1. Which statement accurately describes the primary purpose of the state nurse practice
act (NPA)?
a. To test and license LPN/LVNs.
b
.
To define the
... [Show More] scope of LPN/LVN
practice.
c. To improve the quality of care provided
by the LPN/LVN.
d
.
To limit the LPN/LVN employment
placement.
ANS: B
While improving quality of care provided by the LPN/LVN may be a result of the NPA, the
primary purpose of the NPA of each state defines the scope of nursing practice in that state.
PTS: 1 DIF: Cognitive Level: ComprehensionREF:
2
OBJ: 3 TOP: NPA KEY: Nursing Process Step:
Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
2. The charge nurse asks the new vocational nurse to start an intravenous infusion, a
skill that the vocational nurse has notbeen taught during her educational program. How
should the vocational nurse respond?
a. Ask a more experienced nurse to demonstrate
the procedure.
b
.
Look up the procedure in the procedure
manual.
c. Attempt to perform the procedure with
supervision.
d
.
Inform the charge nurse of her lack of training
in this procedure.
ANS: D
The charge nurse should be informed of the lack of training to perform the procedure, and
the vocational nurse should seek further training to gain proficiency. Although the other
options might be helpful, they are not safe.
PTS: 1 DIF: Cognitive Level: Application
REF:
3
OBJ: 1 TOP: Providing Safe Care KEY: Nursing Process
Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
3. Which patient statement indicates a need for further discharge teaching that the
vocational nurse should address?
a. “I have no idea of how this drug will
affect me.”
b
.
“Do you know if my physician is
coming back today?”
c. “Will my insurance pay for my stay?”
d
.
“Am I going to have to go to a nursing
home?”
ANS: A
Lack of knowledge at discharge about medication effects and side effects is a concern that
should be addressed by the vocationalnurse. The other concerns in the options are the
responsibility of other departments to which the nurse might refer the patient.
PTS: 1 DIF: Cognitive Level: Application REF:
2
OBJ: 1 TOP: Teaching KEY: Nursing Process Step:
Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
4. According to most state NPAs, the vocational nurse acting as charge nurse in a
long-term care facility acts in which capacity?
a. Working under direct supervision of an RN on the
unit
b
.
Working with the RN in the building
c. Working under general supervision by the RN
available on site or by phone
d
.
Working as an independent vocational nurse
ANS: C
The vocational nurse in the capacity of the charge nurse in a long-term care facility acts with
the general supervision of an RN available on site or by phone.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 2
OBJ: 1 TOP: Charge Nurse/Manager
KEY
:
Nursi
ng
Process Step:
N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
5. The nurse is educating a patient that is a member of a health maintenance
organization (HMO). Which informationshould the nurse include?
a. Seek the opinion of an alternate health care
provider.
b
.
Obtain insurance approval for medical services
prior to treatment.
c. Provide detailed documentation of all care
received for his condition.
d
.
Wait at least 6 months to see a specialist.
ANS: B
Most HMOs require preprocedure authorization for treatment. Patients are not required to
seek a second opinion, provide documentation of care, or wait a specific time period before
visiting a specialist.
PTS: 1 DIF: Cognitive Level:
Application REF:
9
OBJ: 9 TOP: Charge Nurse/Manager
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
6. The patient complains to the nurse that he is confused about his “deductible”
that he owes the hospital. Whichstatement accurately explains a deductible?
a. An amount of money put aside for the payment of future
medical bills
b
.
A one-time fee for service
c. An amount of money deducted from the bill by the
insurance company
d
.
An annual amount of money the patient must pay out-ofpocket for medical care
ANS: D
The deductible is the annual amount the insured must pay out-of-pocket prior to the
insurance company assuming the cost. This practice improves the profit of the insurance
company.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 7
OBJ: 9 TOP: Health Care Financing
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
7. The nurse compares the characteristics of a health maintenance organization
(HMO) and a preferred providerorganization (PPO). Which information should the
nurse include about HMOs?
a. HMOs require a set fee of each member
monthly.
b
.
HMOs allow the member to select his
health care provider.
c. HMOs permit admission to any facility the
member prefers.
d
.
HMOs offer unlimited diagnostic tests and
treatments.
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be treated
by the HMO staff in HMO-approved facilities. Excessive use of diagnostic tests and
treatments is discouraged by the HMO.
PTS: 1 DIF: Cognitive Level:
Application REF:
9
OBJ: 9 TOP: Managed Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
8. A patient asks the nurse what Medicare Part A covers. Which response is correct?
a. Medicare Part A covers inpatient
hospital costs.
b
.
Medicare Part A covers reimbursement
to the physician.
c. Medicare Part A covers outpatient
hospital services.
d
.
Medicare Part A covers ambulance
transportation.
ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
intensive care. Medicare Part B pays the physician, ambulance transport, and outpatient
services.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 7, Box
1-4
OBJ: 9 TOP: Government-Sponsored
Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
9. Which is the main cost-containment component of diagnosis-related groups (DRGs)?
a. Hospitals focus only on the specific
diagnosis.
b
.
Hospitals treat and discharge patients
quickly.
c. Reduced cost drugs are ordered for
specific diagnoses.
d
.
Diagnostic group classification
streamlines care.
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each patient’s
diagnostic category regardless of the length of time in the hospital. If hospitals can treat and
discharge patients before the allotted time, hospitals get to keep the excess payment; cost is
contained, and the patient is discharged sooner.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 8
OBJ: 9 TOP: Government-Sponsored
Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
10. The nurse is assessing a group of patients. Which patient would most likely qualify for
Medicaid?
a. A 35-year-old unemployed single mother with diabetes
b
.
A 70-year-old Medicare recipient with retirement income who needs to
be in a long-term care facility
c. An 80-year-old blind woman living in her own home who has
inadequate private insurance
d
.
A 67-year-old stroke victim with Medicare Part A and an income from
investments
ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-income
people with no insurance.
PTS: 1 DIF: Cognitive Level: Application REF:
8, Box 1-5OBJ: 9TOP:
Government-Sponsored Health Insurance–Medicaid
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
11. Which area is the major focus of Healthy People 2020 and the primary mechanism
through which to improve the healthof Americans in the second decade of the century?
a. Research funding
b
.
Health information
distribution
c. Healthy lifestyle
encouragement
d
.
Health improvement
program designs
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and
information to reduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and
to increase effective immunizations, healthy eating habits, and healthy weight.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 6
OBJ: 7 TOP: Healthy People 2020
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
12. Which term explains the type of care that addresses interventions for all dimensions of
a patient’s life?
a. Focused
care
b
.
General
care
c. Directed
care
d
.
Holistic
care
ANS: D
Holistic care addresses the physiologic, psychological, social, cultural, and spiritual needs of
the patient.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 6
OBJ: 8 TOP: Holistic Care
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
13. A patient furiously says, “My doctor was so busy giving me instructions that he
didn’t hear what I was trying to askhim!” Which response is most empathetic?
a. “When people ignore me, I really get mad.”
b
.
“I’m sure that the doctor was rushed and
unaware of your needs.”
c. “I’ll bet that made you feel very frustrated.”
d
.
“Take a deep breath and plan what you will say
to him tomorrow.”
ANS: C
Empathy demonstrates that the nurse perceives the patient’s feelings but does not share the
emotion. Belittling the patient’s feelings, showing sympathy, or defending the doctor
makes the patient feel devalued.
PTS: 1 DIF: Cognitive Level:
Analysis
REF: 1
0
OBJ: 10 TO
P:
Nurse–Patient
Relationship
KEY: Nursing Process Step:
ImplementationMSC: NCLEX:
Psychosocial Integrity
14. The nurse is explaining differences in a therapeutic relationship and a social
relationship to a patient. Whichinformation about therapeutic relationships is most
important for the nurse to include in the explanation?
a. Therapeutic relationships lack formal boundaries.
b
.
Therapeutic relationships are goal directed.
c. Therapeutic relationships meet the needs of each
person in the relationship.
d
.
Therapeutic relationships extend past the
hospitalization period.
ANS: B
The therapeutic relationship is focused on the patient and is goal directed and designed to
meet only the needs of the patient and does not extend past the period of hospitalization.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 9
OBJ: 10 TO
P:
Therapeutic Relationship
KEY: Nursing Process Step:
ImplementationMSC: NCLEX:
Psychosocial Integrity
15. The long-term care facility nurse is caring for a newly admitted 80-year-old patient
who is depressed. Which approach is best for the nurse to employ?
a. Encourage the resident to engage
in an activity.
b
.
Remind the resident of reasons to
be positive.
c. Point out episodes of negative
behavior.
d
.
Present a bright and cheerful
behavior.
ANS: A
Activity and social interaction are helpful to depressed patients. Presenting a cheery approach
and pointing out negative behavior and reasons to be positive are not therapeutic at this stage
of the relationship.
PTS: 1 DIF: Cognitive Level:
Analysis
REF: 1
0
OBJ: 10 TO
P:
Depressed Behavior
KEY: Nursing Process Step:
ImplementationMSC: NCLEX:
Psychosocial Integrity
16. The nurse is caring for a patient who has been on antidepressants for 3 days. The
patient tearfully says, “I still feelterrible. I don’t think anything can help how I feel.”
Which response is best?
a. “I will tell the charge nurse how you are feeling.”
b
.
“You just need to be patient and give your medicine
some time to work.”
c. “Look how much you have improved since you were
admitted to the facility.”
d
.
“It must be frustrating to be going through this difficult
time.”
ANS: D
This response is an empathetic response that allows for further exploration of the patient’s
feelings. The other responses will block communication with this patient.
PTS: 1 DIF: Cognitive Level:
Application REF:
9
OBJ: 10 TO
P:
Therapeutic
Communication
KEY: Nursing Process Step:
ImplementationMSC: NCLEX:
Psychosocial Integrity
17. An overweight male patient rips off his hospital gown, throws it out the door, and
shouts, “I’m not wearing this stupid gown! It is too small, too short, and exposes my
backside to the world!” Which response is most appropriate?
a. Remind patient of the need to wear the gown for
convenience in care.
b
.
Confer with the patient for methods to acquire a
larger gown.
c. Replace the torn gown with another.
d
.
Inform the charge nurse of the hostile behavior.
ANS: B
Allowing hostile patients to make reasonable requests defuses the anger and allows patients
to vent their feelings.
PTS: 1 DIF: Cognitive Level:
Application REF:
9
OBJ: 10 TO
P:
Hostile Behavior
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
18. The nurse is caring for a patient who states, “You are the only nurse who
understands about my pain. Can’t you giveme an extra dose of pain medication?” How
should the nurse respond to the patient’s request?
a. Explain that dosage schedules are by
physician’s orders.
b
.
Ignore the request.
c. Tell the patient that his behavior is
manipulative.
d
.
Agree to give an extra dose of pain
medication.
ANS: A
A matter-of-fact response to a manipulative request limits the effect of the manipulation,
thereby helping the nurse to avoid becoming defensive or being swayed by flattery.
PTS: 1 DIF: Cognitive Level:
Application REF:
9
OBJ: 10 TO
P:
Manipulative Behavior
KEY: Nursing Process Step:
ImplementationMSC: NCLEX:
Psychosocial Integrity
19. A female patient who has recently been diagnosed with an inoperable brain tumor
asks the nurse, “Do you think Godpunishes us?” Which response demonstrates
therapeutic communication?
a. “What do you think?”
b
.
“God loves you.”
c. “Would like to speak with the
chaplain?”
d
.
“God will not give you more than
you can bear.”
ANS: A
Sitting with the patient and offering oneself to listen to the patient’s concerns and
encouraging reflection is the best approach rather than responding with a cliché or
suggesting speaking with the chaplain.
PTS: 1 DIF: Cognitive Level:
Application REF:
1
0
OBJ: 10 TO
P:
Spiritual Care
KEY: Nursing Process Step:
ImplementationMSC: NCLEX:
Psychosocial Integrity
20. The nurse is communicating with a patient who voices concern about an
upcoming high-risk procedure. Whichstatement best demonstrates empathy?
a. “Would you like to talk about your feelings
regarding the procedure?”
b
.
“My mother had the same procedure and did very
well.”
c. “I can’t imagine how you feel.”
d
.
“It must be difficult preparing for the procedure;
how are you feeling?”
ANS: D
This statement by the nurse displays empathy by trying to place oneself in the patient’s
circumstance and validating the patient’s feelings. Simply asking patients if they would like
to talk about their feelings does not show empathy and may elicit a “yes” or “no” response.
Telling the patient one’s mother had the procedure or stating “I can’t imagine how you
feel” does not show empathy toward the patient.
PTS: 1 DIF: Cognitive Level:
Application REF:
1
0
OBJ: 10 TO
P:
Nurse–Patient Relationship
KEY: Nursing Process Step:
ImplementationMSC: NCLEX:
Psychosocial Integrity
MULTIPLE
RESPONSE
21. Which of the following are sources of clear guidelines for upholding clinical
standards for safe and competent care?(Select all that apply.)
a. The state’s nurse practice act (NPA)
b
.
The State Board of Nurse Examiners (BNE)
c. The National Association for Practical Nurse Education
and Service (NAPNES)
d
.
Institutional policies
e. The National Federation of Licensed Practical Nurses,
Inc. (NFLPN)
ANS: C, E
NAPNES and the NFLPN give clear guidelines for clinical standards that can be used as a
basis for court decisions. The NPA hasbroad guidelines, and institutional policies may not be
complete. The BNE enforces the NPA.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 5
OBJ: 3 TOP: Upholding Clinical
Standards KEY:
Nursi
ng
Process Step:
N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
22. Which statement(s) accurately describes the role of the LPN/LVN regardless of
employment placement? (Select all thatapply.)
a. Uphold clinical standards
b
.
Educate patients
c. Communicate effectively
d
.
Collaborate with the health care
team
e. Initiate a care plan immediately
after admission
ANS: A, B, C, D
The LPN/LVN has the accountability to uphold clinical standards, educate patients,
communicate effectively, and collaborate with the health care team. Depending on the type
of facility, initiation of a care plan is often the role of the registered nurse.
PTS: 1 DIF: Cognitive Level:
Comprehension
REF: 2
OBJ: 3 TOP: Roles of LPN/LVNs
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
23. The newly licensed LPN/LVN demonstrates an understanding of employment
opportunities when applying to aposition in which area(s)? (Select all that apply.)
a. An outpatient clinic
b
.
A home health care
agency
c. An intravenous (IV)
therapy team
d
.
A long-term care
facility
e. An ambulatory care unit
ANS: A, B, D, E
With the exception of an IV therapy team, which requires postgraduate education and/or
certification, the other options are open to newly graduated vocational nurses.
PTS: 1 DIF: Cognitive Level: Application REF: 2
OBJ: 2 TOP: Employment Opportunities
for LPN/LVNsKEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
24. What factor(s) should the LPN/LVN consider when delegating a task to unlicensed
assistive personnel (UAP)? (Select all that apply.)
a. A need for the UAP to voluntarily accept the task
delegated
b
.
Continued accountability for the task by the
LPN/LVN
c. Assurance that the task requires no further need for
supervision of the UAP
d
.
An understanding that the task is in the job
description of the UAP
e. A transfer of authority to the UAP
ANS: A, B, D, E
Delegation is a considered act involving the condition of the patient and the competency of
the UAP. Delegation requires that the UAP voluntarily accept the task, which is in the job
description of the UAP. The vocational nurse has transferred authority for the completion of
the task but is still accountable and should supe [Show Less]