Nursing Elites

1. A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?

• A. Infuse 1 liter of normal saline per hour.
• B. Give sodium bicarbonate 50 mEq IV push.
• C. Administer regular insulin 10 U by IV push.
• D. Start a regular insulin infusion at 0.1 units/kg/hr.

Correct answer: A

Rationale: In a patient admitted with diabetic ketoacidosis, the initial priority is to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps correct hypovolemia and restore electrolyte balance, making it the first essential step in managing diabetic ketoacidosis. Sodium bicarbonate is not routinely recommended in treating diabetic ketoacidosis and should not be given routinely as it may worsen the acidosis. Administering regular insulin and starting an insulin infusion are important but should come after fluid resuscitation to stabilize the patient's condition.

2. When a client experiences a major incident, what is the time frame for reporting the incident?

• A. 24 hours.
• B. 36 hours.
• C. 48 hours.
• D. 72 hours.

Correct answer: A

Rationale: The correct answer is A: '24 hours.' It is crucial to report a major incident within 24 hours of its occurrence to ensure timely and accurate documentation. Reporting incidents promptly allows for a swift response and investigation to prevent future occurrences. Choices B, C, and D are incorrect as they exceed the recommended time frame for reporting a major incident, which is 24 hours.

3. An RN�s client with terminal pancreatic cancer asks questions about a do not resuscitate order. Which of the following statements should be included in the RN�s teaching to the client?

• A. When a heart ceases to beat, the client is pronounced clinically dead.
• B. Physicians must write do not resuscitate (DNR) orders.
• C. A DNR order can be written after the health-care provider has discussed it with the client and family.
• D. A DNR requires a court decision.

Correct answer: C

Rationale: A DNR order can be written after the health-care provider has discussed it with the client and family.

4. Nurse Managers work with staff to educate them about ways to diffuse potentially violent situations. Which of the following diagnoses can staff expect to be more frequently associated with violence?

• A. Alcohol or drug withdrawal
• B. Anxiety
• C. Depression
• D. Confusion

Correct answer: A

Rationale: Alcohol or drug withdrawal is more frequently associated with violence as these conditions alter a person's inhibitions. Gilmore (2006) highlights that working with the public involves inherent risks and stressors. Individuals with head trauma, mental illnesses, and those withdrawing from substances are more likely to respond with violence. Anxiety, depression, and confusion do not typically lead to increased violent behavior compared to conditions involving substance withdrawal.

5. A nurse manager is preparing the budget for the year. The budgeted amounts have been set without regard to changes that may occur during the year. What type of budget is the manager preparing?

• A. Fixed budget
• B. Zero-based budget
• C. Variable budget
• D. Operating budget

Correct answer: A

Rationale: The correct answer is A: Fixed budget. A fixed budget is one where the budgeted amounts are set without considering changes that may occur during the year. This type of budget is based on the assumption that the business environment will remain stable. Choice B, Zero-based budget, involves setting the budget at zero and justifying all expenses. Choice C, Variable budget, adjusts based on changes in activity levels. Choice D, Operating budget, is a comprehensive projection of all revenue and expenses for the upcoming period.

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