Nursing Elites

1. A manager has been given a deadline to complete an assignment by the end of the day. It will take every minute left of the afternoon to complete. Which interventions illustrate assertiveness to minimize interruptions in order to meet the deadline? (Select all that apply.)

• A. Allowing voicemail to answer all incoming calls or turning off email notification
• B. Delegating a discharge planning issue for a patient to one of the staff nurses
• C. Placing a 'Do Not Disturb for the Afternoon' sign on the office door
• D. All of the above

Correct answer: D

Rationale: All the interventions listed are appropriate ways to minimize interruptions. By allowing voicemail to answer calls or turning off email notifications, the manager can focus solely on the assignment. Delegating tasks to staff nurses frees up the manager's time. Placing a 'Do Not Disturb for the Afternoon' sign on the office door sends a clear message to minimize interruptions and focus on the deadline. Therefore, all of the above interventions illustrate assertiveness to meet the deadline by minimizing interruptions.

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

• A. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon
• B. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL
• C. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
• D. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain

Correct answer: C

Rationale: The patient with hyperosmolar hyperglycemic syndrome who presents with poor skin turgor and dry oral mucosa requires immediate attention. These signs indicate severe dehydration and potential electrolyte imbalances, which can lead to serious complications. Assessing this patient first allows for prompt intervention and monitoring to stabilize their condition. Choice A is less urgent as the patient has possible dawn phenomenon, which is a common early-morning rise in blood glucose levels. Choice B, with a blood glucose reading of 230 mg/dL, indicates hyperglycemia but does not present with signs of severe dehydration like the patient in choice C. Choice D, with peripheral neuropathy and foot pain, is important but not as urgent as addressing severe dehydration and electrolyte imbalances in the patient with hyperosmolar hyperglycemic syndrome.

3. What type of staffing involves scheduling a certain number of people per day consistently?

• A. Flexible
• B. Mixed
• C. Block
• D. Creative

Correct answer: C

Rationale: The correct answer is C, Block staffing. Block staffing involves scheduling a consistent number of staff per day. This method ensures a predictable workforce on each shift, allowing for better planning and allocation of resources. Choices A, B, and D are incorrect because they do not specifically refer to the consistent scheduling of a certain number of staff per day as seen in block staffing.

4. 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.

5. What is the role of a nurse in a multidisciplinary team (MDT)?

• A. To lead the MDT
• B. To provide emotional support
• C. To advocate for patient needs
• D. To conduct clinical research

Correct answer: C

Rationale: In a multidisciplinary team (MDT), a nurse's role is to advocate for patient needs and ensure their perspectives are considered in the care plan. While leadership may be a part of a nurse's role in some settings, the primary focus in an MDT is collaboration and coordination. Providing emotional support is essential but may not be the primary role of a nurse in an MDT. Conducting clinical research is typically not a direct responsibility of a nurse in an MDT focused on patient care.

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