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. When is the time to make people think about the routines that have been previously followed and to consider what might be a better plan of action?

• A. Collection of data
• B. Planning
• C. Analyzing data
• D. Identification

Correct answer: B

Rationale: The correct answer is B, 'Planning.' Planning is the phase where individuals reflect on current routines and explore alternative courses of action. This stage involves considering new strategies and approaches, making it the most suitable time to challenge existing norms. Choice A, 'Collection of data,' focuses on gathering information rather than actively reconsidering routines. Choice C, 'Analyzing data,' involves assessing the gathered data rather than proposing new plans. Choice D, 'Identification,' does not specifically address the process of reviewing routines and suggesting improvements, making it less relevant to the question.

3. The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following?

• A. �I can have an occasional alcoholic drink if I include it in my meal plan.�
• B. �I will need a bedtime snack because I take an evening dose of NPH insulin.�
• C. �I can choose any foods, as long as I use enough insulin to cover the calories.�
• D. �I will eat something at meal times to prevent hypoglycemia, even if I am not hungry.�

Correct answer: C

Rationale:

4. An active 28-year-old male with type 1 diabetes is being seen in the endocrine clinic. Which finding may indicate the need for a change in therapy?

• A. Hemoglobin A1C level 6.2%
• B. Blood pressure 146/88 mmHg
• C. Heart rate at rest 58 beats/minute
• D. High-density lipoprotein (HDL) level 65 mg/dL

Correct answer: B

Rationale: The correct answer is B. In a young adult with type 1 diabetes, a blood pressure of 146/88 mmHg may indicate the need for a change in therapy as it is above the recommended target levels. High blood pressure can increase the risk of cardiovascular complications in diabetic patients. Choices A, C, and D are within normal ranges and do not necessarily indicate the need for an immediate change in therapy. A Hemoglobin A1C level of 6.2% is generally considered good control for a diabetic patient, a resting heart rate of 58 beats/minute is normal for an active individual, and an HDL level of 65 mg/dL is considered to be in the desirable range for heart health.

5. Which agency reviews whether an organization meets its own criteria for staffing?

• A. American Nurses Association (ANA)
• B. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
• C. Patient Classification Systems (PCSs)
• D. Nursing Care Hours (NCHs)

Correct answer: B

Rationale: The correct answer is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This agency specifies that the right number of competent staff should be provided to meet client's needs. Choices A, C, and D are incorrect as they do not focus on the review of staffing criteria within an organization. The American Nurses Association (ANA) is an organization that supports nurses, Patient Classification Systems (PCSs) are tools used for patient classification, and Nursing Care Hours (NCHs) are related to the number of care hours provided.

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