Nokea
The client with a diagnosis of bladder cancer is to undergo weekly intravesical chemotherapy for the next 8 weeks. Which statement by the client should indicate to the nurse that the client understands how to manage urine as a biohazard?
- A. Void into a bedpan and then empty the urine into the toilet.
- B. Purchase extra bottles of scented disinfectant for daily bathroom cleansing.
- C. Have one bathroom strictly set aside for the client's use for the next 8 weeks.
- D. Disinfect the toilet with household bleach after voiding for 6 hours after a treatment.
Correct Answer: D
Rationale: Intravesical instillation involves instilling a chemotherapeutic agent into the bladder via a urethral catheter. This method of treatment provides a concentrated topical treatment with minimal systemic absorption. The client retains the medication for approximately 2 hours. After intravesical chemotherapy, the client treats the urine as a biohazard. This involves disinfecting the toilet after voiding with household bleach for 6 hours after a treatment. There is no value in using a bedpan for voiding. Scented disinfectants are of no particular use. The client does not need to have a separate bathroom for personal use.
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The nurse working on an adult nursing unit is told to review the client census to determine which clients could be discharged if there are a large number of admissions from a newly declared disaster. The nurse determines that the clients with which medical situations would need to remain hospitalized? Select all that apply.
- A. Laparoscopic cholecystectomy
- B. Fractured hip, pinned 5 days ago
- C. Diabetes mellitus with blood glucose at 180 \mathrm{mg} / \mathrm{dL}(10.2 \mathrm{mmol} / \mathrm{L})
- D. Ongoing ventricular dysrhythmias while receiving procainamide
- E. Newly delivered postpartal client with a blood pressure of 146 / 94mmHg and 2+ proteinuria.
Correct Answer: D,E
Rationale: The client with ongoing ventricular dysrhythmias requires ongoing medical evaluation and treatment because of potentially lethal complications of the problem. The newly delivered postpartal client is showing classic signs for mild preeclampsia. This condition would need to be reversed before discharge. Each of the other problems listed may be managed at home with appropriate agency referrals for home care services and support from the family at home.
The nurse is planning care for a client with the diagnosis of deep vein thrombosis (DVT) of the left leg. The client is experiencing severe edema and pain in the affected extremity. Which interventions should the nurse plan to implement in the care of this client? Select all that apply.
- A. Elevate the left leg.
- B. Apply moist heat to the left leg.
- C. Administer acetaminophen as prescribed.
- D. Ambulate in the hall three times per shift.
- E. Administer anticoagulation as prescribed.
Correct Answer: A,B,C,E
Rationale: Management of the client with DVT who is experiencing severe edema and pain includes bed rest; limb elevation; relief of discomfort with warm, moist heat and analgesics as needed; anticoagulant therapy; and monitoring for signs of pulmonary embolism. In current practice, activity restriction may not be prescribed if the client is receiving low-molecular-weight anticoagulation; however, some primary health care providers may still prefer bed rest for the client.
The clinic nurse wants to develop a teaching program for clients with a diagnosis of diabetes mellitus. Which strategy should the nurse initiate first in order to best meet the clients' needs?
- A. Assess the clients' functional abilities.
- B. Ensure that insurance will pay for participation in the program.
- C. Discuss the focus of the program with the multidisciplinary team.
- D. Include everyone who comes into the clinic in the teaching sessions.
Correct Answer: A
Rationale: Nurse-managed clinics focus on individualized disease prevention and health promotion and maintenance. Therefore, the nurse must first assess the clients and their needs to effectively plan the program. Options 2, 3, and 4 do not address the clients' needs related to the diagnosis.
A registered nurse (RN) in charge of the client care unit is preparing the assignments for the day. The RN assigns unlicensed assistive personnel (UAP) to make beds and bathe one of the clients on the unit and assigns additional UAP to fill the water pitchers and serve juice to all of the clients. Another RN is assigned to administer all medications. Based on the assignments designed by the RN in charge, which nursing care delivery model is being implemented?
- A. Team
- B. Primary
- C. Functional
- D. Exemplary
Correct Answer: C
Rationale: The functional model of care involves an assembly line approach to client care, with major tasks being delegated by the charge nurse to individual staff members. Team nursing is characterized by a high degree of communication and collaboration among members. The team is generally led by an RN, who is responsible for assessing, developing nursing diagnoses, planning, and evaluating each client's plan of care. In primary nursing, concern is with keeping the nurse at the bedside actively involved in care, providing goal-directed and individualized client care. In an exemplary model of team nursing, each staff member works fully within the realm of educational and clinical experience in an effort to provide comprehensive individualized client care. Each staff member is accountable for client care and outcomes of care.
A clinical nurse manager conducts an educational session for the staff nurses about case management. Which premise, if stated by one of the staff nurses, regarding case management, should necessitate a need for further teaching?
- A. Manages client care by managing the client care environment
- B. Maximizes hospital revenues while providing for optimal client care
- C. Represents a primary health prevention focus managed by a single case manager
- D. Is designed to promote appropriate use of hospital personnel and material resources
Correct Answer: C
Rationale: Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal client care. It manages client care by managing the client care environment and includes assessment and development of a plan of care, coordination of all services, referral, and follow-up.