PNC Chronic Disease Management 2 — Questions and Answers
Question 1: The chronic care model emphasizes which approach as central to effective chronic disease management?
- Physician-directed care with minimal patient input
- Informed, activated patient and prepared, proactive care team (Correct answer)
- Hospital-based specialty care coordination
- Pharmacist-led medication management programs
Correct answer: Informed, activated patient and prepared, proactive care team
The chronic care model centers on productive interactions between an informed, activated patient and a prepared, proactive practice team to achieve improved health outcomes.
Question 2: A parish nurse notices a congregant with chronic heart failure has developed sudden onset of worsening shortness of breath and orthopnea. This finding most likely indicates:
- Stable chronic disease course
- Acute decompensation requiring immediate medical attention (Correct answer)
- Normal exacerbation requiring monitoring only
- Side effect of dietary sodium restriction
Correct answer: Acute decompensation requiring immediate medical attention
Sudden worsening dyspnea and orthopnea in a heart failure patient are classic signs of acute decompensation, requiring immediate medical evaluation to prevent hospitalization or death.
Question 3: When counseling a patient on anticoagulation therapy with warfarin, which dietary component must be kept consistent because it affects INR levels?
- Vitamin C intake
- Vitamin K intake (Correct answer)
- Calcium intake
- Iron intake
Correct answer: Vitamin K intake
Vitamin K directly affects warfarin's anticoagulant activity; inconsistent vitamin K intake causes INR fluctuations that increase risk of clotting or bleeding.
Question 4: The 'teach-back' method is most appropriately used by a parish nurse when:
- Reviewing a patient's chart for accuracy
- Confirming that a patient understands health education provided (Correct answer)
- Teaching other nursing staff about procedures
- Assessing a patient's vital signs
Correct answer: Confirming that a patient understands health education provided
The teach-back method—asking patients to explain instructions back in their own words—verifies comprehension and is a best practice for health education and chronic disease self-management support.
Question 5: Which action should a parish nurse teach a congregant with rheumatoid arthritis to take during a disease flare?
- Increase weight-bearing exercises to maintain strength
- Rest affected joints while continuing gentle range-of-motion exercises (Correct answer)
- Apply heat to affected joints and resume full activity
- Discontinue all prescribed medications until symptoms resolve
Correct answer: Rest affected joints while continuing gentle range-of-motion exercises
During a rheumatoid arthritis flare, resting inflamed joints reduces stress and inflammation while gentle range-of-motion exercises preserve function without worsening the flare.
Question 6: Annual diabetes screening using fasting glucose or HbA1c is recommended for which population group?
- All adults over age 30 regardless of risk factors
- Adults aged 35-70 who are overweight or obese (Correct answer)
- Only adults with a family history of Type 1 diabetes
- Adults over 65 with normal weight only
Correct answer: Adults aged 35-70 who are overweight or obese
The USPSTF recommends diabetes screening for adults aged 35-70 who are overweight or obese, as this population has the highest risk for Type 2 diabetes and benefits most from early detection.
Question 7: The '5 A's' behavioral counseling framework (Ask, Advise, Assess, Assist, Arrange) is most commonly applied in chronic disease management for which purpose?
- Conducting a comprehensive physical assessment
- Supporting smoking cessation and health behavior change (Correct answer)
- Arranging specialist referrals for complex cases
- Assessing medication side effects in elderly patients
Correct answer: Supporting smoking cessation and health behavior change
The 5 A's framework is a structured evidence-based approach primarily used for smoking cessation and other health behavior counseling interventions in chronic disease management.
PNC Chronic Disease Management 2
The chronic care model emphasizes which approach as central to effective chronic disease management?