Nursing Elites

1. A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about

• A. self-monitoring of blood glucose
• B. using low doses of regular insulin
• C. lifestyle changes to lower blood glucose
• D. effects of oral hypoglycemic medications

Correct answer: C

Rationale: When a patient has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L), indicating prediabetes, the initial approach is focused on lifestyle modifications to lower blood glucose levels. These changes may include dietary adjustments, increased physical activity, and weight management. Self-monitoring of blood glucose, insulin therapy, and oral hypoglycemic medications are not typically the first-line interventions for patients with prediabetes. Educating the patient about lifestyle changes to lower blood glucose is the most appropriate action at this stage.

2. Achieving Magnet Hospital designation offers hospitals the following advantages: (Select all that apply.)

• A. Greater client satisfaction.
• B. Improved nursing recruitment.
• C. Greater client workload.
• D. Nurses who are independent decision makers.

Correct answer: C

Rationale: Achieving Magnet Hospital designation offers hospitals advantages such as improved nursing recruitment and greater nursing retention. The empowered, independent problem-solving nurses resulting from this designation contribute to greater client satisfaction and improved nursing care. Therefore, the correct answer is 'Greater client workload' (C). Choices A, B, and D are incorrect because although they are beneficial outcomes of achieving Magnet Hospital designation, they are not advantages specifically mentioned in the provided rationale.

3. What is the main purpose of a clinical audit?

• A. To measure patient satisfaction
• B. To evaluate the effectiveness of clinical practices
• C. To identify areas for improvement
• D. To standardize patient care protocols

Correct answer: C

Rationale: The main purpose of a clinical audit is to identify areas for improvement in clinical practices. While patient satisfaction might be a component evaluated during an audit, the primary goal is to ensure that care is safe, effective, and patient-centered, rather than solely focusing on satisfaction. Evaluating the effectiveness of clinical practices is a related but more specific goal compared to the broader aim of identifying areas for improvement. Standardizing patient care protocols can be a result of a clinical audit, but it is not the main purpose, which is to pinpoint areas needing enhancement.

4. The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?

• A. Give the patient 4 to 6 oz more orange juice.
• B. Administer the PRN glucagon (Glucagon) 1 mg IM.
• C. Have the patient eat some peanut butter with crackers.
• D. Notify the healthcare provider about the hypoglycemia.

Correct answer: A

Rationale: The correct action for the nurse to take next is to give the patient 4 to 6 oz more orange juice. The patient's blood glucose has increased from 62 mg/dL to 67 mg/dL after consuming the initial 4 oz of orange juice, indicating that the treatment is effective. Providing additional orange juice will help further raise the blood glucose levels. Administering glucagon (Choice B) is not necessary as the patient's blood glucose is already rising. Having the patient eat peanut butter with crackers (Choice C) is a slower-acting option compared to orange juice. Notifying the healthcare provider about the hypoglycemia (Choice D) is not needed at this point since the patient's blood glucose is improving.

5. After receiving change-of-shift report, which patient should the nurse assess first?

• A. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
• B. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
• C. 40-year-old who is pregnant and has an oral glucose tolerance test result of 202 mg/dL
• D. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain

Correct answer: B

Rationale: The correct answer is B because the patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention. Hypoglycemia is an emergency situation that requires prompt intervention to prevent adverse effects such as seizures or loss of consciousness. Assessing and managing this patient first is crucial to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. While a high hemoglobin A1C level (choice A), an abnormal oral glucose tolerance test result (choice C), and acute abdominal pain (choice D) are important issues, they do not pose an immediate threat to the patient's life compared to severe hypoglycemia.

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