Nursing Elites

1. A nurse is completing an admission assessment for a client who reports vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect?

• A. Blood pressure 144/82 mm Hg
• B. Urine specific gravity 1.03
• C. Neck vein distention
• D. Urine specific gravity 1.01

Correct answer: A

Rationale: In a client experiencing vomiting and diarrhea, the nurse should expect findings such as dehydration, which can lead to hypovolemia and subsequent increased heart rate and decreased blood pressure. A blood pressure of 144/82 mm Hg is indicative of possible dehydration in this client. Urine specific gravity is typically increased in dehydrated individuals, so choices B and D are incorrect. Neck vein distention is not a typical finding associated with vomiting and diarrhea; therefore, choice C is also incorrect.

2. An RN knows that sometimes, when working through an ethical dilemma, the decision makers are unable to arrive at a mutually agreed upon decision. Which of the following is a reason why an agreement cannot be reached?

• A. One or more of the parties may be able to reconcile their values.
• B. The patient’s point of view is recognized as valuable.
• C. The dilemma involves two or more equally unpleasant choices.
• D. The institution is unable to honor the patient’s request.

Correct answer: C

Rationale: An agreement cannot be reached because the dilemma involves two or more equally unpleasant choices.

3. Which of the following is the correct definition of 'chain of command'?

• A. The hierarchy of authority and responsibility
• B. Relationship without authority
• C. Activity directed through linear authority
• D. The tendency for people to perform as expected

Correct answer: A

Rationale: The correct definition of 'chain of command' is the hierarchy of authority and responsibility. This term refers to the order in which authority and power in an organization are wielded and delegated from top management to every employee at every level. Choice B, 'Relationship without authority,' is incorrect because the chain of command specifically involves authority and responsibility. Choice C, 'Activity directed through linear authority,' is not a precise definition of the chain of command, as it does not encompass the full scope of authority and hierarchy. Choice D, 'The tendency for people to perform as expected,' is unrelated to the concept of the chain of command.

4. The healthcare provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?

• A. Avoid snacking at bedtime.
• B. Increase the rapid-acting insulin dose.
• C. Check the blood glucose during the night.
• D. Administer a larger dose of long-acting insulin.

Correct answer: C

Rationale: The Somogyi effect, also known as rebound hyperglycemia, occurs due to an excessive insulin dose at night, leading to hypoglycemia in the early morning hours. To address this, the nurse should instruct the patient to check their blood glucose during the night to determine if hypoglycemia is present, which triggers the rebound hyperglycemia. By monitoring blood glucose levels during the night, the patient can identify if adjustments are needed to prevent this phenomenon and maintain stable glucose levels. Choices A, B, and D are incorrect. Avoiding snacking at bedtime, increasing rapid-acting insulin dose, or administering a larger dose of long-acting insulin are not appropriate actions to manage the Somogyi effect. Checking blood glucose during the night is crucial to identify and prevent the rebound hyperglycemia characteristic of this phenomenon.

5. The healthcare provider is developing a critical pathway for congestive heart failure (CHF). Which components are essential to include? (Select ONE that does not apply.)

• A. Expected length of stay
• B. Assigned staff healthcare provider
• C. Patient outcomes
• D. Medical diagnosis

Correct answer: B

Rationale: Critical pathways are designed to outline the expected sequence and timing of interventions to achieve optimal patient outcomes for a specific medical condition. Components such as the expected length of stay, patient outcomes, and medical diagnosis are crucial in developing a critical pathway for congestive heart failure. However, the assigned staff healthcare provider is not typically a fixed component of a critical pathway as it may vary based on staffing schedules and rotations. Therefore, the assigned staff healthcare provider is the component that does not apply.

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