Nursing Elites

1. A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss with the healthcare provider?

• A. Hemoglobin A1C level is 7.9%.
• B. Last eye exam was 18 months ago.
• C. Glomerular filtration rate is decreased.
• D. Patient has questions about the prescribed diet.

Correct answer: C

Rationale: The most important finding to discuss with the healthcare provider is the decreased glomerular filtration rate. In patients on metformin therapy, monitoring kidney function is crucial as metformin is primarily excreted through the kidneys. A decreased glomerular filtration rate can lead to metformin accumulation in the body, increasing the risk of lactic acidosis, a serious adverse effect. The hemoglobin A1C level being 7.9% indicates poor diabetes control but can be addressed through medication adjustments and lifestyle modifications. The patient needing an eye exam after 18 months is important but not as urgent as discussing the decreased glomerular filtration rate. Patient questions about the prescribed diet can be addressed during the visit without the need for immediate healthcare provider intervention.

2. In a multiple-car accident with multiple trauma clients being sent to an Emergency Department, which type of leadership would be most effective in this situation?

• A. Democratic
• B. Bureaucratic
• C. Laissez-faire
• D. Autocratic

Correct answer: D

Rationale: In a high-stress situation like a multiple-car accident with multiple trauma clients arriving at the Emergency Department, autocratic leadership is most effective. This type of leadership allows for clear direction and quick decision-making, crucial in managing emergencies. Democratic leadership may slow down the decision-making process due to the need for consensus. Bureaucratic leadership focuses on following established rules and procedures, which may not be flexible enough in an emergency. Laissez-faire leadership, characterized by a hands-off approach, is not suitable in urgent situations where immediate action is required.

3. What is the primary responsibility of a clinical nurse leader (CNL)?

• A. Supervise nursing staff
• B. Coordinate patient care
• C. Develop nursing policies
• D. Implement evidence-based practice

Correct answer: B

Rationale: The main role of a clinical nurse leader (CNL) is to coordinate patient care. While CNLs may oversee aspects of nursing staff, the primary focus is on coordinating patient care to ensure effective treatment and outcomes. Developing nursing policies and implementing evidence-based practice are important aspects of nursing leadership but are not the main role of a CNL.

4. What is the primary goal of a nursing informatics specialist?

• A. Manage patient care
• B. Implement new technology
• C. Improve healthcare delivery
• D. Support clinical decisions

Correct answer: C

Rationale: The primary goal of a nursing informatics specialist is to improve healthcare delivery. While managing patient care, implementing new technology, and supporting clinical decisions are important aspects of their role, the overarching objective is to enhance healthcare delivery by leveraging technology to improve patient outcomes, streamline processes, and optimize care. Therefore, the correct answer is to improve healthcare delivery.

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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