Nursing Elites

1. 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.

2. 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.

3. When a client is receiving pain medication through a PCA pump, which of the following actions should the nurse take?

• A. Educate the family not to push the button for the client while the client is asleep.
• B. Explain to the client that vital signs will be monitored regularly due to being on a PCA pump.
• C. Instruct the client to push the button only when pain is above a 7 on a scale of 0 to 10.
• D. Adjust the basal rate and decrease the lock-out interval time if the client's pain level is too high.

Correct answer: D

Rationale: When a client is receiving pain medication through a PCA pump, it is essential to adjust the settings if their pain level is not adequately controlled. Increasing the basal rate and shortening the lock-out interval time can help manage the client's pain more effectively. This adjustment should be made by the healthcare provider based on the client's pain assessment and response to the current settings. It is crucial to individualize the PCA pump settings to optimize pain management for each client. Choices A, B, and C are incorrect because educating the family not to push the button, explaining vital sign monitoring, and setting a specific pain level for button pushing are not direct actions the nurse should take to adjust the PCA pump settings for effective pain management.

4. What should the nurse do after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

• A. Assess the patient for symptoms of hyperglycemia.
• B. Give the patient a snack of peanut butter and crackers.
• C. Have the patient drink a glass of orange juice or nonfat milk.
• D. Administer a continuous infusion of 5% dextrose for 24 hours.

Correct answer: B

Rationale: After a patient treated with intramuscular glucagon for hypoglycemia regains consciousness, providing a snack of peanut butter and crackers is essential to prevent another episode of hypoglycemia. Peanut butter and crackers contain a combination of protein and carbohydrates, which can help stabilize the patient's blood glucose levels. This choice is the most appropriate immediate action to prevent recurrence of hypoglycemia in this scenario. Assessing for symptoms of hyperglycemia (choice A) is not the immediate priority after treating hypoglycemia. While orange juice or nonfat milk (choice C) can help raise blood sugar, they lack the sustained effect of protein found in peanut butter. Administering a continuous infusion of dextrose (choice D) is excessive and not indicated after the patient has already regained consciousness.

5. The charge nurse role has negatively affected your relationship with your friends and made you feel tense and isolated. You decide that you will delegate more time-consuming tasks to staff who are not your friends, who then complain to your nurse manager about your perceived unfairness. You decide to:

• A. Talk with your friends individually to let them know that you will be assigning patients to all staff in an equitable manner.
• B. Not express your angry feelings.
• C. Talk about staff who are annoying you with staff on other units.
• D. Ignore your feelings of uncertainty, hoping they will diminish.

Correct answer: A

Rationale: In this scenario, it is essential to address the perceived unfairness in task delegation. Talking with your friends individually to explain that patients will be assigned equitably is the most appropriate course of action. This approach promotes transparency and fairness in task allocation, helping to maintain professional relationships. Choices B, C, and D are not suitable responses. Choice B ignores the issue, choice C involves unprofessional behavior by gossiping about colleagues, and choice D neglects addressing the root cause of the problem.

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