A nurse manager is presenting an in-service to staff nurses about methods to reduce the costs of client care delivery. Which statement indicates an understanding of the teaching?

"I should use the minimum amount of dressings when providing wound care."

"I should delegate providing closed irrigation to an unlicensed assistive personnel."

"I should use sterile gloves when providing site care to clients who have peripheral IV sites."

"I should wait to empty my client's drainable colostomy until it is three-fourths full."

Answer and Explanation

The Correct Answer is A

Cost-effective care delivery integrates resource management with clinical efficiency to optimize healthcare expenditures. It requires stewardship of supplies and time while maintaining quality standards and preventing expensive complications like nosocomial infections or prolonged hospitalizations through evidence-based resource allocation.

Rationale:

A. Utilizing the minimum necessary supplies for wound management demonstrates effective resource stewardship. Avoiding the excessive use of expensive primary and secondary dressings reduces variable costs without compromising the physiological environment required for secondary intention healing or tissue granulation.

B. Delegating complex clinical procedures like closed irrigation to unlicensed assistive personnel is inappropriate. This task requires clinical judgment and sterile technique; improper delegation can lead to complications that ultimately increase the cost of care through extended treatment and infection.

C. Using sterile gloves for peripheral intravenous site care is unnecessary and increases supply costs. Standard clean technique and the use of nonsterile gloves are scientifically sufficient for peripheral site maintenance, as sterile gloves do not further reduce the incidence of phlebitis.

D. Delaying colostomy drainage until it is 75% full increases the risk of pouch failure. The increased weight causes the skin barrier to detach, leading to peristomal skin breakdown and the need for more frequent, costly appliance changes and specialized wound care.

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Correct Answer is ["B","D"]

Explanation

Peripheral arterial disease and vascular surgical conditions require urgent recognition of ischemic compromise, graft patency monitoring, and aneurysmal rupture risk due to impaired tissue perfusion, potential neurovascular deficit, and high risk of rapid clinical deterioration in vascular surgery patients.

Rationale:

A. Newly diagnosed chronic venous insufficiency requiring teaching is a stable, non-urgent condition. This involves venous valve incompetence leading to edema and skin changes. It is appropriate for teaching but not priority assignment. It does not require specialized vascular nursing judgment or acute monitoring.

B. Femoral-popliteal bypass with paraesthesia indicates possible acute graft occlusion or neurovascular ischemia. This is a postoperative vascular emergency requiring immediate assessment of limb perfusion. The medical unit nurse must recognize deterioration requiring urgent intervention and possible surgical notification.

C. Varicose veins with deep aching pain represents chronic venous disorder. This condition involves venous hypertension and is typically managed conservatively. Although symptomatic, it is not immediately life-threatening. It does not require specialized vascular postoperative surveillance or acute monitoring interventions.

D. Abdominal aortic aneurysm with low back pain suggests possible impending rupture. This is a surgical emergency due to risk of hemorrhage and hemodynamic collapse. Immediate monitoring and rapid escalation are required, making it appropriate for assignment to a nurse capable of recognizing instability.

A. The client has a hard, tender abdomen. B. The client who cannot stop crying and can't answer questions. C. The client has full-thickness burns over 80% of the body. D. The client who is alert and has a sucking chest wound.

Correct Answer is C

Explanation

Disaster triage utilize the START (Simple Triage and Rapid Treatment) method to prioritize victims based on survivability and resource allocation during mass casualty incidents. The black tag signifies individuals who are deceased or have unsurvivable injuries given the current resource constraints. Categorization focuses on maximizing the greatest good for the greatest number of people by diverting resources toward those with the highest probability of survival.

Rationale:

A. A hard, tender abdomen suggests internal hemorrhage or organ perforation, which is a life-threatening condition requiring immediate surgical intervention. This client is categorized as a red tag (immediate) because they have a high survival probability if treated rapidly. They require urgent transport to a definitive care facility for emergency laparotomy.

B. Crying and the inability to answer questions indicate psychological distress or a minor behavioral reaction without life-threatening physical trauma. This client is categorized as a green tag (minor) or "walking wounded" as their physiological status is stable. They do not require immediate medical resources and can wait for psychological first aid or supportive counseling.

C. Full-thickness burns over 80% of the body represent an expectant category due to the extremely high mortality rate and the intensive resources required for treatment. In a disaster, these individuals are black-tagged to ensure critical resources are not exhausted on unsurvivable cases. Comfort care is provided only after all salvageable victims have been stabilized.

D. A sucking chest wound indicates an open pneumothorax that requires immediate occlusive dressing to prevent respiratory collapse. Although the client is currently alert, this is a red-tag (immediate) injury because it will rapidly progress to tension pneumothorax. Immediate intervention is necessary to maintain pleural integrity and adequate ventilation.

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A nurse manager is presenting an in-service to staff nurses about methods to reduce the costs of client care delivery. Which statement indicates an understanding of the teaching?

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