroke, asks the nurse how long he can expect Medicare to cover his treatment. The nurse’s most informative response is:
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:	D
Persons hospitalized for skilled nursing care receive 100 days of Medicare coverage.

DIF:	Cognitive Level: Application	REF:	p. 4	OBJ:	4
TOP:	Skilled Care Limitation	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	14.	The nurse clarifies that health care benefits supported by both federal and state funding are exemplified in:
a.	Cost-containment prospective funding	
b.	Department of Health and Human Services (DHHS) Social Security benefits for dentures	
c.	Centers for Disease Control and Prevention (CDC) surveillance of persons at risk for acquired immunodeficiency syndrome (AIDS)	
d.	Medicaid provision for skilled care in the home	

ANS:	D
Federal and state cooperation are involved in home skilled care issues.

DIF:	Cognitive Level: Application	REF:	p. 7	OBJ:	3
TOP:	Coordinating Medicaid/Medicare Benefits		
KEY:	Nursing Process Step: Implementation		
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	15.	The nurse assessing a 65-year-old patient who is scheduled for outpatient surgery for the removal of cataracts in 10 days will stress the need to:
a.	Have adequate insurance	
b.	Provide adequate postoperative care at home	
c.	Acquire specialized glasses	
d.	Preserve and protect his vision	

ANS:	B
Outpatient surgical patients are at great risk for postoperative complications in the absence of professional monitoring. This risk emphasizes the need for preoperative teaching and the provision of postoperative support in the home.

DIF:	Cognitive Level: Analysis	REF:	p. 7	OBJ:	4
TOP:	Postoperative Care for Outpatients	KEY:	Nursing Process Step: Assessment
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	16.	The nurse explains that skilled nursing facilities are mandated to staff their facility with:
a.	Licensed health professionals around the clock	
b.	RN in charge on each shift	
c.	RNs to supervise the patient care given by aides	
d.	Only RNs to provide complex care	

ANS:	A
A skilled facility must have licensed health care professionals around the clock. Licensed practical nurses (LPNs) may supervise nursing assistants (NAs) who are the major caregivers. LPNs can provide wound care, ostomy care, and monitor intravenous (IV) therapies.

DIF:	Cognitive Level: Application	REF:	p. 12	OBJ:	4
TOP:	Skilled Nursing Facilities Staffing Requirements	
KEY:	Nursing Process Step: Implementation		
MSC:	"NCLEX: Safe, Effective Care Environment: Coordinated care"	

	17.	The purpose of a long-term care facility is to:
a.	Rehabilitate patients to their former level of functioning.	
b.	Restore patients to their optimal level of independence.	
c.	Offer care to patients who do not need hospitalization but cannot care for themselves.	
d.	Exclusively care for patients with dementia.	

ANS:	C
Long-term care facilities care for patients who do not need to be hospitalized but who cannot care for themselves. Although many patients with dementia are residents in a long-term care facility, the purpose of such facilities is not to provide their care exclusively.

DIF:	Cognitive Level: Comprehension	REF:	p. 11	OBJ:	4
TOP:	Long-Term Care Facilities	KEY:	Nursing Process Step: N/A
MSC:	"NCLEX: Safe, Effective Care Environment: Coordinated care"	

	18.	A resident in a long-term care facility has difficulty swallowing and frequently chokes on food and liquids. Because of the threat of aspiration, the nurse initiates a referral for a swallowing evaluation to a:
a.	Physician who specializes in throat disorders	
b.	Dietitian	
c.	Nutritionist	
d.	Speech therapist	

ANS:	D
Speech therapists are qualified to evaluate swallowing disorders.

DIF:	Cognitive Level: Application	REF:	p. 8	OBJ:	4
TOP:	Swallowing Difficulties	KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Physiological Integrity: Coordinated care

	19.	A 2003 report from the Institute of Medicine (IOM), “Health Professions Education: A Bridge to Quality,” outlined:
a.	Specific software technology to increase efficiency in health care	
b.	Evaluation tool to evaluate the quality of health care	
c.	Recommendations for curriculum changes in professional health care schools	
d.	Five core competencies for health care professionals	

ANS:	D
The 2003 IOM report, “Health Professions Education: A Bridge to Quality,” stressed the need for health professionals to be proficient in five areas: (1) providing patient-centered care, (2) working as a member of a team, (3) using evidence-based medicine, (4) focusing on quality improvement, and (5) using information technology.

DIF:	Cognitive Level: Analysis	REF:	p. 13	OBJ:	8
TOP:	IOM report	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A

MULTIPLE RESPONSE

	1.	The nurse clarifies the difference between a health maintenance organization (HMO) and a fee-for-service plan by pointing out that an HMO: (Select all that apply.)
a.	Requires a set fee from each client.	
b.	Allows clients to select their own health care provider.	
c.	Permits admission to any inpatient facility.	
d.	Offers limited referral options.	
e.	Provides both inpatient and outpatient care.	

ANS:	A, E
HMOs require a set fee from each client to use health care providers specified or hired by each HMO. Inpatient and outpatient care are provided in specified facilities. HMOs have a large group of specialists to whom it refers clients. Fee-for-service plans are more expensive, but they allow clients to choose the health care provider and facility.

DIF:	Cognitive Level: Analysis	REF:	p. 6	OBJ:	4
TOP:	Comparison of HMO to Fee-for-Service		
KEY:	Nursing Process Step: Implementation		
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	2.	The nurse assures the parents of a newborn with a congenital heart defect that the home care for their child is eased and supported by: (Select all that apply.)
a.	Availability of smaller and more compact equipment	
b.	Specialized DRGs for home care of children	
c.	Medicaid-funded home care services	
d.	Home care services funded by private insurance	
e.	Grants and stipends from various drug manufacturers	

ANS:	A, B, C, D
Medicaid funds home care for children. Specialized DRGs and home-sized equipment make home care for children more easily accomplished.

DIF:	Cognitive Level: Analysis	REF:	pp. 9, 10	OBJ:	4
TOP:	Home Health Care for Children	KEY:	Nursing Process Step: Planning
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	3.	The nurse outlines the benefits of using a home health aide for the ability to assist a home-bound patient with: (Select all that apply.)
a.	Bathing	
b.	Doing laundry	
c.	Shopping for groceries	
d.	Administering medications	
e.	Ambulating	

ANS:	A, E
Home 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, and grocery shopping are inappropriate for the home health aide and are more appropriately assigned to a homemaker serviceperson.

DIF:	Cognitive Level: Analysis	REF:	p. 9	OBJ:	4
TOP:	Home Health Aid Utilization	KEY:	Nursing Process Step: Planning
MSC:	NCLEX: Health Promotion and Maintenance: Coordinated care	

	4.	When the patient inquires about eligibility for home health care, the nurse states that the criteria for skilled home health care are: (Select all that apply.)
a.	Annual income less than $20,000	
b.	Need for physical or speech therapy	
c.	Nonavailability of transportation	
d.	Must be homebound	
e.	Need for wound dressing changes	

ANS:	B, D, E
Eligibility for skilled care from a home health care aide include the need for nursing care for IV therapies, respirators, wound dressing changes, and physical or speech therapy. No requirement relative to low income or the lack of transportation exists, but the patient must be homebound.

DIF:	Cognitive Level: Analysis	REF:	pp. 7-9	OBJ:	4	
TOP:	Home Health Care
KEY:	Nursing Process Step: Planning	
MSC:	NCLEX: Physiological Integrity: Basic care and comfort

	5.	The nurse explains that the mission of the Public Health Service (PHS) is to: (Select all that apply.)
a.	Ensure safety of foods and cosmetics.	
b.	Provide access to health care services for low-income individuals.	
c.	Support medical research.	
d.	Support substance abuse prevention and treatment.	
e.	Monitor and prevent disease outbreaks.	

ANS:	A, B, C, D, E
The PHS focus is on all levels of ensuring community health, both in providing treatment and supporting prevention. The PHS also supports medical research.

DIF:	Cognitive Level: Analysis	REF:	p. 2	OBJ:	2
TOP:	Public Health Service		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Health Promotion and Maintenance: Prevention and early detection of disease

	6.	The nurse explains that the Medicare Prescription Drug Plan will: (Select all that apply.)
a.	Be included in Medicare, Part A.	
b.	Charge a $250 deductible.	
c.	Pay approximately 25% of prescription drug expenses.	
d.	Cover only prescriptions written by a medical physician.	
e.	Reimburse 95% of out-of-pocket expenses over $3600.	

ANS:	B, E
Medicare Prescription Plan (Medicare Part D) requires a separate enrollment, pays 50% of drug expenses after the $250 deductible is satisfied, honors all prescriptions written by licensed medical personnel who have prescriptive power, and covers 95% of out-of-pocket expenses up to $3600.

DIF:	Cognitive Level: Application	REF:	p. 5	OBJ:	3
TOP:	Medicare Prescription Plan	KEY:	Nursing Process Step: Implementation
MSC:	"NCLEX: Safe, Effective Care Environment: Coordinated care"	

	7.	The nurse explains that physicians prefer to use e-prescription systems to: (Select all that apply.)
a.	Process drug request more efficiently.	
b.	Prevent drug duplications.	
c.	Use less expensive drugs.	
d.	Identify contraindications for a drug.	
e.	Label both the generic and trade names.	

ANS:	A, B, D
E-prescription systems that expedite the request also generate drug information related to contraindications and side effects and can identify duplication of drugs.

DIF:	Cognitive Level: Analysis	REF:	p. 12	OBJ:	7
TOP:	Topic: e-prescriptions		KEY:	Nursing Process Step: Implementation
MSC:	NCLEX: Physiological Integrity: Reduction of risk

	8.	The DHHS is administered by: (select all that apply)
a.	PHS	
b.	Administration for Children and Families	
c.	Administration on Aging	
d.	American Medical Association	
e.	Centers for Medicare and Medicaid	

ANS:	A, B, C, E
The PHS, Administration for Children and Families, Administration on Aging, and Centers for Medicare and Medicaid all share the administration of the DHHS.

DIF:	Cognitive Level: Comprehension	REF:	p. 2	OBJ:	4
TOP:	DHHS	KEY:	Nursing Process Step: N/A	MSC:	NCLEX: N/A

COMPLETION

	1.	The nurse clarifies that the insurance plan that pays the physician in advance each month for each enrolled patient, whether or not the patient is treated by the physician, is a strategy known as ____________________.
ANS:	
Capitation
Capitation is the system of payment that collects monthly “fees” from enrollees and pays the physician whether the patient has been treated or not. It is rather like a salary that assures the attention of a physician in the event of an illness

DIF:	Cognitive Level: Analysis	REF:	p. 4	OBJ:	4
TOP:	Capitation	KEY:	Nursing Process Step: Implementation	
MSC:	NCLEX: Safe, Effective Care Environment