NUR2032C
Care Management
EXAM Q & A
2024
1. A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who has been
admitted to the hospital for an acute exacerbation. The nurse notices that the patient's oxygen
saturation is 88% on room air. What is the most appropriate action for the nurse to take?
a) Administer oxygen via nasal cannula at 2 L/min
b) Administer oxygen via non-rebreather mask at 10 L/min
c) Administer oxygen via venturi mask at 24% FiO2
d) *Administer oxygen via nasal cannula at 1 L/min*
Rationale: The goal of oxygen therapy for patients with COPD is to maintain an oxygen saturation of
88-92%, as higher levels may suppress their respiratory drive and cause carbon dioxide
retention. Therefore, the nurse should start with the lowest possible flow rate of oxygen and
titrate up as needed. A nasal cannula at 1 L/min delivers about 24% FiO2, which is appropriate
for this patient. A non-rebreather mask delivers 100% FiO2, which is too high and may cause
oxygen toxicity. A venturi mask delivers a precise concentration of oxygen, but it is not necessary
for this patient.
2. A nurse is conducting a home visit for a patient with heart failure who has been recently
discharged from the hospital. The nurse assesses the patient's weight, blood pressure, pulse, and
edema. The nurse also asks the patient about their medication adherence, dietary intake, fluid
restriction, and activity level. What is the primary purpose of these assessments?
a) To evaluate the patient's functional status and quality of life
b) To monitor the patient's response to treatment and identify potential complications
c) *To educate the patient on self-care strategies and reinforce discharge instructions*
d) To provide emotional support and counseling to the patient and family
Rationale: The primary purpose of home visits for patients with heart failure is to educate them on
self-care strategies and reinforce discharge instructions, as these are essential for preventing
readmissions and improving outcomes. The assessments that the nurse performs are also
important for evaluating the patient's condition and providing feedback, but they are not the
main goal of the visit.
3. A nurse is planning care for a patient with diabetes mellitus who has a foot ulcer. The nurse
collaborates with a wound care specialist, a dietitian, a podiatrist, and a diabetes educator. What
type of care delivery model is the nurse using?
a) Primary nursing
b) Team nursing
c) *Case management*
d) Functional nursing
Rationale: Case management is a care delivery model that involves coordinating care across
multiple disciplines and settings to achieve optimal outcomes for patients with complex needs.
The case manager acts as a liaison between the patient, family, health care providers, and
, payers. Primary nursing assigns one nurse to be responsible for all aspects of care for a group of
patients during their stay. Team nursing assigns a team of nurses and ancillary staff to provide
care for a group of patients under the supervision of a team leader. Functional nursing assigns
tasks to staff based on their skills and abilities.
B:
Safety
• Guidelines for restraint use:
o Patient's family must be involved in the patient's plan of care
Alternatives to restraints have been tried
Benefit must outweigh the risks
Restraints must be ordered by a physician or licensed practitioner;
prescription only allows 4 hr. of restraints for an adult, 2 hrs. for ages 9-17,
and 1 hr. for 9 and younger
Patient's personal needs must be met
Document use of restraints and patient monitoring
Remove restraints every 2 hours, or according to agency
Keep call bell within pt.’s reach
• Explain the need
• Review manufacturer’s instructions
• Assess patient’s skin integrity, and provide skin care accordingly
• Offer food or liquid
• Provide means for hygiene and elimination
• Monitor vital signs
• Offer range of motion exercises
• Pad bony provinces to prevent break down
• Use quick-release tie knot to tie restraints to bed frame
• Make sure restraints are loose enough for range of motion and is enough
room to fit 2 fingers between restraint and client
• Remove or replace restraints frequently to ensure good circulation
• Never leave alone without restraints
• Patient must be monitored and reassessed
• Injury prevention for diabetics:
• Safety Precautions for toddlers:
o Childproof home environment.
o Prevent poisoning.
o Be alert to manifestations of child maltreatment or abuse.
o Use car seats properly.
• Safety plan for Domestic Abuse:
o A place to stay
o An escape routes
o A person you can call in a crisis
o A signal to a neighbor to call for help
Care Management
EXAM Q & A
2024
1. A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who has been
admitted to the hospital for an acute exacerbation. The nurse notices that the patient's oxygen
saturation is 88% on room air. What is the most appropriate action for the nurse to take?
a) Administer oxygen via nasal cannula at 2 L/min
b) Administer oxygen via non-rebreather mask at 10 L/min
c) Administer oxygen via venturi mask at 24% FiO2
d) *Administer oxygen via nasal cannula at 1 L/min*
Rationale: The goal of oxygen therapy for patients with COPD is to maintain an oxygen saturation of
88-92%, as higher levels may suppress their respiratory drive and cause carbon dioxide
retention. Therefore, the nurse should start with the lowest possible flow rate of oxygen and
titrate up as needed. A nasal cannula at 1 L/min delivers about 24% FiO2, which is appropriate
for this patient. A non-rebreather mask delivers 100% FiO2, which is too high and may cause
oxygen toxicity. A venturi mask delivers a precise concentration of oxygen, but it is not necessary
for this patient.
2. A nurse is conducting a home visit for a patient with heart failure who has been recently
discharged from the hospital. The nurse assesses the patient's weight, blood pressure, pulse, and
edema. The nurse also asks the patient about their medication adherence, dietary intake, fluid
restriction, and activity level. What is the primary purpose of these assessments?
a) To evaluate the patient's functional status and quality of life
b) To monitor the patient's response to treatment and identify potential complications
c) *To educate the patient on self-care strategies and reinforce discharge instructions*
d) To provide emotional support and counseling to the patient and family
Rationale: The primary purpose of home visits for patients with heart failure is to educate them on
self-care strategies and reinforce discharge instructions, as these are essential for preventing
readmissions and improving outcomes. The assessments that the nurse performs are also
important for evaluating the patient's condition and providing feedback, but they are not the
main goal of the visit.
3. A nurse is planning care for a patient with diabetes mellitus who has a foot ulcer. The nurse
collaborates with a wound care specialist, a dietitian, a podiatrist, and a diabetes educator. What
type of care delivery model is the nurse using?
a) Primary nursing
b) Team nursing
c) *Case management*
d) Functional nursing
Rationale: Case management is a care delivery model that involves coordinating care across
multiple disciplines and settings to achieve optimal outcomes for patients with complex needs.
The case manager acts as a liaison between the patient, family, health care providers, and
, payers. Primary nursing assigns one nurse to be responsible for all aspects of care for a group of
patients during their stay. Team nursing assigns a team of nurses and ancillary staff to provide
care for a group of patients under the supervision of a team leader. Functional nursing assigns
tasks to staff based on their skills and abilities.
B:
Safety
• Guidelines for restraint use:
o Patient's family must be involved in the patient's plan of care
Alternatives to restraints have been tried
Benefit must outweigh the risks
Restraints must be ordered by a physician or licensed practitioner;
prescription only allows 4 hr. of restraints for an adult, 2 hrs. for ages 9-17,
and 1 hr. for 9 and younger
Patient's personal needs must be met
Document use of restraints and patient monitoring
Remove restraints every 2 hours, or according to agency
Keep call bell within pt.’s reach
• Explain the need
• Review manufacturer’s instructions
• Assess patient’s skin integrity, and provide skin care accordingly
• Offer food or liquid
• Provide means for hygiene and elimination
• Monitor vital signs
• Offer range of motion exercises
• Pad bony provinces to prevent break down
• Use quick-release tie knot to tie restraints to bed frame
• Make sure restraints are loose enough for range of motion and is enough
room to fit 2 fingers between restraint and client
• Remove or replace restraints frequently to ensure good circulation
• Never leave alone without restraints
• Patient must be monitored and reassessed
• Injury prevention for diabetics:
• Safety Precautions for toddlers:
o Childproof home environment.
o Prevent poisoning.
o Be alert to manifestations of child maltreatment or abuse.
o Use car seats properly.
• Safety plan for Domestic Abuse:
o A place to stay
o An escape routes
o A person you can call in a crisis
o A signal to a neighbor to call for help
