Nokea
The nurse is a member of a team that is planning a client-centered approach to care of clients with chronic obstructive pulmonary disease (COPD) using the Chronic Care Model (CCM). The team should focus on improving quality of care and delivery in which of the following areas? Select all that apply.
- A. The community.
- B. Clinical information systems.
- C. Delivery system design.
- D. Administrative leadership.
- E. Emphasis on the acute care setting.
Correct Answer: A,B,C
Rationale: The Chronic Care Model emphasizes community resources (A), clinical information systems (B), and delivery system design (C) for chronic disease management. Administrative leadership and acute care focus are less central.
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The nurse is preparing a client for a paracentesis. The nurse should:
- A. Have the client void immediately before the procedure.
- B. Place the client in a side-lying position.
- C. Initiate an I.V. line to administer sedatives.
- D. Place the client on nothing-by-mouth (NPO) status 6 hours before the procedure.
Correct Answer: A
Rationale: Voiding before paracentesis (A) prevents bladder injury. Side-lying (B) is incorrect; upright is preferred. IV sedatives (C) are not routine, and NPO (D) is unnecessary.
The emergency department (ED) nurse cares for a client with severe intra-abdominal bleeding. The client has tachycardia, hypotension, and a thready pulse. The nurse anticipates the primary healthcare provider (PHCP) will prescribe which blood product?
- A. Packed red blood cells (PRBCs)
- B. Platelets
- C. Granulocytes
- D. Fresh frozen plasma (FFP)
Correct Answer: A
Rationale: Severe intra-abdominal bleeding with tachycardia, hypotension, and thready pulse indicates significant blood loss, requiring PRBCs to restore oxygen-carrying capacity. Platelets, granulocytes, and FFP address other issues like clotting or infection, but PRBCs are primary for acute hemorrhage.
Which nursing action is important in preventing cross-contamination?
- A. Change gloves immediately after use.
- B. Stand 2 feet from the client.
- C. Speak minimally when in the room.
- D. Wear long-sleeved shirts.
Correct Answer: A
Rationale: Changing gloves immediately after use prevents cross-contamination by removing potential pathogens from the nurse's hands before touching other surfaces or clients. The other actions are less effective in preventing contamination.
The nurse is teaching a 17-year-old client and the client's family about what to expect with high-dose chemotherapy. Which of the following side effects should be included in the teaching plan?
- A. Fever.
- B. Chills.
- C. Tachycardia.
- D. Dyspnea.
Correct Answer: A
Rationale: Fever is a common side effect of high-dose chemotherapy due to neutropenia and increased infection risk, and should be included in the teaching plan.
Following a total hip replacement, the nurse should do which of the following? Select all that apply.
- A. With the aid of a coworker, turn the client from the supine to the prone position every 2 hours.
- B. Encourage the client to use the overhead trapeze to assist with position changes.
- C. For meals, elevate the head of the bed to 90 degrees.
- D. Use a fracture bedpan when needed by the client.
- E. When the client is in bed, prevent thromboembolism by applying thigh-high antiembolism stockings.
Correct Answer: B,D,E
Rationale: Using a trapeze, fracture bedpan, and antiembolism stockings supports recovery and prevents complications. Prone positioning and 90-degree elevation risk dislocation.