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A client is having difficulty breathing while receiving supplemental oxygen via a nasal cannula in a supine position. Which of the following interventions should the nurse take first?
- A. Suction the client's airway.
- B. Instruct the client to perform incentive spirometry every hour.
- C. Assist the client to an upright position.
- D. Humidify the client's supplemental oxygen.
Correct Answer: C
Rationale: The correct answer is C: Assist the client to an upright position. This is the priority intervention because placing the client in an upright position helps improve lung expansion and oxygenation by optimizing ventilation-perfusion matching. This position also reduces the risk of aspiration and improves overall respiratory function.
Choice A (Suction the client's airway) is not the first intervention because difficulty breathing in this scenario is more likely due to positioning rather than airway obstruction.
Choice B (Instruct the client to perform incentive spirometry every hour) is not the first intervention as it may not address the immediate issue of breathing difficulty related to supine positioning.
Choice D (Humidify the client's supplemental oxygen) is not the first intervention as lack of humidification is not likely the cause of the client's difficulty breathing in this situation.
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The healthcare provider is developing a critical pathway for congestive heart failure (CHF). Which components are essential to include? (Select ONE that does not apply.)
- A. Expected length of stay
- B. Assigned staff healthcare provider
- C. Patient outcomes
- D. Medical diagnosis
Correct Answer: B
Rationale: The correct answer is B because the assigned staff healthcare provider is not an essential component in developing a critical pathway for congestive heart failure (CHF). The rationale is that the focus of a critical pathway is on standardizing the care process to improve outcomes and efficiency. Including specific assigned staff members may not be feasible due to staffing variations and may limit flexibility in care delivery. Expected length of stay (A) helps in planning resources, patient outcomes (C) are crucial for evaluating effectiveness, and medical diagnosis (D) guides treatment protocols. Therefore, choice B is not essential compared to the other components.
A nurse is caring for a client with a diagnosis of terminal cancer. Which of the following statements by the client should indicate to the nurse that the client is ready to hear information regarding palliative care?
- A. "I am ready to learn about chemotherapy to help cure my cancer."
- B. "I just want you to give me something to get this over with soon."
- C. "I want you to tell me about measures available to keep me comfortable."
- D. "I know that many people have recovered fully from cancer, and so will I."
Correct Answer: C
Rationale: The correct answer is C because the client's statement demonstrates a desire for comfort-focused care, which is the essence of palliative care for terminal cancer patients. The client is expressing a clear preference for measures that prioritize comfort and quality of life over aggressive treatment. This indicates readiness to receive information about palliative care.
Choice A is incorrect because the client mentions chemotherapy for a cure, indicating a focus on curative treatment rather than comfort care. Choice B is incorrect as the client seems to be expressing a desire for a quick end to their suffering, which may not align with palliative care goals. Choice D is incorrect because the client is expressing unrealistic optimism about recovery, which may hinder acceptance of palliative care.
Monitoring the number of times a medication is given utilizing the 'five rights' is an example of which phase of the Six Sigma program?
- A. Measure
- B. Management
- C. Quantitative
- D. Goal
Correct Answer: A
Rationale: The correct answer is A: Measure. In the Six Sigma program, the Measure phase involves collecting data to understand the current process performance. Monitoring the number of times a medication is given using the 'five rights' aligns with this phase as it focuses on measuring the accuracy and effectiveness of medication administration. This data helps identify any deviations from the desired standards and provides insights for improvement.
Summary of why other choices are incorrect:
B: Management - This choice does not specifically address the phase related to data collection and measurement.
C: Quantitative - While data collection is quantitative in nature, this choice does not capture the specific phase of Six Sigma that focuses on measurement.
D: Goal - This choice does not directly relate to the phase involving data collection and measurement; it is more focused on setting objectives and targets.
What is the role of a nurse in a multidisciplinary team (MDT)?
- A. To lead the MDT
- B. To provide emotional support
- C. To advocate for patient needs
- D. To conduct clinical research
Correct Answer: C
Rationale: The correct answer is C - To advocate for patient needs. Nurses in an MDT play a crucial role in ensuring that the patient's best interests are prioritized and their needs are met. Nurses advocate for patients by communicating their preferences, coordinating care, and ensuring that all team members work together effectively. Leading the MDT (choice A) is typically done by the team leader, not specifically the nurse. Providing emotional support (choice B) is part of the nurse's role, but not the primary role in an MDT. Conducting clinical research (choice D) is important, but not the primary focus of a nurse in an MDT.
When in opposition to an immediate superior, a nurse manager should use which important strategy in a confrontation?
- A. Using 'I' language
- B. Using absolutes
- C. Using 'why' questions
- D. Using negative assertions
Correct Answer: A
Rationale: The correct answer is A: Using 'I' language. This strategy is effective in confrontation as it focuses on expressing one's own thoughts and feelings without blaming the other person. By using "I" language, the nurse manager can communicate assertively and take ownership of their perspective, which can lead to a more constructive dialogue.
Summary:
B: Using absolutes can come across as rigid and may escalate the confrontation.
C: Using 'why' questions can be perceived as accusatory and defensive, potentially leading to further conflict.
D: Using negative assertions can create a hostile environment and hinder effective communication.